Construction Of An Evidence-based Practice Program For Postpartum Pelvic Floor Rehabilitation Managemen

Objectives:The overall purpose of this study is to combine the available evidence with clinical conditions to construct an "Evidence-Based Practice Plan for Postpartum Pelvic Floor Rehabilitation Management." Specifically to ① clarify the current status and management workflow of clinical nursing management of postpartum pelvic floor rehabilitation,identify existing problems,and understand stakeholders’ values for postpartum pelvic floor rehabilitation management;② organize and analyze the best evidence for postpartum pelvic floor rehabilitation;③clarify the clinical significance and applicability of the best evidence.and identify barriers in the clinical transformation of evidence:④ based on the best evidence and clinical status,construct an evidence-based practice plan that is suitable for China’s clinical situation.Methods:This study uses the KTA knowledge transformation model as the theoretical guide,and refers to the description of the steps as well as processes of knowledge transformation in the reference book issued by the RNAO to lead the implementation of the guideline.First,the semistructured interview method is used to understand the current clinical managment of postpartum pelvic floor rehabilitation,and to clarify the existing problems and the direction of improvement.On this basis,the literature research method is used to retrieve and screen the evidence related to the topic and evaluate its quality;the recommendations that are included in the evidence are translated,synthesized and expertly demonstrated to form the best summary of evidence for this research topic,as the initial recommendations for the construction of this study.Then use the survey method and interview method to evaluate the clinical applicability of the best evidence,clarify the recommendations and possible barriers that can be applied in the pilot team at the current stage,and understand the readiness of the evidence-based practice in the pilot department.Finally,by combining the results of surveys and interviews,as well as comprehensively preparing the clinical practice of the pilot ward,to formulate corresponding action strategies,leading to an evidence-based practice plan for postpartum pelvic floor rehabilitation management.Results:① Status of postpartum pelvic floor rehabilitation management:this study surveyed 6 medical staffs from 5 hospitals in Beijing,including obstetricians and gynaecologists,pelvic floor specialist nurses,and nursing managers,as well as 15 mothers who performed semistructural studies on them In-depth interviews.The results of the analysis interview are as follows.Management status:a.Postpartum pelvic floor rehabilitation nursing managers have a better understanding of PFD;b.Clear division of medical responsibilities and different hospital management processes;c.Pelvic floor rehabilitation clinics are equipped with full-time rehabilitation management nursing staff;d.The talent training status of each hospital is uneven;e.The existing medical resources can meet the needs of most patients,but the human resources are still insufficient;f.The postpartum pelvic floor rehabilitation management effect is obvious.Existing problems:a.Insufficient education and education,low awareness of pelvic floor rehabilitation,and low self-attention of mothers;b.Urgent need to form a multidisciplinary management cooperation team;c.Lack of emphasis on pelvic floor specialization construction:d.Necessary to establish an information system for pelvic floor disease prevention and control;e.Promote education and raise awareness of pelvic floor rehabilitation for pregnant women.Maternal status:a.Maternal pelvic floor rehabilitation related cognition is low.while willingness to participate in pelvic floor rehabilitation is high but mobility is poor;b.Maternal lack of pelvic floor rehabilitation related education and professional guidance is urgently needed.② Through systematic searching and screening,this study included 7 evidence-based guidelines,4 evidence summaries,and 3 expert consensus.The use of various types of evaluation tools showed that the quality was generally good,of which AGREE II quality evaluation results were 6 guides are Grade A.while 1 is Grade B.There are 134 recommendations in 7 guidelines and 4 evidence summaries.After translation and classification.the same or similar items are synthesized.After expert demonstration,evidence is obtained.A total of 32 recommendations are in line with China’s national conditions and the scope of the nursing staffs.③ Through questionnaire survey and semi-structured interview method.32 recommendations were evaluated for clinical applicability.As a result.23 recommendations are suitable for clinical development:4 recommendations are recommended for clinical development after modification according to clinical conditions:5 recommendations are temporarily not recommended for clinical implementation.At the same time.it is clear that the current pilot department is still in the initial stage of postpartum pelvic floor rehabilitation management.The organizational structure of the rehabilitation management team can meet the clinical management needs;the department’s pelvic floor rehabilitation management related materials are insufficient;the talent training plan is insufficient:the venue resources are still sufficient to meet clinical needs.These can be supported by a multidisciplinary team,and the department is basically equipped with the conditions to carry out evidence-based practice.④ Finally,the best evidence,the factors that promote and hinder the transformation of evidence,the needs and attitudes of stakeholders,and the readiness of the pilot department to formulate the best evidence action strategy,based on the postpartum pelvic floor rehabilitation management process and postnatal pelvic floor rehabilitation health education manual.And specific forms of management principles such as postpartum pelvic floor rehabilitation team management and related personnel training planning established the evidence-based practice of this study.Conclusion:① Postpartum pelvic floor rehabilitation management involves multiple links including education,screening,assessment and diagnosis,treatment management,and supervision and follow-up.The content and process of postnatal pelvic floor rehabilitation management need to be improved according to the specific conditions of the hospital;effective pelvic floor functions health education for obstacle diseases:as long as the hospital’s resources and policies allow it.the postnatal pelvic floor multidisciplinary team is formed and improved,and the corresponding specialist staff is trained.In general,most hospitals still have more empirical decisions on postpartum pelvic floor rehabilitation management,and there is a large variability in clinical practice.There is an urgent need to construct a postnatal pelvic floor rehabilitation management plan that meets specific clinical scenarios.② Based on the clinical status analysis and following evidence-based nursing methods and concepts,systematically search,screen,and evaluate the existing evidence.In this study,we strictly followed the quality evaluation plan and the inclusion and exclusion criteria of the literature,and finally included 7 guidelines,4 Evidence summaries and 3 expert consensus;then extract,translate,classify,and synthesize recommendations from 7 evidence-based guidelines and 4 evidence summaries,and select experts who are suitable for China’s national conditions and for obstetrics and gynecology The best evidence within the scope of the nurse’s work authority,including a multidisciplinary team,assessment diagnosis and symptom management,a total of 32 recommendations.Provides a wealth of evidence resources for program construction.③ Through the clinical applicability survey of 32 recommendations to the staff of the pelvic floor rehabilitation team in the pilot hospital,27 recommendations were obtained that are suitable for clinical development as the evidence basis for constructing an evidence-based practice plan;at the same time,the pilot hospital was identified The pelvic floor rehabilitation team has the conditions to introduce the best evidence in terms of organizational structure,resources,and multidisciplinary teams.④Based on the clinical status,the best evidence and the obstacles to evidence conversion,the pilot department’s readiness,etc.,the main body of the action strategy that constitutes the best evidence clinical practice plan is developed and revised by experts to finally form the"Postpartum pelvic floor rehabilitation management cycle".Proof of Practice.The content of the program is comprehensive,easy to understand,and the recommendations are clear and clear,which can provide clinical management decision basis for clinicians.