The Construction And Clinical Translation Of A Nursing Program For Patients With Stroke

Objective:Stroke can bring serious health and social issues for patients and their families,however there were no stroke nursing practice standards in China yet.According to evidence-based approaches,the purpose of this study was to design a stroke nursing program with best evidences and adaption of the Chinese domestic context,which could provide a scientific and continuing theoretical guideline of standardizing the stroke nursing practices in China.Methods:1.Research one---The current nursing status in China.Field study of three health institutions and semi-structured interviews among multiple professional health care providers were conducted to explore the current stroke nursing practices,and analyzed the data in terms of i-PARIHS framework to find facilitation and barriers of successful implementation.2.Research two--The construction of a nursing program with evidence-based principles.The construction was based on reviewing and evaluating guidelines and systematic review articles in stroke nursing practices by using AGREE?methodology and OQAQ methodology.With JBI model,a group meeting was organized to decide the nursing topics in the nursing program.Then,the nursing program was developed in terms of 5W1 H.2.Research three--Revision of the nursing program from the different health care professionals' perspectives and stakeholders' perspectives.The nursing program was revised through interviews among multiple professional health care providers and a focus group discussion of nursing specialists in health institutions of clinical translation based on evidence-based principles.3.Research four--Clinical translation and evaluation of nursing programs.Two sub nursing programs,DVT prevention nursing program and dysphagia and nutrition nursing program,were applied in three health institutions to evaluate the effects of clinical translations during two periods of PDCA method.The effects of clinical translations were evaluated by the structure,process,and outcome evaluation approaches.Results:1.Research one: The results of field study among three health institutions and interviews with 15 nurses,doctors,and rehabilitation professionals reported that the current nursing practices covered hyper acute,acute,and rehabilitation phases with basic nursing practices as main tasks.Limited rehabilitation nursing practices were varied among different health institutions.There were many gaps between best practices and current clinical nursing practices.Lack of specific nursing knowledge,varied clinical nursing tasks,and lack of communication among multiple health care professionals could be considered as main difficulties in conducting nursing programs.The effective strategies included encouragement from leaders,the willingness of improving rehabilitation nursing among nurses,the opportunity of cooperation between nurses and other health care professionals,and the arrangement of flexible nursing staff.2.Research two: 44 guidelines and 64 systematic review articles related to nursing and stroke were included from evidence-based databases and guideline websites and evaluated.Twelve topics,including hyper-acute/acute phase,rehabilitation phase,dysphagia and nutrition,fall prevention,and etc.,were used to select evidences with high level recommendation,and 384 evidences were gained.Based on these evidences,the nursing program was set up with the 5W1 H framework(Who,Where,When,What,Why,How)consisted of three sub nursing programs in different phases;4 complication prevention nursing programs,such as Deep Venous Thrombosis(DVT)prevention;and 5rehabilitation nursing programs(e.g.dysphagia and nutrition nursing program).3.Research three: In-depth interviews with 15 nurses,doctors,and rehabilitation professionals and a focus group discussion with 9 nursing specialists(the authority coefficient was 0.925)in 4 health institutions were conducted to revise the nursing program as following:(1)the nursing programs in different disease phases were place-oriented;(2)deleted prehospital phase in terms of the Chinese conditions;(3)simplified the content in the hyper acute phase;(4)added depression screening and nursing interventions in the acute phase;(5)renamed urinary and fecal nursing as urinary and fecal management and moved them to “rehabilitation nursing item” in the nursing program;(6)deleted,extended,and changed some nursing interventions in terms of the current clinical status.4.Research four: Results of clinical translation of DVT prevention nursing program.Nursing recording materials were standardized: a DVT screening form for administratedpatients,a nursing recording form,and a health education handbook for patients;moreover,the nursing program management was standardized: specific nursing staff in charge of nursing program management,the patients' management approaches in terms of different nursing models,and clarity of deadlines in conducting the nursing program.5.Research four: Results of clinical translation of dysphagia and nutrition nursing program.Swallowing rehabilitation management was standardized in this part: a dysphagia screening form for administrated patients,responsibilities of speech and language therapists(SLT)and nurses,a swallowing rehabilitation recording form of stroke patients between SLT and nurses,and a demonstration-supervision-independent completion approach for nurses' education.6.Research four: Effects of clinical translation of two nursing programs.In the first clinical translation study,57 patients/family members were educated,and the education score was significantly improved after education(Z=-6.457,P<0.01),similarly,26 educated nurses got higher scores after training(Z=-4.244,P<0.01).For nursing compliant behaviors,the items of using reliable and valid screening tools,patients' education,observation of bleeding,and issues of using Intermittent Pneumatic Compression(IPC)and skin assessment were improved significantly(P<0.05).In the second clinical translation study,15 patients/family members were educated,and the education score was significantly improved after education(t=-7.046,P<0.01),similarly,23 educated nurses got higher scores after training(t=-15.842,P<0.01).For nursing compliant behaviors,the items of having related training,screening promptly for administrated patients,continuing screening,using reliable and valid screening tools,transferring to SLT,and monitoring the swallowing rehabilitation practices for patients were improved significantly(P<0.05).The in-depth interviews with 9 nurses identified that conducting nursing programs made nursing practices systematical,standardized,active,and prompt.Also,it helped nurses gain special nursing knowledge,increase confidence,advance nursing awareness,enhance the relationship between patients and nurses,and improve research awareness.Increasing nursing tasks could be handled by routine work,fragmented services,and screening priority.Conclusions:This study set up 12 sub nursing programs in terms of evidence-based approaches,providing a standardized nursing practice framework for continuously caring patients with stroke.The nursing programs in this study followed nursing practice standards(5W1H),and clarified the cooperation between nurses and other health care professionals.The clinical translation of two nursing programs developed nursing management standardization,especially the rehabilitation nursing standardization,and made it possible to have cooperation among stroke caring team members.The nursing programs in this study were scientific and practical,which provided direction for stroke nursing practices in China.