Research On Nursing Status Of Elderly Functional Constipation Based On Clinical Practice Guidelines

ObjectiveTo evaluate the quality of clinical practice guidelines on senile functional constipation at home and abroad,synthesis nursing recommendations from high-quality guidelines;to design questionnaires based on the integrated recommendations;to understand the situation quo of clinical management of senile functional constipation and the gap between the status and guideline;to analyze the barriers to the application of guideline in clinical practice,and put forward corresponding implementation strategies and to provide reference for the clinical transformation of guidelines.Methods1.Systematically retrieve the clinical practice guidelines related to senile functional constipation.Screen guidelines based on the inclusion and exclusion criteria.Appraise the methodological quality of guidelines with guidelines evaluation tool(AGREE II).Extract,translate and integrate recommendations of the high-quality guidelines.Evaluate the rigor and appropriateness of recommendation integration with expert consultation.2.Draft the preliminary Questionnaire of the Status of Senile Functional Constipation Management according to the KTA model and the integrated recommendations.The questionnaire was revised and adjusted based on the results of expert consultation and a pilot study.In addition,the researcher and nursing quality control experts formulated the criteria and algorithm formulas for meeting of the recommendations based on the experience of routine standards on formulation and inspection of nursing quality.3.To the Questionnaire of the Status of Senile Functional Constipation Management.A stratified sampling method was used to disseminate questionnaires towards the clinical nurses and nursing managers from general hospital or traditiongal Chinese medicine or hospital of integrated traditiongal Chinese and western medicine in Beijing with the admission of senile functional constipation patients.SPSS statistical software?Excel2016 software?Modeler 18.0 software was used for statistical analysis.Findings1.This study included five evidence-based guidelines for the management of senile functional constipation from the United States,Canada and Korea,three of which were issued by professional academic organizations,and two by nursing associations and nursing research centers.Using the AGREE ? evaluation,the guidelines form RNAO,AHRQ,KSNM were grade A,the guidelines form ASCRS,ACG were grade B.A total of 37 recommendations were extracted from five clinical practice guidelines.After integration and the expert's argument,12 final recommendations were formed included in the four topics,including 5 evaluations,4 nursing interventions.,1 evaluation,2 education and organizational policies.2.The final questionnaire of the status of senile functional constipation management included 75 items.It consists of three parts:The first part:General information includes 18 items.The second part:the status of nursing management including 19 evaluation items,22 nursing intervention items,6 evaluation items,6 education and organizational policie items.The thied part:4 barriers items(evidence factor,personal factor,resource factor,organizational factor).The item-level CVI was 0.8?1.0 and the S-CVI of the questionnaire was 0.895.The coefficient of section-level re-test was 0.754?0.862 and the coefficient of scale-level re-test was 0.904.The standards and algorithm formulas for meeting the recommendations were formulated.3.In this study,330 questionnaires were distributed,330 were returned,317 were valid,the return rate was 100%,and the questionnaire effectiveness rate was 96.1%.?81.7%nurses indicated that they needed relevant training;63.4%nurses were able to conduct patient evaluations;90.9%and 77.0%nurses could manage the medication care and implement health education for patients respectively;69.4%nurses would evaluate the effect;10.7%departments establish an interdisciplinary team approach to manage constipation and 17.9%departments organize and delivere Comprehensive education programs.?The gap between the practice and guidelines:The top three items where clinical practice met the recommendations were nursing intervention n on toilet mode(27.4%),nursing intervention on activities and sports(21.8%),satisfaction and effect evaluation(16.1%).The top four items failing to meet the recommendations were interdisciplinary teams(89.3%),comprehensive education and project promotion(82.1%),and physical examination and assessment on medication history(77.9%).?Statistical analysis showed that whether or not nurses had received relevant training had an impact on clinical practice(P<0.01).Trained nurses would do better in clinical practice,and the rate of compliance to guideline recommendations was higher(P<0.01).Through the analysis of association rule,strong association rules were mined.The main barriers to the clinical practice of senile functional constipation were:'low achievability and low recognition'among evidential factors,'Nurses lack of knowledge'and 'patients unacceptability' among personal factors,'insufficient human resources' among resource factors and 'lack of regulation' among organizational factors.Conclusion1.The five foreign guidelines included in this study have good quality overall and rich recommendation contents,involving recommendations on evaluation,health education,evaluation,educational and organizational policies.The recommendation contents are similar with strong operability,which can guide clinical nursing work well.2.The questionnaire of the status of senile functional constipation Management based on clinical practice guidelines has good coefficient and can be used as a reliable tool.Tt is more scientific for quantifie constipation through formulating the standerds and algorithm formulas.3.Teaching,training and scientific research on senile functional constipation need to be improved,and nurses have a high demand for training.Most nurses can provide comprehensive nursing care for elderly patients with functional constipation,but there is a big gap between the practice and guidelines.Nursing intervention and effect evaluation are mostly accordant with guidelines,while the evaluation and education and organizational policy are distant with guidelines.4.Based on the of barriers and association rules in clinical practice,we recommend that take"strengthening nurse training and personnel training","standardizing the nursing programs of functional constipation","strengthening multisectoral cooperation and establish an interdisciplinary team" measures.It can be targeted to develop clinical practice programs and promote the clinical transformation of evidence.