Construction Of Integrated Traditional Chinese And Western Medicine Nursing Program For 0 Level Diabetic Foot

Objective:1.To summarize the evidence of Chinese and Western medicine nursing for0 level diabetic foot,and to understand the gap between nursing practice and evidence of 0 level diabetic foot.To analyze the obstacle factors of evidence in clinical application,and to formulate action strategies,so as to provide basis for the construction of integrated traditional Chinese and Western medicine nursing program for 0 level diabetic foot.2.Based on evidence and action strategies to construct the integrated traditional Chinese and Western medicine nursing program for 0 level diabetic foot,to promote the clinical application of the best evidence,narrow the gap between evidence and practice,to standardize nurses ’ care for patients with 0level diabetic foot,improve the quality of care,and effectively prevent diabetic foot.Methods:Based on the evidence-based continuous quality improvement model,to construct the integrated traditional Chinese and Western medicine nursing program for 0 level diabetic foot,which is divided into two parts:1.Summary of evidence of Chinese and Western medicine nursing for 0level diabetic foot : establish evidence-based problems,and retrieve relevant evidence on the prevention and management of diabetic foot in Chinese and Western medicine by searching professional associations and organizational websites,guide networks,and domestic and foreign databases,and use corresponding quality evaluation tools.Evaluate,extract and summarize high-reliability clinical practice evidence of Chinese and Western medicine nursing for 0 level diabetic foot.2.Construction of integrated traditional Chinese and western medicine nursing program for 0 level diabetic foot :(1)Evaluation of the clinical applicability of the evidence : Using the expert meeting method,inviting experts from the pilot ward to evaluate the evidence from the four aspects of feasibility,suitability,clinical significance and effectiveness of the evidence,determine the evidence of introducing clinical practice,and construct the review indicators based on the evidence;(2)Analysis of the current situation and obstacle factors of clinical application of evidence: Based on the review indicators,using the field observation method and questionnaire survey method to investigate the the current situation of evidence application in the pilot ward,to understand the gap between 0 level diabetic foot nursing practice and evidence;using brainstorming method to analyze the obstacle factors of the application of evidence in clinical clinic,and formulate action strategies;(3)Construction of integrated traditional Chinese and Western medicine nursing program for 0 level diabetic foot:the research group based on evidence and action strategy,constructing the first draft of the integrated traditional Chinese and Western medicine nursing program for 0 level diabetic foot.Using expert meeting method,to invite experts to discuss the content of the program,the research group modified and improve the program according to the expert opinions to form the integrated traditional Chinese and Western medicine nursing program for 0 level diabetic foot.Results:1.Summary of evidence of Chinese and Western medicine nursing for 0level diabetic foot:Through rigorous literature search and quality evaluation,22 articles were finally included,including 2 evidence summaries,9 guidelines,3expert consensus,1 nursing program and 1 technical manual,1 clinical practice,and 5 systematic reviews.There were 43 items of evidence in 3 aspects,mainly including foot risk screening and evaluation(9 items),traditional Chinese medicine nursing(20 items),and health education(14 items).2.Construction of integrated traditional Chinese and western medicine nursing program for 0 level diabetic foot :(1)Evaluation of the clinical applicability of the evidence:Ten experts participated in the meeting,the expert positive coefficient was 1,the expert judgment coefficient was 0.910,the familiarity was 0.920,and the authority coefficient was 0.915.Among the 43 pieces of evidence,there were 36 pieces with a pass rate of 100 %,3 pieces with a pass rate between 80 % and100 %(Excluding 100%),1 piece with a pass rate between 60 % and80 %(Excluding 80%),and 3 pieces with a pass rate of less than 60%.After expert discussion,3 pieces of evidence that do not meet the clinical situation were deleted,and 39 pieces of evidence were finally included,and 10 first-level review indicators and 31 second-level review indicators were developed.(2)Analysis of the current situation and obstacle factors of clinical application of evidence:(1)Department level:the implementation rate of foot nursing related education materials is 100%,the implementation rate of foot nursing standard or process is 0%,and the obstacle factors are mainly the lack of perfect foot nursing process and program.(2)Nurse level:the accuracy rate of risk assessment was 0 %,and the accuracy rate of risk assessment was 0 %,the implementation rate of IWGDF grading and screening frequency guidance for patients was 0 %.The accuracy rates of traditional Chinese medicine foot bath,acupoint massage,acupoint application,health education were 73.33 %,74.57 %,82.25 % and 70.95 %respectively.The score of foot care knowledge of nurses with 0 level diabetic foot was(80.33 ± 12.74),and the compliance rate was 53.33 %.The main obstacle factors were lack of evidence-based knowledge training,insufficient risk assessment and health education tools,weak basic knowledge of traditional Chinese medicine and less understanding of evidence.(3)Patient level : The scores of knowledge,attitude and behavior of diabetic foot care were(10.04 ± 2.69),(13.34 ± 2.31)and(10.73 ± 2.17),respectively.The standardized scores were 71.71 %,66.70 % and 59.61 %,respectively.Knowledge and attitude were at a medium level,and behavior was at a low level.The analysis of obstacle factors was that patients did not pay enough attention to the prevention of grade 0 diabetic foot,poor knowledge,and low enthusiasm for active learning.(3)Construction of integrated traditional Chinese and Western medicine nursing program for 0 level diabetic foot:Ten experts participated in the meeting.The positive coefficient of experts was 1,the coefficient of expert judgment was0.92,the familiarity was 0.90,and the authority coefficient was 0.91.According to the expert opinions,four contents were modified,and the integrated traditional Chinese and Western medicine nursing program for 0 level diabetic foot was finally formed,including three main contents : western medicine nursing(foot risk screening and assessment,risk factor intervention),traditional Chinese medicine nursing(syndrome differentiation,syndrome differentiation,emotional nursing,traditional Chinese medicine exercise),and integrated traditional Chinese and western medicine health education.The auxiliary tools and processes for the implementation of grade 0 diabetic foot assessment sheet,foot risk assessment and health education process,health education record sheet and other programs were developed.Conclusions:1.This study used evidence-based thinking and scientific methods to summarize the evidence of integrated traditional Chinese and Western medicine nursing for 0 level diabetic foot,involving foot risk factor screening and evaluation,traditional Chinese medicine nursing,health education and other aspects,which can provide evidence support for the construction of integrated traditional Chinese and Western medicine program and clinical nursing practice for 0 level diabetic foot.2.The current situation of clinical application of Chinese and Western medicine nursing evidence for 0 level diabetic foot is not good.Under the guidance of " evidence-based continuous quality improvement model," this study is based on evidence and combined with clinical situation to construct a nursing program of integrated Chinese and Western medicine for 0 level diabetic foot,which can provide evidence-based decision-making basis for clinical nurses to carry out prevention and nursing of 0 level diabetic foot.