| Research objectives:This study aims to construct an evidence-based preoperative nutrition management plan for patients with ovarian cancer suitable for clinical application scenarios,so as to improve the preoperative nutritional status of patients with ovarian cancer,promote postoperative rehabilitation,improve patients’ clinical outcomes,and improve the level of nursing services,and verify the effectiveness of the plan through clinical practice.Research methods:This study is divided into the following five parts:1.Evidence summary of preoperative nutritional management in patients with ovarian cancer.According to the "6S" evidence resource pyramid model,from top to bottom,the evidence-based evidence comprehensive database,clinical practice guideline website,evidence synthesis/systematic review database,Nutrition Society website and relevant original research database were systematically searched from January 2017 to April 2022.The quality of the included literature was evaluated,the evidence content was extracted and the subject was summarized.2.Identify evidence appropriate for introduction into practice.According to the implementation steps of the KTA framework,the expert meeting method was adopted to form an expert meeting questionnaire based on the best evidence obtained.Experts were organized to cut and adjust the best evidence,determine the evidence items that could be included,and calculate the authority of experts.3.Identify gaps and barriers.Based on the evidence of the included practices,the research group discussed and formulated the review indicators.From June 2022 to July 2022,a clinical review was conducted in the gynecological ward of a Class ⅲ Grade A hospital in Nanjing to analyze the gap between the clinical scenario and the evidence.At the same time,qualitative interviews were conducted with medical staff and patients in the ward to understand the status and needs of preoperative nutritional management of ovarian cancer patients.Combined with the review results and interview results,the barriers and promoting factors of evidence transformation were clarified.4.Construct a preoperative nutritional management plan for patients with ovarian cancer.In view of the obstacle factors,based on evidence and promoting factors,the research group formulated the first draft of the preoperative nutrition management plan for patients with ovarian cancer.After two rounds of expert consultation,the plan was revised and improved,and the preoperative nutrition management plan for patients with ovarian cancer was finally obtained.SPSS 27.0 was used to analyze the data of the authority coefficient and coordination degree of experts.5.Preliminary application of preoperative nutritional management program for patients with ovarian cancer.The nutritional management program was applied in the pilot ward,and the nutritional Care ability Scale for Clinical Nurses was used to evaluate the nutritional care ability of nurses.The nutritional care ability of nurses and the implementation of review indicators were compared before and after the implementation of the program.Using the method of quasi-experimental study,patients with ovarian cancer who underwent surgery from March 2022 to July 2022 were selected as the control group,and patients with ovarian cancer who underwent surgery from November 2022 to March 2023 were selected as the intervention group.The control group received routine nursing measures,and the intervention group received preoperative nutrition management plan for preoperative management.The changes of nutritional status and rehabilitation indicators of the two groups were compared to verify the effectiveness of the program.SPSS 27.0 software was used for data analysis.Research results:1.A total of 4575 articles were retrieved in this study,and 4316 were left after removing duplicate articles.4183 articles were deleted after reading titles and abstracts,and 178 articles were initially included.It included 6 aspects: management organization,screening evaluation,nutritional intervention,monitoring and evaluation,personalized intervention and physical activity.2.16 experts,including 4 clinicians,9 nurses,2 nutritionists and 1 pharmacist,were organized to hold an expert meeting and determined 11 pieces of evidence suitable for clinical application;The familiarity of experts in this field was 0.81,the judgment coefficient was 0.92,and the expert authority coefficient was 0.87.3.The research team formulated a total of 13 review indicators.After review,it was found that there was no organization and process of nutrition management in the pilot ward,and the implementation of evidence was poor.The interview results of 16 medical staff showed that there were five obstacles such as poor preoperative nutritional status of ovarian cancer patients,the importance of nutritional management,insufficient attention and insufficient knowledge.The results of qualitative interview of 12 ovarian cancer patients showed that there were 4obstacles such as insufficient intake and lack of knowledge,as well as the needs at the knowledge level and the objective level.Evidence-based practice reform faces obstacles and promoting factors from four aspects: evidence itself,practice environment,medical staff,patients and family members.4.Aiming at the obstacle factors,based on evidence and promoting factors,the research team constructed the first draft of the preoperative nutrition management plan for ovarian cancer patients,and consulted 24 experts by letter.The questionnaire recovery rate was 100%,the familiarity of experts was 0.950,and the authority coefficient was 0.856.Experts put forward 7 suggestions for revision;After two rounds of expert consultation,a preoperative nutrition management plan for ovarian cancer patients was finally formed,including 4 firstlevel indicators,10 second-level indicators and 46 third-level indicators.5.An implementation team including gynecologists,clinical nurses,nutritionists,psychological counselors and rehabilitation therapists was established to sort out the intervention process and carry out training for nursing staff.The results showed that the score of nutritional knowledge was(55.16±9.63)before the training and(85.47±9.10)after the training,and the difference was statistically significant(t=13.00,P<0.05),which indicated that the training improved the nutritional knowledge of nurses.The score of nutritional nursing ability of nurses was(233.00±41.74)before training and(265.00±16.41)after training,and the difference was statistically significant(t=4.11,P<0.05),indicating that the training improved the nutritional nursing ability of nurses.Patients in the intervention group received preoperative nutritional management,while patients in the control group received routine nutritional nursing.The nutritional indicators and rehabilitation indicators of the two groups were compared.The mean preoperative albumin of the control group was(201.02±61.29)mg/L,and that of the intervention group was(251.76±56.52)mg/L,and the difference was statistically significant(t=3.22,P<0.05).The average score of NRS2002 was(1.85±1.26)in the control group and(1.29±0.64)in the intervention group,and the difference was statistically significant(t=2.41,P<0.05),indicating that the preoperative nutritional risk of patients had decreased.In addition,compared with the control group,the preoperative PNI score,postoperative fatigue degree,the first time to get out of bed,anal exhaust time of the intervention group were improved,and the differences were statistically significant(P<0.05).The above results indicate that the implementation of the preoperative nutritional management scheme obtained in this study can improve the preoperative nutritional status of patients to a certain extent and promote postoperative rehabilitation.Research conclusion:This study summarized the best evidence for preoperative nutritional management of ovarian cancer patients,and introduced the evidence into clinical practice according to the KTA model to form a preoperative nutritional management plan for ovarian cancer patients suitable for clinical scenarios.The preliminary application of the management program confirmed that the program has good feasibility,practicality and effectiveness,which can improve the nutritional status of patients with ovarian cancer before surgery and promote the rehabilitation process of patients after surgery,and has certain clinical application value. |
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