Study On Establishing Management Programs For Traumatic-hypothermia Patients In Emergencydepartment

Objective:Firstly,this study was based on the previous literature review and scientific retrieval,and the best evidence for nursing of post-traumatic hypothermia patients in emergency department was adopted by systematic review.Summarizes and integrates the best evidence for preliminary construction of Delphi expert questionnaire,and provide a theoretical basis for the establishment of management programs for post-traumatic hypothermia patients in emergency department.Secondly,using the preliminary construction of the expert questionnaire,two rounds of expert consultation were conducted via Delphi method to finalize the management programs.which can be used to guide clinical nursing practice in our country and to provide evidence-based basis for hospital staff.This management programs can reduce the incidence of post-traumatic hypothermia and increase the success rate of treatment.Methods:Using the systematic review method to retrieve the trauma related guidelines as well as Cochrance Library,Pubmed,Embase,Chinese Biomedical Literature Database,Wanfang database,Chinese Journal Full-text Database(CNKI).The search deadline is February 2017.In order to make a scientific retrieval literature strategy,combining the mesh words and the free words.In this study,for the retrieved literature,the evidence grading stantards of Australian JBI2014 Evidence-Based Health Care Center and Johns Hopkins were used to classify and evaluate quality.To summarize the measures that are associated with post-traumatic hypothermia care,and make the first draft of management pragrams.Using the Delphi method,selected from Nanjing,Jinan,Harbin,Suzhou,Xuzhou,Nantong,such as level of first-class comprehensive hospital,a total of 17 emergency department,general surgery and other clinical medical and nursing experts.The experts evaluate the importance and operability of each index,and gives the expert opinions such as the specific index deletion and modification.Through two rounds of Delphi,the experts put forward their opinions and suggestions based on our national conditions and clinical practice.In view of relevant literature and discussion,in combination with that research practice,the index screening criteria are the index importance and operability value equality,no less than 3.5,and variation coefficient(CV)<0.25.Conform to the above conditions selected.If only one condition match,the task group decided to modify,delete,or increase the related measures according to the scientificity,practicability,maneuverability principle and consulting with experts.Finally establish indicators for the second round of the Delphi.Optimal sequence diagram method is adopted to establish the matrix,determine weights of first index.At the same time,according to experts on the importance of the secondary and tertiary entry assignment mean evaluation method to determine the weights of secondary and tertiary index.And even product method is used to determine the weights and the combination weight coefficient.Statistical analysis was conducted by Microsoft Excel 2015 to establish database and SPSS24.0 statistical software package for statistical analysis.And all data were recorded in pairs.Arithmetic mean is obtained by using the statistical description and nonparametric tests(X),standard deviation(S),coefficient of variation(CV),the Kendall harmonious coefficient(W),etc.And P<0.05 was considered to be statistically significant.Results:61 published papers were included.Through systematic review,the first draft included 3 primary items("hypothermia related assessment","graded intervention" and"coordination with the team"),14 second-level items,and 34 three-level items.Through two rounds of Delphi,the final management programs consisted of 4 first-level items("hypothermia related assessment","prevention and graded intervention","evaluation"and "team coordination and cooperation"),15 secondary items and 36 three-level items.The effective recovery rate of the two rounds of Delphi is 95%and 100%respectively.The expert authority coefficient is 0.85 and 0.86 respectively.The coordination coefficients at all levels ranged between 0.257 and 0.347.And the significance test result indicated P<0.001.Conclusion:There had a high level of enthusiasm,authority and team coordination in experts.With high scientific practicability and operability,the final management program is in line with China's national conditions,so as to facilitate reference and application for clinical healthcare personnel.The management program can be used as a basis for objective reference,comprehensive evaluation and scientific management.