| ObjectiveTo construct an evidence-based nursing program for totally implantable venous access port in cancer patients,and to carry out clinical translation and application of the program,evaluating the effectiveness of the application of the program at three levels:patient,practitioner and system,respectively,to provide a scientific basis for clinical care.Methods1.Construction of an evidence-based nursing program for totally implantable venous access port in cancer patients.Using the method of evidence-based nursing research,the evidence related to guidelines,evidence summaries,systematic reviews,expert consensus and randomised controlled trials of port care were summarised through literature search,and the evidence was refined and synthesised according to the evidence recommendation level and evidence grading method.Through group discussions,a preliminary evidence-based nursing program for totally implantable venous access port in cancer patients was developed;through expert meeting validation,a final draft of the evidence-based nursing program for totally implantable venous access port in cancer patients was developed.2.Clinical translation application of an evidence-based nursing program for totally implantable venous access port in cancer patients.Using the JBI evidence-based health care model as the main theoretical guide,the translational application of the program was conducted in the radiotherapy department of a tertiary care hospital from July 15,2022 to December 15,2022,and was divided into three major parts:pre-application baseline audit of the program,getting program into practice,and evaluation of the post-application effects of the program.Members of the pre-application program team developed review indicators based on the constructed nursing program,and conducted a status quo review of nurses’review indicator implementation rate,port knowledge test level,and patients’ port-related complication rate to clarify the gap between the status quo of clinical practice and the indicators developed for the review.Based on the results of the status review,a brainstorming method was used to conduct a barrier factor analysis,construct strategies for change and implement it,using the Ottawa Research Application Model theoretical framework as a guide to gradually introduce the care programme into the clinic.Finally,the effectiveness of the application of the nursing program was evaluated at three levels:system,practitioner and patient,comparing the differences in the implementation rate of the nurses’review indicators,the level of port knowledge testing,and the incidence of port-related complications in patients,catheter blockage,vascular catheter-related infections,catheterrelated thrombosis and unplanned extubation before and after the application of the program.Results1.Construction of an evidence-based nursing program for totally implantable venous access port in cancer patients.Sixteen literature articles were systematically searched and included,including seven guidelines,two evidence summaries,four expert consensus articles,and three systematic reviews.A total of 42 pieces of evidence covering various aspects of port maintenance in oncology patients were summarised through a rigorous literature quality evaluation,evidence extraction and grading.Discussions were held by members of the research team to initially construct an evidence-based nursing program for totally implantable venous access port in cancer patients.An expert meeting was then held to include 12 medical and nursing experts in their specialties,with an expert authority coefficient of 0.9375,to revise and adjust the framework and specific contents of the program,resulting in the final draft of the evidence-based nursing program for totally implantable venous access port in cancer patients,including 3 dimensions of needle insertion and maintenance,complication prevention,management and education.2.Clinical translation application of an evidence-based nursing program for totally implantable venous access port in cancer patients.Patient level:Baseline data of patients in both groups before and after protocol application were comparable,with no statistically significant differences(P>0.05).When comparing the incidence of port-related complications between the two groups,the incidence was lower after program application(0.5%)than before(3.0%),but the difference was not statistically significant(P=0.058).The incidence of vascular catheter-related infections was lower after protocol application(0.5%)than before(1.5%),a non-statistically significant difference(P=0.320).The incidence of catheter occlusion was lower after the regimen(0)than before(1.5%),a statistically insignificant difference(P=0.084).No catheter-related thrombosis occurred in either group.When comparing the rate of unplanned extubation between the two groups,the incidence was lower after program application(0)than before(0.5%),but the difference was not statistically significant(P=0.319).Practitioner level:the implementation rate of all review indicators was effectively improved after program application,with implementation rates>60%.The nurse knowledge test scores were(40.21±11.74)and(76.00±6.32)before and after program application,respectively,with a statistically significant difference(P<0.001).System level:The existing port maintenance operational procedures in the unit were revised and improved after the program application,with the addition of a simple version of the port assessment record sheet and an Aseptic Non Touch Technique decision flow chart.Conclusions1.This study is based on an evidence-based construction of totally implantable venous access port nursing program for cancer patients,and is scientifically and clinically applicable,which can provide a reference basis for clinical practice.2.The implementation of the nursing protocol has good feasibility,and through the clinical translation application of the nursing protocol,it has helped to reduce the incidence of port-related complications and unplanned extubation rates in patients,and improved the nursing staff’s knowledge of port maintenance and the standardisation and compliance of the operation,thus improving patient outcomes. |
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