Content Analysis And Implementation Survey Of Clinical Practice Guidelines Of Pressure Injury

Objective: To provide reference and support for the implementation and spread of clinical practice guidelines(CPGs)of pressure injury(PI),we analyzed the content of CPGs and assessed the consistency of recommendations.Then we compared the recommendations with routine clinical care and explored the obstacle factors of evidence-based nursing practice.Methods:(1)Quality assessment and content analysis of CPGs: CPGs were collected from the Chinese and foreign databases,the guideline databases,and the websites of relevant academic institutions or societies.We first used Appraisal of guidelines for research and evaluation II(AGREE II)and Reporting items for practice guidelines in healthcare(RIGHT)to assess the methodological quality and reporting quality of included CPGs.Then we extracted the population and intervention form recommendations of the included CPGs to analyze the content and compare the consistency of the recommendations.(2)Survey on CPG implementation and obstacle factors of evidence-based practice: We conducted a survey in seven hospitals in Xi’an city,Xinzheng city,and Lanzhou city to explore the coincidence rate between the consistent recommendations and the routine clinical care.Two questionnaires,Clinic Readiness to Evidence-based Nursing Assessment(CREBNA)and Evidence-Based Practice Belief Scale,Evidence-Based Practice Implementation Scale(EBP Belief Scale,EBP Implementation Scale),were undertaken in the departments with a high prevalence of PI of these seven hospitals,and the factors influencing the score of scales were explored by univariate and multivariate analyses.Results:(1)Quality assessment and content analysis of CPGs: We finally included19 CPGs from the United States,United Kingdom,Canada,Japan,and five international organizations.Among them,18 CPGs reported the classification of evidence levels,and 13 CPGs reported the recommendation ratings.The overall methodological quality and reporting quality of the included CPGs were not good.The median score of AGREE II was 53.3%(maximum score of 78.6% and minimum score of 38.5%),and “Applicability”(the fifth domain)got the lowest median score(37.5%).As for the RIGHT checklist,the average reporting rate was 64.7%,and none of the CPGs had reported “Review and quality assurance “(the fifth domain)entirely.We extracted 49 main recommendations to compare,and 46 recommendations were the same in the content.(2)Survey on CPG implementation and obstacle factors of evidence-based practice: 17 departments from the above seven hospitals were included in this survey,and we received 289 valid questionnaires.Among the consistent recommendations,15 recommendations matched all the departments(17/17),but three recommendations matched none of the included departments.The average overall score of CRENMA was 120.78±20.07,the average score of the subscale of evidence,the subscale of organization and environment,and the subscale of promoting factors were47.51±8.52,36.42±6.47,and 36.85±7.87 respectively.The univariate analysis showed that the nurses who only worked straight day shifts and the nurses with bachelor’s degrees or above had higher scores on CREBNA scale than those who worked in shifts around the clock and those with technical school education.And for the subscale of evidence,the professional title,the highest degree,different work shifts,training of evidence-based practice,and thesis publication were associated with the score of the subscale of evidence(p<0.05).The multivariate regression analysis revealed that the nurses who worked straight day shifts,with bachelor’s degrees or above,and have published papers got higher scores in the subscale of evidence(p<0.05).The average score of EBP Belief Scale and EBP Implementation Scale was 3.52±0.44 and 1.76±0.80.The univariate analysis and multiple regression analysis both showed that the nurses who worked straight day shifts,received training of evidence-based practice,and have published papers got higher scores in EBP Belief Scale(p<0.05),and no difference was found in the univariate result of EBP Implementation Scale.Conclusion: The quality of CPGs needed to be promoted,and the main recommendations were in good consistency.However,most of the main recommendations were conflicting in rating level,and some recommendations were different in content.The consistent main recommendations and routine clinical care matched well.The readiness of evidence-based nursing practice and the level of evidence-based practice belief of nurses were good,but nurses’ level of evidence-based practice implementation needed to be improved.