| ObjectivesIn order to form a nursing practice program which is scientific,normative and implementable,to promote patients postoperative rehabilitation,and to provide a theoretical guidance for optimizing the content and process of early mobilization and improving the quality of nursing,we should establish "Early Mobilization Program for Patients after Laparoscopic Radical Gastrectomy" and verify the clinical application effect by systematically searching,evaluating and summarizing evidencebased evidence.Methods1.Evidence synthesis: comprehensively search the relevant literature,perform quality evaluation and content analysis.A quality review was conducted with JBI Levels of Evidence and Grades of Recommendation,and the best evidences were integrated.2.Evidence-based program: A review of clinical implementation status was conducted based on the established criteria to identify barriers.Relevant interested populations were organized to evaluate and adjust the feasibility of the evidence and then structured the draft.Also,Delphi expert consultation was performed to revise the draft and eventually form the management program.3.Clinical trials: According to the eligibility criteria,33 patients underwent laparoscopic radical gastrectomy from September 2021 to December 2021 were assigned to the experiment group,while 33 patients from May 2021 to August 2021 were selected to the control group which received routine postoperative care.We compared the first-time mobilization,first exhaust time,first defecation time,the length of hospital,pain score and postoperative complications between the two groups.SPSS26.0 software was used for statistical analysis,P<0.05 was considered statistically significant.Results1.A total of 12 literature were included,including 2 guidelines,4 expert consensus,1 systematic review,and 5 randomized controlled trials.Finally,16 pieces of evidences including preparation before activity,rehabilitation exercise,early activity process,organizational management,and safety guarantee were summarized from 5 dimensions.2.On the basis of the previous summary and content analysis,we constructed the"Early Mobilization Program for Patients after Laparoscopic Radical Gastrectomy”.The program covers 8 aspects: target population,health education,preoperative guidance,definition of early mobilization,early mobilization method guidance,compliance management,and safety assurance.After two rounds of Delphi,7 items were deleted,16 items were modified,and 1 item was added,which finally established a program with 56 items of 3 dimensions.The expert authority coefficient was 0.82,which indicated that the expert authority was relatively high.The coefficient of variation of the first round was 0.05～0.27,and the Kendall harmony coefficient was 0.15;The coefficient of variation of the second round was 0.00～0.19,and the Kendall harmony coefficient was 0.15,and the differences were statistically significant（P<0.001）.3.（1）There were no statistically differences in age,gender,BMI,education level and type of medical insurance between the two groups,and they were comparable（P>0.05）.（2）The implementation rate of early mobilization within 24 hours after operation was 97.0% and 24.2% for patients in the intervention and control group,respectively.The first time of mobilization was 17.39±4.24 h and 39.32±18.00 h,respectively,and the difference was statistically significant（P<0.05）.（3）There were statistically differences in the motion distance and time on the POD1,POD2 and POD3（P<0.05）.（4）There were significant differences in the first exhaust time（33.48±12.8h vs.57.61±19.61 h,P<0.05）,defecation time（40.98±18.64 h vs.68.55±28.65 h,P<0.05）and length of hospital stay（15.91±2.90 d vs.18.18±5.25 d,P<0.05）between the two groups.（5）There was no significant difference in preoperative pain scores between the two groups（P>0.05）.There were no significant differences in NRS resting pain scores on POD1,POD2 and POD3 between the two groups（P>0.05）.On POD1,there were significant differences in dynamic pain scores（P<0.05）.On POD2 and POD3,there was no significant difference in dynamic pain scores（P>0.05）.（6）The Complication rates in the intervention group such as nausea,vomiting,pulmonary infection,urinary retention,fall and unplanned extubation were less than that in the control group,but the difference were no statistical significance（P>0.05）.Conclusion1.This study constructed a program based on the best evidence,in line with the actual clinical situation in China,and revised according to expert opinions.The program is scientific,standardized and operable,which can provide theoretical guidance for clinical nursing practice.2.This study verified the clinical utility of "Early Mobilization Program for Patients after Laparoscopic Radical Gastrectomy",effectively promoted the transformation of evidence into practice,and provided direction for further clinical promotion. |
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