Evidence Synthesis And Empirical Study Of Medical Adhesive-related Skin Injuries Prevention In Elderly Patients

Objectives:1.To retrieve,evaluate the relevant evidence of the prevention of medical adhesive-related skin injuries in elderly patients,and to summarize the best evidence to provide evidence-based basis for clinical work.2.To introduce and pilot test the best evidence in preventing and reducing the incidence of medical adhesive-related skin injuries in elderly patients,to improve nurses' compliance with the application of evidence-based clinical practice.Methods:1.We systematically searched for evidence on prevention of medical adhesive-related skin injuries in BMJ,UpToDate,JBI,RNAO,SIGN,CGC,Cochrane Library,PubMed,EMbase,INS,ISTAP,CBM,Wanfang,CNKI,airiti Library,including guidelines,systematic reviews,best practices information sheet,evidence summary,expert consensus and original research.Literatures published in the past 10 years were retrieved from June 1,2008 to May 31,2018.Two researchers independently completed the quality evaluation of the included documents,and combined with the judgment of professionals,extracted and summarized the evidence of the documents that met the quality standards.2.In June 2018,a qualitative interview was conducted on the stakeholders of the evidence-based practice project in the geriatric department of a tertiary teaching hospital in Shandong by phenomenological research method.The main content of the interview was the obstacle factor analysis of the best evidence application.Based on the results of qualitative research and the best evidence,10 review indicators were formulated.Evidence-based nursing practice was implemented in pilot wards from July to November 2018.Through baseline review and analysis of clinical situation obstacles,evidence-based change program was constructed and implemented to evaluate the effect of evidence application.Results:1.The evidence summary part of this study included 11 articles,including 3 guidelines,1 evidence summary,3 expert consensus,3 randomized controlled trials and 1 cohort study.The best evidence summarized covers 6 aspects,including skin assessment,skin protection,operation preparation,manipulation,observation and maintenance,supervision and training.There were in totoal of 20 pieces of evidence.2.After the application of evidence,the changes of patients,nurses and organizations were as follows:(1)Patient level:? The incidence of medical adhesives-related skin injuries in elderly patients:3 months after the application of evidence,the incidence of medical adhesives-related skin injuries in elderly patients decreased from 10.08%to 0.76%,the difference was statistically significant(P<0.05).?The incidences of skin itching and pain in patients using viscose products:The incidences of skin itching in elderly patients decreased from 19.33%,39.50%to 2.27%,3.79%,after application of evidence 3 months later(P<0.05).(2)Nurse level:?Nurse's implementation of the review criteria:After 3 months of evidence application,the rate of implementation of the review indicators by the examined nurses has been greatly improved.? Nurses' knowledge of medical adhesives-related skin injuries:After training,nurses' knowledge of relevant evidence in six aspects:skin evaluation,skin protection,product selection,manipulation,observation and maintenance,training and supervision was significantly improved(P<0.05).? Evidence-based nursing ability of nurses:3 months after the application of evidence,nurses'evidences-based nursing ability evaluation scores in evidence-based nursing ability,evidence formation ability,evidence integration ability,evidence dissemination and evaluation ability,evidence application ability were significantly improved(P<0.05).(3)Systematic level:Departments have formulated and improved evaluation forms,processes and standards,propaganda materials,training and assessment materials.Conclusion:1.Based on evidence-based nursing model,this study constructed a good practical prevention strategy of medical adhesives-related skin injuries in elderly patients,aiming to guide clinical nurses to identify high-risk patients accurately,and adopt skin protection measures,select dressings correctly,standardize the techniques and procedures of dressing removal,so as to reduce the skin damage caused by medical adhesive.2.The application of the best evidence can reduce the incidence of medical adhesive-related skin injuries in elderly patients and promote patients' comfort;it can effectively improve nurses' knowledge level and evidence-based nursing ability,strengthen evidence-based awareness;improve the organizational evidence-based cultural atmosphere,expand department-related materials,effectively improve the quality of nursing and ensure patient safety.