Evidence-based Nursing Practice Of Post-Stroke Depression Prevention And Management

Objective:(1)Construct the evidence-based practice program for the prevention and management of post-stroke depression.(2)Describe the systematic process of the evidence-based practice scheme gradually applied to the clinical pilot ward,and evaluate its feasibility and effectiveness.Methods:(1)This study took the "evidence-based continuous quality improvement model" proposed by Fudan University’s Evidence-Based Nursing Center as the theoretical framework,and used a computer system to retrieve guidelines and expert consensuses related to the prevention and management of post-stroke depression,evidence summary and systematic review and other literatures,after independent quality evaluation by 2 researchers,screening and integration of relevant evidence on PSD prevention and management.(2)Through the expert demonstration meeting,analyze the best evidence of PSD prevention and management one by one,and construct the evidence-based practice plan of PSD prevention and management based on evidence.Evidence-based practice groups are transformed into corresponding review indicators according to the specific items of the program.(3)Using the participatory observation method,the stroke patients and nurses who were hospitalized in the clinical pilot ward from January 1 to February 28,2021 were selected as the research subjects,and the current situation was reviewed according to the review form made by the evidence-based practice group.(4)Using the purposeful sampling method,conduct focus group interviews with stakeholders of the evidence-based practice project during the period from March 1,2021 to April 30,2021,analyze obstacles,and formulate improvement measures and take actions.(5)Using a before-and-after control study method,by comparing the baseline review group who participated in the study from January 1 to February 28,2021 with the evidence application group from May 1 to June 30,2021,at the nurse level,patient level and system level To analyze and evaluate the feasibility and effectiveness of this evidence-based practice program in clinical pilot wards.Results:(1)A total of 17 literatures were included in this study,including 3 guidelines,2 expert consensuses,6 systematic reviews,and 6 evidence summaries.Twenty-four pieces of evidence for PSD prevention and management were obtained from 5 aspects of PSD risk factors,screening,prevention,treatment and health education.(2)Through expert demonstrations,24 pieces of evidence will be analyzed piece by piece,10 pieces of evidence that are not in line with practicality will be eliminated,and the "Evidence-Based Practice Plan for PSD Prevention and Management" will be formulated,which will be converted into 15 pieces of evidence by the evidence-based practice team.indicators,and formulate corresponding review objects and methods.(3)Through the current situation review,15 review indicators were obtained,of which 7had an implementation rate of 0,and most of the evidence was not applied in clinical practice.Through focus group interviews,the obstacles to the implementation of the evidence-based project mainly include the nurse level(lack of PSD management related knowledge,low enthusiasm caused by the increase of workload),the patient level(lack of correct understanding and insufficient attention to PSD),and the system level(lack of PSD related data,evaluation tools,nursing management process and relative lack of human resources).(4)Results of changes at nurse,patient and system levels before and after evidence application:1 Nurse level: the implementation of the review indicators: After a series of reform measures,the implementation rate of 15 review indicators has increased to more than 80%,which is significantly higher than that before the application of evidence.After a series of reform measures,the implementation rate of the 15 review indicators has increased to more than80%,which is significantly higher than that before the application of evidence;comparison of PSD knowledge scores of nurses: PSD scores of nurses after training The score increased from 55～75(62.50±7.53)to 75～95(86.07±5.26),which was significantly higher than that before training,and the difference was statistically significant(t=-13.926,P<0.05).2 Patient level: Comparison of the incidence of PSD in patients: After 2 months of evidence application,the incidence of PSD decreased from 36.78% to 22.67%,but the difference was not statistically significant(P>0.05).Comparison of HAMD scores of patients: two months after the application of evidence,the HAMD scores of patients decreased from 6.00(4.00～8.00)to 5.00(4.00～6.00),and the difference was statistically significant(Z=-2.537,P<0.05).3 System level: After the evidence was applied,the department formulated and improved the depression screening scale,procedures and standards,health education,training and assessment.Conclusion:(1)Based on the evidence-based basis,this study constructed the "EvidenceBased Practice Program for PSD Prevention and Management",which provided some reference and guidance for clinical nurses to carry out PSD prevention and management.(2)After applying the evidence-based practice progrom for PSD prevention and management to the clinical pilot ward,it effectively reduced the incidence of PSD in patients,standardized the PSD prevention and management behavior and nursing process of clinical nurses,improved the level of PSD related knowledge of nurses,enriched the relevant knowledge materials of departments,and effectively improved the quality of clinical nursing.