The Construction Of An Evidence-based Practice Plan For The Prevention And Repair Of Perineal Injury In Paralyzed Women

Objectives:To Evaluate the quality of the guidelines of perineal damage prevention and repair,selecte recommendations within the responsibilities of nurses and midwives in China.To descript and analyze the clinical status of perineal damage prevention and repair,understanding the gap between clinical practice and the best evidence,construct the evidence-based practice scheme for the prevention and repair of maternal perineal injury based on the promoting factors and obstacle factors of the process,thus up-to-date knowledge and skills of obstetric workers on perineal damage prevention and repair,improve the work quality of pilot wards perineal protection work,standardize nursing operation through the entire process of evidence-based practice and eventually improve the quality of perineal injury and repair work.Methods:?Systematically searched the official website of American Congress of Obstetricians and Gynecologists(ACOG)and 6 other globally recognizsed institutes of Obstetricians and Gynecologists,National Guideline Clearinghouse(NGC)and 8 other guideline development organizations;Database and cross-media search engine with specific search terms were also searched from 2011-2016.Evaluate the quality of final included guidelines with AGREE ? after deleting those inconsistent with the inclusion and exclusion criteria.?Translated all of the 92 recommendations of 4 A guidelines,integrated the same or similar recommendations according to certain principles on the premise of ensuring the original meaning of these recommendations.Selected recommendations within the responsibilities of nurses and midwives in China through the expert meeting.?Then,evaluated the clinical applicability of the recommendations though investigation and interview method.Formulated the corresponding strategies based on the recommendations,barriers and promoting factors,clinical practice readiness in the pilot ward,and construct clinical practice plan finally.Results:?Seven pieces of evidence-based guidelines are finally included.The overall qualities are high.Four of them are ranked as A level and the other three are ranked as B level;?We have got 92 recommendations from 4 A-level guidelines and there were 63 recommendations after integration.However,only 27 recommendations can be done by nurses and midwives in China according to experts' opinions.?The clinical status of 7 recommendations is ideal and 10 recommendations are currently unavailable in the current resources,national conditions or policies,and 10 recommendations can be promoted in the pilot ward within the next 1 year;?The relevant information about the perineal injury in the department is not systematic and perfect.The perineal injury rate was high especially the episiotomy rate.The department satisfies the basic conditions of evidence-based practice,and stakeholders expressed interest of the evidence-based practices.Finally,develop the action strategies for best evidence in the form of knowledge manual,health education manual,training principle,and perineal damage management principle and so on.Conclusion:?The overall quality of the included guidelines in this field is better,and the contents of the guidelines are basically consistent.But most of them are beyond the responsibilities of nurses and midwives in China.More practical exploration and scientific research are necessary to enrich the evidence of nursing and midwifery or may need to redefine the scope of duties of obstetrician,nurses and midwives;?The guidelines recommend items are high clinical significance.Although about 1/3 of the entries have been well developed in the current clinical practice,there is still a certain gap between the clinical practice and the evidence.they can be tailored to our local context to guide the clinical nursing practice,and improve the quality of clinical services.?The current situation of the prevention and repair of perineal injury is not optimistic,but stakeholders have a positive attitude towards the evidence-based practice in the pilot ward.It is considered as a feasible and good evidence conversion strategy to build an evidence-based practice program...