| Objective:The purpose of this study is as follows: First,to understand the current status of bladder management in patients after radical hysterectomy,and to retrieve,evaluate,extract and integrate high-quality evidence related to bladder management.Second,to construct the first draft of the bladder management plan after radical cervical cancer surgery on the basis of current investigation and evidence integration.Third,to use the Delphi method to modify and improve the first draft of the plan,and finally form a bladder management plan after radical hysterectomy;Finally,to carry out clinical empirical research on the plan constructed in this research.The ultimate goal is to provide a scientific,standardized,and feasible reference for clinical medical staff to implement bladder management after RH,promote the recovery of patients’ bladder function,and improve the quality of life of patients with cervical cancer.Method:1 In order to collect and analyze the clinical data of patients who had accepted radical hysterectomy from January 2018 to September 2018 in the gynecological ward of a tertiary A hospital in Chongqing,the medical record retrospective analysis method was used.A questionnaire survey was used to investigate the knowledge,beliefs and behaviors related to bladder management among gynecological nurses working in second-level or higher hospitals in Chongqing.2 First,conduct a systematic search of domestic and foreign clinical guidelines,systematic reviews and evidence summaries on bladder management,and then carry out literature screening and quality evaluation,and finally extract high-quality evidence that meets the need for bladder management in patients after radical cervical cancer surgery.3 Based on the current investigation and the integration of evidence,the first draft of the bladder management plan after radical cervical cancer was drawn up.Revise and improve the first draft of the plan through Delphi expert letter inquiries,and finally clarify the bladder management plan after radical hysterectomy.4 A clinical empirical study of the constructed bladder management plan was carried out using the experimental research method.Cervical cancer patients who underwent radical hysterectomy in a gynecological ward of a tertiary hospital in Chongqing from December 2019 to August2020 were selected as the research subjects.The patients were divided into a test group and a control group.In order to evaluate the feasibility and effectiveness of the program,the recovery of bladder function,the incidence of urinary tract infection,the time of indwelling urinary catheter,the quality of life in different periods after the operation,and the satisfaction of discharge from the hospital between the two groups of patients were compared.Results:1 By analyzing the clinical medical records of 145 patients undergoing radical hysterectomy,it is concluded that the indwelling catheter time of patients after radical hysterectomy is 6 to 62 days,with an average of(15.43±8.21)days;the discharge rate with catheter is 57.24%,and the catheterization rate is 57.24%;the replacement rate was 21.38%,the incidence of urinary tract infection was 41.38%,and 2 cases of patients with poor urinary catheter removal and self-resolving underwent intermittent catheterization.During the indwelling of the urinary catheter,patients routinely use iodophor stock solution or diluent to clean the perineum and urinary catheter locally,twice a day.A survey of 402 gynecological nurses in Chongqing were did.Their knowledge scores was(7.41±2.33)points.Their behaviors scores was(30.06±3.82)points.Their attitude scores was(29.69±7.58)points.Their total score was(67.17±10.10)points.The overall correct rate of answers by gynecological nurses to knowledge about bladder management after radical resection of cervical cancer is 61.77%.The knowledge scores of postgraduate nurses was(10.00±1.73)points.The knowledge scores of undergraduate nurses was(7.54±2.30)points.The knowledge scores of junior college nurses was(7.07±2.37)points.The knowledge scores of staff nurses and contract nurses were(8.06±2.18)points and(7.24±2.35)points.The knowledge scores of nurses in tertiary and secondary hospitals were(7.91±2.25)points and(6.64±2.26)points.The results showed that they were statistically different(P < 0.05).2 A total of 8 guidelines,3 systematic reviews and 3 evidence summaries were included.A bladder management plan was finally formed by extracting and integrating the evidence items.The plan includes 5aspects.They are bladder function assessment,indwelling catheter management,intermittent catheterization management,bladder function training and health education.There are a total of 24 pieces of evidence;3 Combining with the results of the preliminary investigation and the integration of evidence,the first draft of the bladder management plan after radical hysterectomy was formed.The first draft of the plan includes 5first-level items,16 second-level items and 43 third-level items.The first draft of the plan was revised and improved through 2 rounds of Delphi expert letter inquiries,and the final bladder management plan included 5first-level items,14 second-level items,and 35 third-level items;4 A clinical empirical study was conducted on the protocol.The results showed that the bladder function recovery rate of the experimental group was 85.94%,and the control group was 54.69%.The indwelling catheter time of the experimental group was(10.70±7.57)days,the control group was(29.17±19.65)days.The respectively incidence of infection were9.38% and 75.00%,the quality of life scores at discharge were(88.41±7.13)points and(84.11±2.62)points,and the quality of life scores for the first month after surgery were(111.70±4.14)points and(103.30)±7.13)points,the quality of life scores at 3 months after surgery are(119.73±1.45)points and(119.17±1.50)points,and discharge satisfaction were(98.50±1.76)points and(92.19±3.69)points.Comparison of the above All have significant differences(P<0.05).Conclusion:1 It was found that patients with radical hysterectomy had a longer time of indwelling catheter,a higher discharge rate with CAUTI,a higher rate of catheter replacement after removal and a higher incidence of urinary tract infection by retrospectively analyzing the clinical medical records of patients radical hysterectomy.Medical staff still carry out bladder management for patients with traditional nursing methods.Few new ideas and methods have been used to promote bladder function rehabilitation in patients with radical hysterectomy.Gynecological nurses have poor knowledge of bladder management after with radical hysterectomy.The methods of bladder management after with radical hysterectomy are not standardized and systematic.However,gynecological nurses have a strong willingness to change the status quo of bladder management after radical hysterectomy.2 The best evidence items extracted and integrated can be used as potential application items to construct bladder duct scheme after radical hysterectomy.Based on the current situation investigation and evidence integration results,a draft of bladder management plan after radical hysterectomy was constructed.After two rounds of Delphi expert letter consultation,the bladder management program after radical hysterectomy was finally determined.The whole scheme construction process is scientific and rigorous,with good scientific nature and clinical applicability.3 Through the initial clinical application of the bladder management plan,the experimental group patients’ bladder function recovery rate,catheter indwelling time,incidence of catheter-related urinary tract infection,quality of life at different postoperative periods,and discharge satisfaction were significantly better than those in the experimental group.Control group.It shows that the bladder management plan after radical hysterectomy constructed in this study based on evidence-based and Delphi method has good clinical practicability and effectiveness.It is worthy of further promotion and application in clinical practice. |
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