Construction Of Evidence - Based Nursing Practice Of Level 0 Diabetic Foot Bath

ObjectiveBased on the comprehensive literature retrieval, systematic review and literature analysis, this study aimed at observation on nursing effect of foot bath on 0 level diabetic foot. Then integration of the best available evidence by collection, collation and evaluation, to develop a standardized, systematic, rigorous evidence-based nursing practice program of foot bath on 0 level diabetic foot, thereby regulate TCM clinical nursing, and providing a more secure, reliable and comfortable care to patients with diabetic foot.Methods1 Systematic Review:MEDLINE, PubMed, EMbase, CNKI, VIP and Wanfang Data were searched from the time of their data building to May 2015. The literatures about the effect of Traditional Chinese Medicine (TCM) foot bath on 0 level diabetic foot were acquired. Quality apprasial of the literatures by using the Cochrane Handbook 5.1.1, Review Manager 5.3.5 was used to analyze the literatures.2 Literature research:MEDLINE, PubMed, EMbase, CNKI, VIP and Wanfang Data were searched from the time of their data building to January,2016. Retrieved literatures about foot bath and the content about time, frequency, temperature, soaking range and precautions of foot bath were analyzed.3 Guidelines Analysis:National Guideline Clearinghouse, Registered Nurses’Association of Ontario, Scottish Intercollegiate Guidelines Network, Best Practice and medlive were searched from the time of September 2014 to October 2015, related publications were manually searched. Content of the guidelines included were analyzed.Results1 Through the systematic literature search, and critical quality apprasial of all retrieved literatures, then analysis the 18 literatures included in the standard finally, including 6 randomized controlled trials and 12 quasi-randomized controlled trials. Depending on the nursing intervention and control groups taken by the study is divided into four subgroups for analysis. Meta-analysis showed that, TCM foot bath care is better than conventional care for patients with 0 level diabetic foot. Foot bath help to improve the ankle-brachial index, nerve conduction velocity, microcirculation of the patients of the 0 level diabetic foot, and reduce the rate of patients with vascular disease. Specifically described the nursing intervention programs of the studies included in the analysis, and provided evidence to support next literature analysis.2 Extract the contents of the included 18 literatures on foot bath operation, and expand the literature search direction.6 literatures, a nursing program and a technical manual released by State Administration of Traditional Chinese Medicine were supplemented included. Organize and analyze the content of the 26 literatures/programs/manual. Comprehensive evidence of foot bath time, frequency, temperature, soaking range and precautions. To provide reference for the further development of evidence-based nursing practice program of TCM foot bath on 0 level diabetic foot.38 English guidelines were included in total, the issuing authorities of which are:Registered Nurses’ Association of Ontario (1), National Institute for Health and Clinical Excellence (1), International Working Group on the Diabetic Foot (2), Australian Diabetes Society (1), National Health and Medical Research Council (1) and foreign Endocrine-related expert group (1). Types of all the guidelines are evidence-based practice guidelines. Through the collation and analysis of guidelines’content, extract on evidence about educational programs and the risk factors inducing diabetic foot ulcer. Provide strong evidence for the next step of evidence-based nursing practice program development.4 Firstly summary of the evidence, then graded the evidence and determine the recommended level according to JBI evidence grading structure, formation "The Best Practice Program of Foot Bath on 0 Level Diabetic Foot" and "Evidence-based Nursing Practice Program of Foot Bath on 0 Level Diabetic Foot"(first draft).4 clinical experts it for review and modified to form the final version, the contents include:Scope, best practices program, grading and recommended level of evidence, background, concepts, the process of building the program, application recommendations, references and appendices.Conclusion1 Meta-analysis showed the effect of TCM foot bath on patients with 0 level diabetic foot is better than routine nursing care, which could relieve foot pain, numbness, cold and other symptoms, improve microcirculation of the foot. TCM foot bath has the advantages of easy operation, high safety and small side effects; it could play the advantages and features of traditional medicine, and worth to promote the application of clinical and family.2 The formation of "evidence-based" program, through the systematic and scientific evaluation and analysis of evidence, which named "Evidence-based Nursing Practice Program of Foot Bath on 0 Level Diabetic Foot". The program is based on best evidence, evidence-based resources, domestic clinical status quo and professionals’ clinical expertise, to provide evidence from risk factors, foot bath points, cautions and health education.3 Caring for patients with 0 level diabetic foot is an interprofessional endeavour. Effective care depends on a coordinated interprofessional approach incorporating ongoing communication between health-care professionals and patients with 0 level diabetic foot ulcers. By the construction of evidence-based nursing practice program, Endocrinology nurses could enhance these competencies which based on knowledge, skills, attitudes and judgment over time, TCM clinical nursing procedures will be standardized and the quality of clinical care will be enhanced.