| Background:Post stroke dysphagia is one of the common symptoms.Post stroke patients with dysphagia if not timely identification and treatment,it will lead to a series of complications,increase of the rate of aspiration pneumonia,pulmonary infection,dehydration and malnutrition risk,increase of medical cost,seriously affect the quality of life of the patients,eventually leading to increased morbidity,bring a heavy burden to the country,the society and the family.Early identification and management of patients with dysphagia can reduce the incidence of pneumonia,reduce fatal complications,promote the overall recovery,improve the quality of life,etc..Foreign guidelines related to post stroke dysphagia identification and management are abundant and mature,and successful application of clinical practice guidelines could help nurses to a make scientific decision-making and reduce the variability of clinical practice,promote the patient safety,improve the cost-effectiveness of health service.While foreign clinical nursing practice guidelines is comparatively rich and mature,considering the factors from the system,customs and culture,economy,equipment,these foreign guidelines may not be suitable for China's situation,these guidelines should not be blindly copied and applied,the implementation of the guidelines must be localizated.Compared to foreign mature clinical practice guidelines and their implementation,there is no systematic,scientific guide to the localization of the guildelines.Therefore,it's urgent to explore the process and mode of implementation of the foreign high quality guidelines into China local context.Objectives:To investigate the quality of the home and abroad evidence-based guidelines related to post stroke dysphagia identification and management,make a description and analysis of post stroke dysphagia patients identification and management of clinical practice situation,understand the gap between evidence and clinical practice,and through the local implementation of guidelines in clinical,to ultimately improve stroke patients with dysphagia nursing quality,nursing operation specification,and create a good evidence-based practice cultural atmosphere.Methods:In this study,we use the Iowa model of evidence-based practice as a guide,reference the evidence-based clinical practice guidelines ADAPTE procedures,reference guide issued by RNAO to implement the corresponding implementation strategy tool,knowledge and problem as the trigger,establishing a practice team,using the method of literature research,retrieval related guidelines,and use AGREE II to guide the strict guilelines appraisal and evaluation,recommend high quality guidelines as the basis of evidence-based practice on post stroke dysphagia recognition and management,form the initial recommendation items pool,complete the guideline applicability assessment through the experts meeting;and using observation method,interview method,questionnaire survey method to understand the baseline clinical practice Status,according to the audit results and the guideline implementation barriers and promoting factors analysis rusults of the experimental unit,formulated the corresponding action strategy,and eventually develop appropriate clinical practice plan and put the plan into the ward.Results:?We included 5 guidelines,the overall quality is well through AGREE ?,all areas of the two guidelines standard scores were more than 60%,quality is classA,3guidelines were class B,we screened 6 recommendations that can be used in the pilot unit.?The scores of the pilot ward nurses'behavior dimension,attitude dimensions and knowledge and skills of EBPQ were 4.08±1.50?4.82±1.25 and 3.81±1.23,lower than foreign level,attitude scores was the highest of the three dimensions.The main obstacle factors followed by was "lack of sufficient time to find the related research,do not know how to find suitable research" and "it is difficult to search Research Report" on searching and evaluation of the evidence,the biggest obstacle factors in the application of evidence was "didn't have enough time to carry them out",followed by was "lack of evidence-based practice required resources(instrumentation)";lack of nurses' knowledge,standardization process and the logo was also the present obstacles,the biggest promoting factors was nursing leadership' support.The implementation of recommendation rate was from 0%to 25%,most of them did not carry out completely,such as departments should have well reliability and validity screening tools,well monitoring and recording,process standardization,and dysphagia logo.?We selected a pilot ward in a class 3 hospital in Beijing for evidence-based practice,and we took a variety of strategies to promote the guidelines implementation.It showed no statistical significance(P>0.05)in the general data of nurses and patients.About the quality of life,the score of patients after evidence-based practice on the activity dimension,role emotional dimension,mental health dimension,PCS and the overall quality of life was higher than patients before implementation,the difference is statistically significant(P<0.05).The patient's satisfaction score was significantly higher than that before implementation,and the patient's hospitalization time was significantly lower,and the difference was statistically significant(P<0.05).The scores of nurses' satisfaction scores and the level of the management related knowledge were higher than that of the patients with stroke after implementation of evidence-based program,and the differences were statistically significant(P<0.05).After the implementation of evidence-based practice,most of the standard implementation rate of 100%,nurses on the compliance of the program is better.Conclusion:?The overall quality of the included guidelines about the identification and management of post stroke dysphagia patients is better,and the contents of the guidelines are basically consistent.We can learn from these foreign high quality guidelines,and tailored to our local context,so as to guide and standardize the clinical nursing practice,improve the quality of clinical health care services.?The current situation of the identification and management of post stroke dysphagia patients is not optimistic,and there is still a large gap between the corresponding standards.The knowledge,attitude and practice activity level of nurses is lower than that of foreign,the attitude of pilot ward on evidence-based practice change is more positive,they have come to realize that evidence based practice is the necessity,but at present the obstacle factors mainly include lack of time,the ability of evidence retrieval and evaluation,standardization process,relevant knowledge and so on.?Evidence-based nursing practice needs all levels of stakeholders and multidisciplinary cooperation,combining the best evidence with their own judgment and patient's intention and value concept,give a individual nursing,reflect the humanistic idea and improve the quality of life of PCS level in patients with dysphagia and also the level of satisfaction,may reduce hospitalization time.?Lack of evidence based knowledge,skills and time is the prevailing problems on evidence-based practice.Evidence-based guidelines are scientific and standardized,it bringing together a large number of high quality evidence that has been rigorously evaluated,and the guidelines implementation to a large extent solve the prevailing problems and improve the staff satisfaction,practical ability,sense of professional values,induce its evidence-based practice interest and get satisfaction from the practice of evidence-based nursing. |
PDF Full Text Request