Evidence-based Nursing Study Of Prevention And Management Of Venous Thromboembolism In Patients With Gynecological Malignancies

Objective:1.The relevant evidence of prevention and management of venous thromboembolism in patients with gynecological malignant tumors was systematically retrieved,evaluated,and summarized into the best evidence.2.To carry out the evidence-based practice,apply the best evidence of prevention and management of venous thromboembolism in patients with gynecological malignant tumors to clinical practice,and explore the practical effect of the best evidence.Methods:1.Systematic retrieval of BMJ Best Practice,Up To Date,National Institute for Healthcare Optimization,Ovid-JBI Library,Scottish Interhospital Guideline Network,International Guideline Collaboration Network,Registered Nurses Association of Ontario,American Blood Association,American Oncology Association,Cochrane Library,Embase,Pub Med,CINAHL,CNKI,Yimaitong,Wanfang,and Chinese Biomedical Literature Database on the prevention and management of VTE in patients with gynecological malignancies.It includes clinical decision-making,guidelines,evidence summary,expert consensus,recommended practice,and systematic review.The retrieval time limit is from the establishment of the database to March 2022.Four researchers with systematic evidence-based medicine learning backgrounds evaluated the quality of the literature and extracted and summarized the evidence that met the inclusion criteria.2.According to the " evidence-based continuous quality improvement model " constructed by the evidence-based nursing center of Fudan University,the transformation of evidence into clinical practice is promoted from four stages : evidence acquisition,status review,evidence introduction and effect evaluation.A total of 120 patients with gynecological malignant tumors who were hospitalized in a tertiary hospital in Chengde from April to November 2022 were selected as the research objects.Sixty patients with gynecological malignant tumors admitted from April 11,2022 to July30,2022 were used as the control group,and 60 patients with gynecological malignant tumors admitted from August 1,2022 to November 30,2022 were used as the evidence application group.A total of 14 nurses were included by comparing the nurses themselves before and after.The changes of patients,nurses and systems before and after the application of evidence were compared.Results:1.The results of changes in patients,nurses,and systems before and after evidence-based practiceA total of 17 articles were included in this study,including 4 guidelines,5 systematic reviews,3 expert consensuses,1 best practice,and 4 evidence summaries.After the extraction of evidence,the final summary of the risk assessment,grading prevention,physical prevention,basic prevention,drug prevention,and health education 6 aspects,a total of 27 best pieces of evidence.2.Results of changes in patients,nurses,and systems before and after the application of evidence(1)Patient level The level of knowledge,belief,and practice of VTE prevention in patients with gynecological malignant tumors: the total score of knowledge,belief,and practice questionnaire in the evidence application group(79.18±3.48)was higher than that in the control group(58.05±3.48),and the score of knowledge part(29.67±2.55)was higher than that in the control group(21.35±2.41).The score of the belief part(20.73±2.66)was higher than that of the control group(14.95±1.88).The behavioral part score(29.22±4.73)was higher than that of the control group(21.75±2.20),and the difference was statistically significant(P<0.05).The incidence of VTE: No VTE occurred in the evidence application group,and 5 patients in the control group developed VTE(P=0.057).(2)Nurse levelThe nurses in the evidence application group scored(92.57 ± 5.84)points on the prevention of venous thrombosis in gynecological malignant tumors,which was higher than that in the control group(74.86 ± 4.28)points(P < 0.05).(3)System levelThe implementation of the review indicators: The implementation rate of the evidence review indicators in the evidence application group was85%-100.00 %,which was higher than that in the control group 0.00%-66.66%.To formulate the nursing operation process of intermittent pneumatic compression and graduated compression stockings for preventing VTE in patients with gynecological malignant tumors.Conclusions:1.This study summarizes the relevant evidence of VTE prevention and management in patients with gynecological malignant tumors,and provides an evidence-based basis for clinical nursing staff to carry out clinical practice reform and promote continuous improvement of nursing quality.2.To carry out clinical practice on the best evidence of VTE prevention and management in patients with gynecological malignant tumors,standardize the VTE prevention program and nursing process of gynecological malignant tumors,improve the mastery of VTE prevention knowledge in patients with gynecological malignant tumors,improve patient compliance,and improve patient outcomes.