Implementation Of The Oral Care Program Of Stroke Patients With Dysphagia Based Evidence And Pre-experimental Intervention

ObjectiveIn order to provide a reasonable,standardized and continuous oral care program for patients with dysphagia after stroke.this research combined evidence searching,qualitative interview,expert meeting and clinical empirical research to build the oral care program in stroke patients with dysphagia,provide new ideas for clinical nursing work.Methods1.In addition to evidence based guidelines and systematic review of management of dysphagia patients.2.Depend on Joanna Briggs Institute Reviewers’ Manual and Grade System Classification of Quality of evidence and strength of recommendation(2014),Evidence was integrated and graft of the programs of oral care for the stroke patients with dysphagia was formed.A panel meeting including medical expels and nursing specialists of neurology department,rehabilitation specialists and oral specialist was organized to make amendments and form text of the programs of oral care for the stroke patients with dysphagia.3.A non-randomized controlled trial was conducted to assess clinical effectiveness of the programs of oral care for the stroke patients with dysphagia.Objects of the study were eligible patients who underwent Neurology department in one grade-III general hospital in hubei province from January to May in 2019.The evaluation index are four aspects to reflect the effect that oral health assessment(oral health score,patients’ halitosis,the plaque index),oral function evaluation,correlation after stroke incidence of pneumonia(SAP),hospitalized patients nursing satisfaction.According to the evaluation results to build team members for the stroke patients with dysphagia to supplement improve oral care solution.EPidata3.0 software was used for data entry,and SPSS Statistics Version22.0 was used to perform statistical analysis,Results1.Perform a database search to evaluate the quality of the documents retrieved,and finally included 6 descriptive studies,6 experimental studies,5 systematic reviews,5 clinical practice guidelines,comprehensive dysphagia assessment,oral assessment,oral care methods,tools,Solution and other information to provide evidence support for the construction of oral care programs for the stroke patients with dysphagia.The draft programs of oral care for the stroke patients with dysphagia was developed on the basis of the systematic review and expert consultation,The final formation includes four aspects which are oral care preparation period,oral care evaluation system,oral care intervention system and effectiveness evaluation during oral care.2.The expert’s intention to investigate the recommendations of the oral care plan for patients with dysphagia after stroke shows that the judgment score for accuracy is 4.22±1.07～4.88±0.48,the coefficient of variation is 0.08～0.23;the judgment score for importance is 4.41±0.90 ～ 4.90±0.30,coefficient of variation 0.06 ～ 0.23;operability judgment score is 4.37±1.14～4.88±0.39,coefficient of variation 0.08～0.24.3.Eight patients with dysphagia after stroke in the department of neurology of a grade-III general hospital in hubei province were selected for a preliminary experimental study.The implementation of programs of oral care for the stroke patients with dysphagia can reduce the patients’ oral health score,the incidence of patients’ halitosis.The plaque index,evaluation of oral function and incidence of post-stroke associated pneumonia(SAP)had no obvious changes after 14 days of intervention,which may be related to shorter intervention time.In hospitalized patients nursing satisfaction through semi-structured interviews,against the patient’s opinion and the suggestion of the stroke patients with dysphagia improvement and perfection of oral care solution,so as to ensure the necessity,scientificity and feasibility of the oral care program for patients with dysphagia after stroke.Conclusions1.Based on the current research status of oral care for stroke dysphagia patients in my country,the best evidence,combined with the comprehensive judgment of professionals,formed the follow-up recommendations,and finally produced the oral care plan for patients with dysphagia after stroke.2.The pre-clinical trial of the oral care plan for patients with dysphagia after stroke can reduce the patients’ oral health score,the incidence of patients’ halitosis.Due to the intervention time is shorter,the plaque index,oral function evaluation,and the incidence of stroke associated pneumonia(SAP)had no obvious changes.In hospitalized patients nursing satisfaction through semi-structured interviews,against the patient’s opinion and the suggestion of the stroke patients with dysphagia improvement and perfection of oral care solution.It confirmed the programs of oral care for the stroke patients with dysphagia to build and implement the important significance for clinical practice.