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Evidence-based Research On The Effect Of Different Care Methods In Neonatal Umbilical Cord Care

Posted on:2021-05-16Degree:MasterType:Thesis
Country:ChinaCandidate:Y SunFull Text:PDF
GTID:2404330620977425Subject:Care
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Background and purpose The umbilical cord is a cord-like tissue connecting the fetus and the placenta.It is an important channel for maternal and fetal gas exchange,nutrient supply and metabolite excretion.The umbilical cord is clamped after the birth of the newborn,but at this time the umbilical part is still an open wound,which is the main portal for the invasion of pathogenic microorganisms.If the umbilical cord care is not properly handled,the mild may lead to local infection and bleeding,the severe may lead to neonatal septicemia and endanger the life of the newborn.After umbilical cord clamping,it is necessary to take proper care of the umbilical cord,keep it clean and prevent infection.To explore the application effect of different nursing methods,help medical staff to select umbilical cord nursing method,and effectively guide clinical practice.Firstly,we collected the worldwide published neonatal clinical practice guidelines(CPGs),to comprehensively analyze the recommendations and consistency of neonatal umbilical cord care.Secondly,network meta-analysis was used to evaluate the effects of different umbilical cord nursing methods and rank their effects.Finally,we investigated the current use of umbilical cord care methods,investigate and evaluate the evidence-based practice readiness of the upcoming evidence application project,identify the influential factors that may be faced during the implementation process,and formulate individualized intervention strategies to promote evidence conversionMethods(1)Comparison and analysis of CPG recommendations: Searching major Chinese and foreign databases(Pub Med,Web of Science,Cochrane library,EMBASE,Chinese Biological Medicine Database,Wang fang database and China National Knowledge Infrastructure)and CPG database,including The National Institute for Health and Clinical Excellence and the Scottish Intercollegiate Guidelines Network,Guidelines International Network and New Zealand Guidelines Group guideline database,World Health Organization and Neonatal Society and Association.We collected neonatal CPGs containing umbilical care recommendations and analyzed recommendations from different CPGs.(2)Network meta-analysis of the effects of different umbilical cord care methods: Randomized Controlled Trials(RCTs)were collected from major Chinese and foreign databases to evaluate umbilical cord care method.Cochrane bias risk assessment tool was used to evaluate the risk of bias in RCTs.Network Meta-analysis was used to assess and compare the effects of umbilical cord care methods.(3)Survey on the status of umbilical cord care method use and evidence-based nursing practice readiness: We adopt a convenient sampling method,and use a general data questionnaire and Clinic readiness of Evidence-Based Nursing Assessment(CREBNA)scale to investigate pediatric and obstetric nurses in eight hospitals,to understand the current status of umbilical cord care method use,to evaluate the relevant factors affecting the preparation of evidence-based practice in the application of evidence for the selection of umbilical cord care methods,and obstacles that may be faced during implementation.Results(1)Comparison and analysis of CPG recommendations: A total of eight CPGs were included,which mostly from the from Australia,the United States,United Kingdom,Singapore and New Zealand,and the World Health Organization.In 2017,2016 and 2014,three(37.50%),three(37.50%)and two(25.00%)CPGs were published respectively.Three CPGs for umbilical cord care and five newborn care CPGs including umbilical cord care recommendations were included.In terms of umbilical cord care recommendations,the umbilical cord clamping timing and whether the umbilical cord needs to be milking were the same.However,recommendations for the selection of cord care nursing methods were only presented in two CPGs and were not consistent;(2)Network meta-analysis of the effects of different umbilical cord care methods: 28 RCTs(37,492 newborns)finally were included in network meta-analysis,involving 12 umbilical cord care methods(iodine,alcohol,hydrogen peroxide,triple dyes,furacillin,chlorhexidine,green clay,breast milk,alkaline fuchsin,salicylic acid,olive oil and washed umbilical cord)and natural drying method,mainly from China,the United States,Italy and India.Among the 28 RCTs,only seven RCTs provided random sequence generation process and assigned hidden information,and six RCTs blinded the result evaluators.The other deviations of the six RCTs were unclear.The results of the network meta-analysis showed that compared with umbilical cord drying care,using iodine,alcohol,hydrogen peroxide,triple dyes,furacillin,chlorhexidine,green clay,breast milk,alkaline fuchsin,salicylic acid,olive oil and washed umbilical cord for umbilical cord care,the incidence of umbilical inflammation,umbilical redness,umbilical bleeding,and neonatal death was not statistically significant.Compared with natural drying cord care,alcohol[MD = 4.20,95% CI(-10,18.40)],green clay[MD=0.08,95% CI(0,0.16)],iodine[MD=2.50,95% CI(-2.2,7.2)],salicylic acid[MD=0.03,95% CI(0,0.06)],triple dye [MD=0.02,95% CI(0,0.04)],furacillin[MD=-0.62,95% CI(-6.10,4.86)],hydrogen peroxide[MD= 0.06,95% CI(0,0.12)] has no difference in umbilical cord separation time,but breast milk can be reduced cord separation time [MD =-8.0,95% CI(-13.88,-2.12)].Umbilical cord care with triple dye,alcohol combined with nitrofurazone,had less risk in the incidence of Escherichia coli,Staphylococcus and Klebsiella pneumoniae,and natural cord drying care was at the greatest risk.SUCRA describes the ordering sequence as a triple dye,alcohol combined with nitrofurazone,alcohol,green mud powder,olive oil,water,and natural drying care.(3)Survey on the status of umbilical cord care method use and evidence-based nursing practice readiness: A total of 101 questionnaires were collected.At present,the use of umbilical cord care methods is not uniform,and the difference is large.Only 11.88% of study subjects used natural drying care method for umbilical cord care.The subjects of the questionnaire were all women,with an average age of(29.84±9.45)years and engaged in neonatal care for(9.54±11.23)years.The total score of CREBNA was 134.04±8.92,the total score of evidence subscale was 51.14±8.27,the total score of organizational environment subscale was 40.84±3.37,the total score of promoting factors subscale was 42.65±3.65,and the average score of each item of the scale was 3.29-4.75.Single factor analysis results showed that there were significant differences in the total score of CREBNA scale in different education levels,scientific research practice experience,different levels of understanding in evidence-based practice,and participation in evidence-based nursing training(P<0.05).Multiple linear regression analysis showed that education and scientific research experience were the main factors affecting the readiness of evidence-based nursing practice,and the difference was statistically significant(P <0.05).Conclusions At present,there were few recommendations on umbilical care method selection in the newborn CPGs and existing inconsistencies.The results of network meta-analysis showed that compared with iodine,alcohol,hydrogen peroxide,triple dyes,furacillin,chlorhexidine,green clay,breast milk,alkaline fuchsin,salicylic acid,olive oil and washed umbilical cord,natural cord drying care did not increase the rate of omphalitis,umbilical redness,umbilical bleeding,neonatal mortality and delay the time of umbilical cord separation.At the same time,the natural cord drying method could promote the umbilical cord to separate.In the case of good sanitary conditions,natural cord drying care is recommended.The current practice plan(natural drying cord care)has a good preparation for evidence-based nursing practice.
Keywords/Search Tags:umbilical cord care, clinical practice guidelines, recommendations, Network meta-analysis, evidence-based nursing practice readiness
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