Evidence-based Nursing Practice For Preoperative Visit For Transcatheter Aortic Valve Replacement

Objectives:1.Retrieving,evaluating and summarizing the best evidence for TAVR preoperative visits at home and abroad.2.To screen the best evidence suitable for clinical translation and developing scientific and effective review indicators for TAVR preoperative visits.3.To investigate and analyse barriers and facilitators to preoperative TAVR visits based on the review indicators and construct evidence-based practice protocols for TAVR preoperative visits.4.To carry out the initial application of the evidence-based practice protocol for TAVR preoperative visits and evaluate its feasibility and effectiveness.Methods:Using the clinical translation model of evidence proposed by the Centre for Evidence-Based Care at Fudan University in 2020 as a guide,the TAVR preoperative visit care programme was constructed and clinically translated for application,comprising four components:1.Summary of the best evidence for TAVR preoperative visit: Conduct a rigorous quality evaluation and literature analysis by systematically searching for clinical practice guidelines,evidence summaries,systematic evaluations and expert consensus related to TAVR preoperative visit care protocols to screen and integrate evidence related to TAVR preoperative visit care protocols.2.Developing indicators for the review of TAVR preoperative visits: convene an expert panel to conduct a scenario analysis of the best evidence for TAVR preoperative visits based on the FAME principles,select evidence suitable for clinical translation,and develop indicators and methods for the review.3.Analysing barriers/promoters and constructing an evidence-based practice protocol:understanding the gap between evidence and clinical practice through observation,relevant stakeholder interviews and questionnaires,using brainstorming to analyse barriers and promoters,and developing an TAVR Preoperative Visits Evidence-Based Practice Protocol.4.Carrying out the initial application of the TAVR Preoperative Visit Evidence-Based Practice Protocol: using a non-concurrent controlled trial to synthesise and evaluate the feasibility and effectiveness of the application of this evidence-based practice protocol in the practice setting.Results:1.Through systematic literature search and evaluation,a total of 18 pieces of literature were included,including 3 guidelines,1 evidence summary,1 systematic evaluation and 13 expert consensus,which were integrated with evidence from 3aspects: multidisciplinary team,preoperative assessment and preoperative mission,and finally 30 best pieces of evidence were summarized.2.Through the expert group meeting,a scenario analysis of the evidence was conducted according to the FAME principles,13 pieces of evidence that were not suitable for clinical translation were removed,and 25 review indicators and their review methods were developed for the best remaining evidence.3.A baseline review of the 25 review indicators,of which only 2 indicators had an implementation rate of 100.0% and 3 indicators had an implementation rate of 0.0%,with the majority of the evidence not being fully carried out in the translational setting.The evidence-based practice group discussed and analysed that the barriers to evidence-based practice were at the organisational level(lack of nursing norms and processes,incomplete promotional materials,inadequate training),at the nurse level(low level of knowledge related to TAVR preoperative visits,high work pressure,low priority),and at the patient level(low level of knowledge).Facilitating factors were:adequate leadership attention,high belief in evidence-based practice among nurses,high implementation and learning motivation among nurses,and harmonious nurse-patient relationships.Based on the barriers and facilitators,corresponding change strategies were developed at the system,practitioner and patient levels,resulting in the TAVR Preoperative Visits Evidence-Based Practice Protocol.4.Preliminary application results of the evidence-based practice program:(1)The nurses’ knowledge level score related to TAVR preoperative visits increased from(59.24 ± 12.19)to(73.26 ± 9.90)before and after the evidence-based practice,with a statistically significant difference(P < 0.05),and the implementation rate of 18 out of25 review indicators increased compared with that before the application of the program,with a statistically(2)The knowledge level of patients about TAVR increased after the application of the evidence-based programme(6.31±1.89)compared with the pre-application score(8.94±2.08),and the satisfaction score of the preoperative visit after the application(11 points)was higher than before the application(9 points),and the differences were statistically significant(P<0.05).Conclusions:1.Based on the evidence-based clinical translation model,the TAVR Preoperative Visit Evidence-Based Practice Protocol,which combines the best available evidence,professional judgement,specific clinical scenarios and stakeholders’ wishes,is scientifically sound and feasible,and has implications for clinical practice.2.By conducting a non-concurrent controlled trial to comprehensively analyse and evaluate the effectiveness of the programme application,it was found that the implementation of the Transcatheter Aortic Valve Replacement Preoperative Visit Evidence-Based Practice Programme can standardise nurses’ work behaviour in implementing preoperative visits,promote nurses’ knowledge and expand nurses’ evidence-based thinking,while improving patients’ knowledge and compliance and improving the overall quality of nursing services;and by dynamically adjusting the change strategies to maintain continuous clinical quality improvement.