Empirical Study Of A Graded Pulmonary Rehabilitation Care Program To Prevent Stroke-related Pneumonia In ICU Patients

ObjectiveBased on the concept of evidence-based nursing,the Delphi method is adopted to construct a hierarchical pulmonary rehabilitation nursing program to prevent stroke-related pneumonia in ICU patients,and to clinical application to evaluate the prevention effect of stroke-related pneumonia in ICU patients,and to provide scientific and standardized nursing guidance program for clinical nursing staff.Methods1.Establishment of the draft of graded pulmonary rehabilitation nursing program:Literature survey was conducted on Chinese and English databases to determine the grading framework of the program,evidence retrieval,evidence screening,evidence evaluation and evidence integration were conducted based on PIPOST model,and items of the program were constructed by sorting out pulmonary rehabilitation measures to prevent stroke-related pneumonia.2.Form the final draft of the graded pulmonary rehabilitation nursing plan:prepare the expert correspondence questionnaire,send two rounds of correspondence questionnaire to the experts in the subject area,modify the plan according to the expert opinions when the importance score is>4.00 and the coefficient of variation CV<0.25,further improve the plan through small sample pretest,and determine the final draft of the pulmonary rehabilitation nursing plan.3.The scheme was applied to the clinic to verify the effect:A total of 88 patients with cerebral apoplexy who were hospitalized in the ICU of neurology department of a Grade A hospital in Xi’an from August 2022 to October 2022 were selected by convenient sampling method as the research objects.The control group was given the routine nursing in the ICU of neurology department,and the intervention group was given the graded pulmonary rehabilitation nursing program constructed in this study on the basis of routine nursing.The incidence of stroke-associated pneumonia（SAP）,clinical pulmonary infection score（CPIS）,standard swallowing Function Assessment Scale（SSA）,upper limb Motor Function Scale（Fugl-Meyer）,oxygenation index,blood gas index,length of ICU stay were used as outcome indexes to evaluate the intervention effect of this program.4.The final data result was analyzed by SPSS23.0 software.Measurement data with（?）+s description,to conform to the normal distribution and does not conform to the normal distribution of data using t test and analysis of rank and inspection;Count data usingχ2 inspection analysis.Test level a=0.05,P<0.05 indicates that there is a significant difference between the two groups of data.Results1.Literature research results:The research progress at home and abroad was summarized through literature analysis and the best evidence,and the draft plan of 3first-level indicators,18 second-level indicators and 35 third-level indicators was initially formed by referring to the existing guidelines,expert consensus and the literature content of rehabilitation nursing measures to prevent stroke-related pneumonia.2.Expert letter consultation results:the positive coefficients of the two rounds of expert letter consultation were 90%and 100%respectively,the authority coefficients of expert opinions were 0.85（≥0.70）,the coefficient of variation of item importance was0-0.114,and the coefficient of variation of feasibility was 0-0.127.Kendall’s W coordination coefficients are 0.206 and 0.396.Based on the data statistics,experts’modification opinions,and the review of the research group,a total of 1 item was deleted,2 items were added,1 item was split,3 items were merged,and 8 items were modified.Finally,a graded pulmonary rehabilitation nursing plan for preventing stroke-related pneumonia in ICU patients was formed,including 3 first-level indicators,15 second-level indicators,and 39 third-level indicators.3.Results of randomized controlled trial:Before intervention,there was no significant difference between the two groups of patients in gender,age,education level,number of complications,swallowing dysfunction,motor dysfunction,smoking status,drinking status,GCS score,NIHSS score and other general information,indicating that the outcome indicators of the two groups of patients were comparable.After intervention,the incidence of SAP,clinical pulmonary infection score,standard swallowing function score,Pa CO₂ value and ICU stay days in observation group were significantly lower than those in control group.Fugl-Meyer score,Pa O₂ value and Pa O₂/Fi O₂ value were significantly higher than those in control group,all P<0.05.ConclusionsIn this study,the first draft of the plan was constructed using evidence-based nursing theory,and the final draft of the plan was determined through expert consultation and pretest,and the process of constructing the plan was rigorous and scientific.Through clinical application verification,the program can effectively reduce the incidence of stroke-related pneumonia in ICU patients,improve patients’lung function,swallowing function,upper limb function,and reduce ICU hospital stay,and there are no adverse events such as falls,bed falls,and tube detachments in the experimental group during the implementation of the program.This protocol is safe and feasible and has important clinical value.