| Objective:Developing an evidence-based practice protocol to prevent patients with gastric surgery from underfeeding in enteral nutrition support,also exploring the effect of the protocol and to evaluating evidence-based practice compliance of the nurse,in order to optimize nursing process of enteral nutrition and promote the continuous improvement of nursing quality.Methods: First Part,Literature Study:Based on JBI model of evidence-based healthcare,clinical practice guidelines of enteral nutrition,system reviewes and original studies were searched for literature analysis.The best available evidences were extracted and integrated,and the level of evidence and grades of recommendation were evaluated by using the evaluation criteria of Oxford Center for Evidence-Based Medicine.Finally,stakeholders were invited to evaluate feasibility of these evidences and revise the protocol.Based on the recommended items of the evidence-based nursing protocol,the audit criteria and methods were formulated,and obstacles in the clinical implementation of the recommended items and solutions were identified through the clinical practice audit of EN in patients with gastric cancer.Second Part,Quasi-Experimental Study:Using convenient sampling methods,selected 94 patients with gastric cancer who undergoing gastrectomy from the gastrointestinal surgery department of a tertiary hospital from January 2018 to July 2018 in Bengbu,Anhui province.Patients were divided into control group and study group according to their admission time sequence.Patients in the control group received the usual care,and patients in the study group received nursing care according to the protocol.The patient's nutritional status was assessed by Patient-Generated Subjective Global Assessment(PG-SGA)on the first day after admission and one week after surgery.The self-designed questionnaire was used to investigate patients' intake of enteral support from the first time to the third day.Blood samples were collected on the first day after admission and one week after surgery for nutritional index detection.The nurse and the patient's family jointly monitored the postoperative intestinal function recovery of the patient,and whether there was intestinal intolerance.The nurse recorded the hospitalization time by checking the electronic medical when patients discharged.Using T test to analyze the intake of enteral nutrition,laboratory indicators,postoperative intestinal recovery indicators,hospitalization time and the knowledge level of nurses in the two groups,and Non-parametric rank sum test was used to analyze the score of PG-SGA in two groupsUsing purpose sampling methods,selected ten nurses from gastrointestinal surgery department.To evaluate the knowledge level of the nurse before and one week after the implementation of the protocol by using the self-designed knowledge test questionnaire according to the content of the protocol.Using T test to analyze the knowledge level of nurses,and assessed the nurse's evidence-based practice compliance according to the audit criteria.Results: 1.The evidence-based practice protocol included the practical scheme based on the best recommended items and the measures to solve the obstacles in the application of recommended items.The practical scheme consisted of six domains and 18 recommended items: nutritional assessment,enteral feeding procedures,bowel function management,feeding tube care,prevention and nursing of complication,and health education,with 11 items being Grade A of recommendation and seven items being Grade B of recommendation.The obstacles contained eight items and four aspects: nurses,systems,materials and patients.2.In this research,13 audit criteria and audit methods were confirmed,among which items 1,4 and 5 by referring to nursing records;items 3,6,7,8 and 12 used the observational method;items 2,9,10 and 11 by checking nursing documents;item 13 used the knowledge test.3.Postoperative start time of enteral nutrition: After the implementation of the protocol,the postoperative fasting time of the study group was shortened,and the postoperative average start time of enteral nutrition was(55.15±11.09)h,which was significantly earlier than that of the control group,with statistically significant differences between the two groups(P<0.05).4.Postoperative intake of enteral nutrition: After the implementation of the protocol,the daily calories provided by enteral nutrition in the study group reached the target demand respectively(28.41±4.48)%,(32.67±9.29)%,(54.87±10.51)%,there was no significant difference in the intake of enteral nutrition between the two groups on the first day and the second day(P>0.05),and the intake of the study group on the third day was higher than that of the control group(P<0.05).5.Enteral nutrition intolerance: There were 41 cases of enteral nutrition intolerance in the two groups,including 13 cases in the study group and 28 cases in the control group,with statistically significant differences between the two groups(P<0.05).6.The score of PG-SGA(1)Preoperative: There was no significant difference in the total score of PG-SGA between the two groups on the day of admission(z=-1.62,P>0.05),and the scores of the disease status of the two groups were statistically different(z=-2.32,P<0.05).(2)One week after surgery: The PG-SGA scores of the two groups were over 8 points one week after surgery,which was a state of the serious malnutrition.There was a statistically significant difference in the total scores of PG-SGA between the two groups(z=-2.10,P<0.05).7.Laboratory indicators: All indicators of the two groups were decreased one week after surgery compared with that before surgery(P<0.05).One week after surgery,the study group was superior to the control group in two indicators: albumin(ALB)and lymphocyte count(TLC),with statistically significant differences(P<0.05).Total protein(TP)in the study group was higher than that in the control group,but the difference between the two groups was not statistically significant(P>0.05).8.Postoperative intestinal function recovery and hospitalization time: There was no statistically significant difference between the two groups in the first exhaust time and the first oral intake time(P>0.05),but the study group was shorter than the control group in both of the above two indicators.The hospitalization time in the study group was shorter than that in the control group,with statistically significant differences(P<0.05).9.The nurse's knowledge level of prevention and management of underfeeding in enteral nutrition: After the implementation of the protocol,the nurse's knowledge score was significantly higher than that before,with statistically significant differences(P<0.05).10.Evidence-based practice compliance of the nurse: During the baseline audit,the execution rate of the criteria 1,2,3,4,5,9,10,11 and 13 was 0%;the execution rate of criteria 6 was 70%;the execution rate of criteria 7 was 80%;the execution rate of criteria 8 was 20%,and the execution rate of criteria 12 was 40%.After the implementation of the protocol,the execution rate of criteria 1,2,3,4,6,7,9,10,12 and 13 was 100%;the execution rate of criteria 5 and 11 was 80%,and the execution rate of criteria 8 was 90%.Conclusion: 1.The protocol was developed based on current best evidence,clinical situation,patient preferences and professionals' expertise,which could provide reference for the clinical nursing practice of preventing and managing enteral nutrition underfeeding of patients with gastric cancer after gastrectomy.2.This protocol could prevent or reduce the occurrence of underfeeding in enteral nutrition of patients with gastric cancer after gastrectomy,which give full play to the therapeutic effect of enteral nutrition,thereby improving the nutritional status of patients.3.This study could improve the nurse's evidence-based practice compliance and the knowledge level of prevention and management of underfeeding in enteral nutrition. |
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