| Objectives 1.To comprehensively retrieve,evaluate,screen and integrate relevant evidence on neurogenic bowel management in patients with spinal cord injury,form the best evidence summary of neurogenic bowel management in patients with spinal cord injury,and provide evidence-based basis for clinical nursing work.2.The best evidence is used in clinical practice to improve nurses’ knowledge related to neurogenic bowel management in patients with spinal cord injury,improve patients’ bowel management outcomes and enhance the quality of clinical nursing.Methods 1.Guidelines,expert consensus,best practices,evidence summaries,and systematic reviews/meta-analyses related to neurogenic bowel management in patients with spinal cord injury were comprehensively searched according to the "6S pyramid" model.The quality of the included literature was evaluated,and then the relevant evidence in the literature that met the quality standards was screened and extracted.2.The expert meeting method was used to logically sort out,refine the content and evaluate the applicability of the included evidence,and finally form the best evidence suitable for clinical neurogenic bowel management in patients with spinal cord injury for this clinical practice.3.Using the i-PARIHS framework as a theoretical guide,design review indicators based on the best evidence and conduct a baseline review.With the results of baseline review and promoting/inhibiting factors of evidence transformation were analyzed from the three levels of change,recipients and organizational environment,and formulate corresponding reform strategies to promote the evidence to clinical transformation.This clinical practice was carried out in the spinal cord injury rehabilitation ward of a Grade-A tertiary hospital in Gansu Province from January 1 to March 17,2023.After the application of evidence,the effects were evaluated from three levels of patients,nurses and organization.Results 1.A total of 16 literatures were included,including 10 guidelines,one evidence summary,one expert consensus,and four systematic reviews/meta-analyses.Based on the principle of "treatment pyramid" of neurogenic bowel and the topic classification of related guidelines,the relevant evidence in the included literature was screened and sorted out,and a preliminary draft of evidence with 10 dimensions and46 items was formed.By holding an expert meeting,the preliminary draft of evidence was sorted out,integrated and evaluated for its applicability.Due to the same theme,two pieces of evidence were combined and seven pieces of evidence were removed because of insufficient clinical feasibility.Finally,based on expert opinions the best evidence summary with 38 items in seven dimensions including basic bowel management,nutrition management,oral/rectal drug management,adjuvant treatment measures,management of complications,health education and mental status assessment was formed for clinical practice.2.After the application of the best evidence,initial results have been achieved at the patient level,nurse level and organizational level:(1)Patient level: After the application of the best evidence,the defecation frequency of patients at discharge was mainly concentrated in the range of 2 ~ 6 times per week,the incontinence rate decreased from 82.61% to 42.86%,and the duration of defecation gradually became normal.In addition,the satisfaction of patients at discharge was also greatly improved,and the difference was statistically significant(P< 0.05).(2)Nurse level:(1)After the application of the best evidence,the nurses’ knowledge level of neurogenic bowel management after spinal cord injury was significantly improved,and the theoretical test score was increased from 69.10±12.65 points to 91.75±4.90 points,the difference was statistically significant(P < 0.01).(2)After the application of the best evidence,the implementation rate of nurses’ review indicators was significantly improved.Except for indicator 12,which was not reviewed in clinical practice,the remaining 37 indicators were reviewed.The number of review indicators with an implementation rate of less than 60% was reduced from13 at baseline to five;There were seven review indicators with implementation rates ranging from 61.54% to 89.29%,except for indicator nine,the difference of implementation rates before and after the other six indicators was statistically significant(P < 0.05).There were 26 indicators with an implementation rate of more than 90%,among which 14 indicators had statistically significant differences before and after implementation(P < 0.05).(3)Organizational level:(1)The pilot department established a specialized team for bowel management,developed a process standard for neurogenic bowel management in spinal cord injury patients,and added patients’ defecation diary,which provided evidence-based basis and scientific guidance for nurse to guide and help patients with bowel management.(2)The educational manual on neurogenic bowel management plan for patients with spinal cord injury and the educational manual on the prevention and treatment of potential complications of neurogenic bowel in patients with spinal cord injury were produced to provide a reference basis for clinical health education for nursing staff.(3)A special quality control team was established to optimize the syllabus and contents of relevant knowledge training for nursing staff.Conclusion Based on clinical practice and expert advice,this study summarized the best evidence for neurogenic bowel management in patients with spinal cord injury from seven dimensions: basic bowel management,nutrition management,oral/rectal drug management,adjuvant treatment measures,management of complications,health education and mental status assessment.By conducting the best evidence clinical practice study,the nurses’ knowledge of neurogenic bowel in patients with spinal cord injury and the implementation rate of evidence-based review indicators are improved.In addition,the process of neurogenic bowel management in patients with spinal cord injury and related educational manuals were also developed,which effectively improved the ability of nursing staff to guide patients in managing their bowel,increased the success rate of bowel management in patients,effectively improved the quality of nursing,and provided a reference for future evidence-based practice in the management of other complications in patients with spinal cord injury. |
PDF Full Text Request