Study On The Effect Of Evidence-based Bundle Care For Preventing Aspiration Pneumonia In Stroke Patients With Nasal Feeding

[Objectives]1.Based on the concept of evidence-based nursing,Delphi method is used to construct a bundled nursing program to prevent stroke patients with nasal feeding complicated with aspiration pneumonia.2.Through clinical trials,to verify the effect of cluster nursing schemes on the prevention of aspiration pneumonia,and to provide a standardized nursing scheme for clinical nurses to care for patients with nasal feeding after stroke.[Methods]1.Guided by the evidence-based nursing theory,we formulated a rigorous search strategy,consulted the literature,summarized the items related to the prevention of aspiration pneumonia,and set up a clustering scheme construction group to initially design the connotation of the items.The Delphi method was used to evaluate the importance and manipuility of the initially formed items and medical statistical methods were used to analyze the relevant data to test the reliability of the expert consultation.The clustering plan construction group conducts targeted discussions,gathers expert opinions,and determines a clustering care plan.2.Using the convenient sampling method,we selected 90 stroke patients treated by nasal feeding from the Department of Neurology of a top three Chinese medicine hospital in Nanjing from May 1,2019 to December 30,2019.Among them,the control group was given routine care,on the basis of that,the treatment group practiced a cluster nursing scheme.We took the incidence of AP,nasal feeding tube indwelling time,oral hygiene,length of hospital stay,and hospitalization costs as evaluation indicators to evaluate the effectiveness of the implementation of cluster nursing.[Results]1.A clustering nursing scheme was constructed with 4 first-level items,9 second-level items,and 30 third-level items.After 2 rounds of expert consultation,the recovery rates were both 100%;the authority coefficient of experts was 0.87 and 0.91.The coefficients of variation of the importance of all items ranged from 0.00 to 0.189,the coefficients of variation of the manipuility of all items ranged from 0.00 to 0.186.2.The results of clinical controlled trials showed that the incidence of AP,the length of hospital stay and hospitalization costs in the treatment group were significantly lower than those in the control group(P<0.05);and the gastric tube indwelling time and MBOAS scores in the treatment group were lower than those in the control group,which was significantly different(P<0.01).[Conclusions]1.Based on the concept of evidence-based nursing,the study constructed a clustering nursing scheme,which was scientific,for the prevention of concurrent AP in stroke patients with nasal feeding by using the Delphi method.2.Through clinical trials,it was verified that the clustering nursing scheme for preventing AP in stroke patients with nasal feeding could decrease the incidence of AP,shorten the indwelling time of gastric tubes,improve the patients' oral hygiene and reduce the hospitalization costs and the hospitalization days,which was worth being promoted and applied.