| Background:With the deepening and acceleration of population aging,the medical needs of the older adults are increasing,and the number of elderly inpatients is increasing year by year.Frailty,as one of the main health problems affecting the elderly inpatients,is more common in the elderly inpatients,and increases the risk of fall,infection,disability,readmission and even death.This seriously affects the quality of life of patients,increases the health care costs of patients,and hinders the development process of healthy aging.Frailty is considered to be a dynamic and reversible process,so early screening and assessment of frailty in elderly inpatients is of great significance to delay the progression of frailty.At present,a number of guidelines and literature on frailty have been published in the world,which provide scientific evidence for the screening and assessment of frailty.However,the screening and evaluation of frailty in Chinese clinical institutions is at the beginning stage and there is a large gap between the best evidence.Therefore,in order to standardize the screening and evaluation of elderly inpatients,it is imperative to carry out evidence-based nursing practice according to the best evidence and suitable for specific clinical situations in China.Objectives:The aim of our study was to systematically search,evaluate and summarize the best evidence of frailty screening and assessment at home and abroad.To establish evidence-based practice program for screening and evaluation of frailty in geriatric inpatients according to the best evidence.This evidence-based practice program was applied to specific clinical situations,and its feasibility and effectiveness were evaluated.Methods:This reseachstudy was guided by the knowledge to action process.The research framework of our study is problem identification,the knowledge creation cycle,evidence-based practice program building and outcomes evaluating.(1)Identify problem: To investigate the current status of frailty screening and assessment in clinical practice departments.From November to December 2021,296 nurses from the Department of Geriatrics,cardiovascular medicine and Neurology of the First Hospital of Jilin University were investigated in a cross-sectional survey using the self-compiled frailty screening and assessment knowledge questionnaire to understand the nurses’ knowledge of frailty screening and assessment.(2)The knowledge creation cycle: This study systematically searched 6 Chinese and English databases such as Pubmed and 5 websites such as the National Institute for Health and Care Excellence.The clinical practice guidelines,expert consensus,systematic review and evidence summary on frailty.Appraisal of Guidelines for Research & Evaluation Ⅱ(AGREE Ⅱ)and JBI tool were used to evaluate the quality of included literature.Then,we graded the included evidence according to the “JBI evidence pre-score system and recommendation level system”.(3)Building evidence-based practice program: In this part,a total of three meetings were held.First,9 nurses with different working years and professional titles were selected by purposive sampling to hold a stakeholder meeting to identify evidence suitable for pilot practice site.Then,an evidence-based practice group meeting was held built evidence-based practice program for “Screening and Evaluation of Frailty in Geriatric Inpatients”(draft).Finally,the draft of the program was reviewed through the expert meeting included 12 experts and finally developed the final version of the program.(4)Evaluating outcomes: We designed a non-contemporaneous controlled trial to verify the feasibility and effectiveness of this program.From September to November2022,the inpatients and nurses in the geriatric department of First Hospital of Jilin University in Changchun were selected as the research objects.Based on the inclusion and exclusion criteria,52 patients were selected as the baseline investigation group(control group),and 49 patients were selected as the program application group(experimental group).Routine treatment and nursing was provided to the control group.The program application group(experimental group)implemented the Evidence-based Practice Program for Screening and Evaluation of frailty in elderly inpatients and routine treatment and nursing.The feasibility and effectiveness of the program was verified by evaluating the scores of nurses’ frailty screening and assessment knowledge,the implementation rate of the review indicators and patient satisfaction.Results:(1)The validity and reliability of the self-designed knowledge questionnaire was good.The Cronbach’s α of the questionnaire was 0.994,and the test-retest reliability correlation coefficient was 0.81.The I-CVI were all above 0.78,and the scores ranged from 0.86-1.00.The S-CVI of this questionnaire was 0.976.The cross-sectional results showed that the knowledge scores of 296 nurses were 39.00(16.25,44.00),and the knowledge level needed to be improved.(2)A total of 32 literatures were included in our study,including 6 guidelines,4expert consensus,21 systematic reviews and 1 evidence summary.The overall quality of the six guidelines was good,with the average score between 5.3 and 7.0.Two guidelines were rated as Grade A and the other four were rated Grade B.The quality of other literatures were medium or above.Through evidence extraction,integration and analysis,a total of 33 pieces of best evidence for frailty screening and assessment were finally included.(3)Through stakeholder meetings and internal meetings of the evidence-based practice group,the evidence-based practice program was preliminarily developed.Twelve experts were invited to conduct expert meeting.The average Ca and Cs were0.95 and 0.883,and the Cr was 0.92.The final version of “Screening and Evaluation of Frailty in Geriatric Inpatients” was developed after expert meeting.The program consists of 5 dimensions,including education and training,frailty screening,frailty assessment and comprehensive assessment of aging(4)After the implementation of the program,the knowledge level of nurses was significantly improved,and the difference was statistically significant(p<0.001).The compliance of the nine audit criteria were over 80%,and the difference was statistically significant(p<0.001).The satisfaction of patients in the implementation group was significantly higher than that in the control group(p < 0.001).Conclusions:(1)The knowledge level of frailty screening and evaluation of clinical nurses need to be improved.There is a certain gap between the practice status of screening and evaluation of frailty in clinical pilot departments and the best evidence,so it is necessary to promote the transformation of evidence in clinical and improve the quality of screening and evaluation of clinical frailty.(2)Through systematic search,evaluation and summary of relevant guidelines,expert consensus and other literature,out study formed the best evidence summary of frailty screening and assessment,which could provide a reference for clinical screening and assessment of frailty in elderly inpatients.(3)Based on the best evidence,the opinions of stakeholders and experts,the Evidence-Based Practice Program for “Screening and Evaluation of Frailty in Geriatric Inpatients” is developed.The results of implementation of evidence showed that the program could improve the knowledge level of nurses,standardize the nursing behavior of nurses,and improve the satisfaction of patients,which indicates the program is feasible and effective. |
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