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COVID-19 infection prevention and control management during hyperbaric oxygen therapy: a best practice implementation project. 高压氧治疗期间COVID-19感染防控管理:最佳实践实施项目。
IF 2.3 4区 医学 Q2 Medicine Pub Date : 2023-12-01 DOI: 10.1097/XEB.0000000000000400
Michal Hájek, Dittmar Chmelař, Miroslav Rozložník, Alexandra Lochmanová, Jakub Tlapák, Tereza Vrbová, Miloslav Klugar, Jitka Klugarová

Objective: This implementation project compared standard operating procedures, accepted preventive measures, and disinfection procedures between the initial stage of the COVID-19 pandemic (first wave: March 15 to May 31, 2020) and the later stages of the pandemic (second and third waves: September 1, 2020 to January 31, 2021).

Introduction: This project sought to improve compliance with international evidence-based guidelines and clinical standards for the prevention and control of COVID-19 infection during hyperbaric oxygen therapy taking into account the conditions of the local hospital.

Methods: Guided by the JBI evidence implementation framework, seven evidence-based audit criteria were developed for the prevention and control of COVID-19 infection during hyperbaric oxygen therapy. A questionnaire was used to measure compliance in baseline and follow-up audits.

Results: Differences between the baseline and follow-up audits were noted for criteria 6 and 7. Criterion 6 increased from 0% to 100% as the hyperbaric facility was equipped with certified ultraviolet-C radiation for air disinfection during the later period, but this equipment was not available in the initial period of the pandemic. Criterion 7 dropped from 100% in the baseline audit to 0% in the follow-up audit because of a significant increase in the operational burden of the treatment capacity of the facility, which made it impossible to comply with the recommended distancing between patients.

Conclusions: Differences were found in preventive measures, disinfection procedures, work organization, and approach to care strategy. The project objectives were met and the implementation strategies proved effective. Larger sample sizes would need be needed to confirm the reproducibility of the results.

目的:本实施项目比较2019冠状病毒病大流行初期(第一波:2020年3月15日至5月31日)和后期(第二波和第三波:2020年9月1日至2021年1月31日)的标准操作流程、可接受的预防措施和消毒程序。项目简介:本项目旨在结合当地医院的实际情况,提高高压氧治疗期间COVID-19感染防控的国际循证指南和临床标准的合规性。方法:以JBI证据实施框架为指导,制定高压氧治疗期间防控COVID-19感染的7项循证审计标准。使用问卷来衡量基线和后续审计的依从性。结果:基线审计和随访审计在标准6和标准7上存在差异。标准6从0%增加到100%,因为高压设施在后期配备了经过认证的紫外线- c辐射,用于空气消毒,但在大流行初期没有这种设备。标准7从基线审计的100%下降到后续审计的0%,因为该设施的治疗能力的运营负担显著增加,这使得不可能遵守建议的患者之间的距离。结论:在预防措施、消毒程序、工作组织、护理方法等方面存在差异。项目目标已经实现,实施战略证明是有效的。需要更大的样本量来确认结果的可重复性。
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引用次数: 0
Implementation of virtual music therapy in the practice of Czech music therapists: a best practice implementation project. 虚拟音乐治疗在捷克音乐治疗师实践中的实施:最佳实践实施项目。
IF 2.3 4区 医学 Q2 Medicine Pub Date : 2023-12-01 DOI: 10.1097/XEB.0000000000000386
Jiří Kantor, Anna Neuwirthová, Barbora Hořejší, Jan Koucun, Lucia Kantorová, Tereza Vrbová, Zachary Munn, Jitka Klugarová, Miloslav Klugar

Introduction and aims: Czech music therapists lacked the skills and knowledge to adapt their practice to virtual music therapy (VMT) at the beginning of the COVID-19 pandemic, when physical contact was restricted. The aims of this project were to implement the best evidence-based recommendations concerning VMT in the practice of Czech music therapists and increase the number of therapists using VMT.

Methods: The project used the JBI Evidence Implementation Framework to promote change in the practice of participants. A baseline audit of 26 practitioners was conducted using questionnaires and interviews. The audit criteria consisted of 8 best practice recommendations, followed by the implementation of targeted strategies and a follow-up audit.

Results: Of the 26 music therapists, 18 began practicing VMT following the rollout of the implementation strategies. Strategies included educational workshops, instructional materials, technological support, individual counseling, and interactive training sessions. There was an increase in compliance with all audit criteria. The most critical barriers were lack of knowledge about VMT and lack of technical skills; lack of resources; technological challenges; low confidence of music therapists to provide VMT; and reduced need for VMT after the lockdown restrictions were relaxed.

Conclusions: The implementation project helped to overcome temporary pandemic restrictions, increase the quality of VMT practice, develop strategies for VMT training, and identify reasons for using VMT during the pandemic and beyond.

简介和目的:在新冠肺炎大流行初期,身体接触受到限制,捷克音乐治疗师缺乏将他们的实践适应虚拟音乐疗法(VMT)的技能和知识。该项目的目的是在捷克音乐治疗师的实践中实施关于VMT的最佳循证建议,并增加使用VMT的治疗师的数量。方法:本项目采用JBI证据实施框架来促进参与者实践的改变。通过问卷调查和访谈对26名从业人员进行了基线审计。审计标准包括8项最佳实践建议,其次是实施有针对性的战略和后续审计。结果:在26名音乐治疗师中,18名在实施策略推出后开始练习VMT。策略包括教育工作坊、教学材料、技术支持、个人咨询和互动训练课程。遵守所有审计标准的情况有所增加。最关键的障碍是缺乏对自动驾驶汽车的了解和缺乏技术技能;缺乏资源;技术挑战;音乐治疗师提供VMT的信心较低;在封锁限制放松后,对VMT的需求也有所减少。结论:实施项目有助于克服大流行期间的临时限制,提高VMT实践的质量,制定VMT培训战略,并确定在大流行期间和之后使用VMT的原因。
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引用次数: 0
Structured, nurse-led ward rounds to improve interprofessional communication and optimize care of vascular surgery patients: a best practice implementation project. 结构化、护士主导的查房,以改善跨专业沟通并优化血管手术患者的护理:一个最佳实践实施项目。
IF 2.3 4区 医学 Q2 Medicine Pub Date : 2023-12-01 DOI: 10.1097/XEB.0000000000000385
Nicholas Wee Siong Neo, Yao Li, Ailene Bandoy Salazar, Jessica Kai Lun Gan, Jun Jie Ng, Poh Chi Tho

Introduction: Ward rounds are crucial inpatient activities during which patients' conditions are discussed. Team-based models such as nurse-led ward rounds (NLWRs) have been conceptualized and trialled, with positive results.

Methods: An evidence-based quality improvement pilot project to introduce NLWRs was implemented at a cardiovascular medical-surgical unit in a Singapore tertiary hospital. The JBI Evidence Implementation Framework was used to guide the project. The evidence-based NLWR format incorporated stakeholder feedback on NLWR frequency, preparation, coordination, and content. Baseline and 6-month post-implementation audits were carried out.

Results: The 4 audit criteria improved from baseline, reaching 100% compliance for criteria 1, 2, and 3 associated with interprofessional communication and collaboration. An improvement from baseline (30% to 46.7%) was also observed for criterion 4 on patient involvement during medical ward rounds. Moreover, there were improvements in clinical outcome data such as patient hospitalization length, "best medical therapy" rates, and inpatient complications. A statistically significant improvement in nurses' confidence to lead discussions during medical rounds was also observed ( p  = 0.026).

Conclusions: This project promoted greater compliance with NLWR criteria through audit and feedback cycles and the contextualization of implementation strategies. A well-supported program that prepares nurses for interprofessional communication also improves nurses' confidence in team communication, bolstering their ability to provide high-quality patient care.

导语:查房是重要的住院活动,在查房期间讨论患者的病情。基于团队的模式,如护士带领的查房(NLWR),已经被概念化并进行了试验,取得了积极的结果。方法:在新加坡一家三级医院的心血管外科实施了一项基于证据的质量改进试点项目,以引入NLWRs。JBI证据实施框架用于指导该项目。基于证据的NLWR格式包含了利益相关者对NLWR频率、准备、协调和内容的反馈。进行了基线审计和实施后6个月的审计。结果:4项审计标准比基线有所改善,达到了与跨专业沟通和协作相关的标准1、2和3的100%合规性。在医疗查房期间,标准4的患者参与度也比基线(30%至46.7%)有所改善。此外,患者住院时间、“最佳药物治疗”率和住院并发症等临床结果数据也有所改善。在医疗查房期间,护士领导讨论的信心也有统计学上的显著提高(p = 0.026)。结论:该项目通过审计和反馈周期以及实施战略的背景化,促进了对NLWR标准的更大遵守。一个支持良好的项目,为护士进行跨专业沟通做好准备,也提高了护士对团队沟通的信心,增强了他们提供高质量患者护理的能力。
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引用次数: 0
Providing a scaffold for considering theoretical frameworks in evidence implementation projects: the JBI approach to evidence implementation. 为在证据实施项目中考虑理论框架提供一个脚手架:JBI的证据实施方法。
IF 2.3 4区 医学 Q2 Medicine Pub Date : 2023-12-01 DOI: 10.1097/XEB.0000000000000397
Zachary Munn, Alexa McArthur, Miloslav Klugar, Daphne Stannard, Adam S Cooper, Yeetey Enuameh, Kylie Porritt

Abstract: There are many theories, models, and frameworks that have been proposed in the field of implementation science. Despite this, many evidence implementation or practice improvement projects do not consider these theories, models, or frameworks in their improvement efforts. The JBI approach is one example of an implementation theory, model, or framework. This approach has been developed particularly with health care professionals in mind and is designed to clearly guide pragmatic evidence implementation efforts based on the best available evidence. In this paper, we discuss how the JBI approach to evidence implementation can interact with and support theory-informed, pragmatic evidence implementation projects.

摘要:在实施科学领域,已经提出了许多理论、模型和框架。尽管如此,许多证据实现或实践改进项目并没有在他们的改进工作中考虑这些理论、模型或框架。JBI方法是实现理论、模型或框架的一个例子。这一方法是专门为卫生保健专业人员制定的,旨在明确指导基于现有最佳证据的务实证据实施工作。在本文中,我们讨论了JBI的证据实施方法如何相互作用并支持基于理论的、务实的证据实施项目。
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引用次数: 0
Effectiveness of exercise interventions on urinary incontinence and pelvic organ prolapse in pregnant and postpartum women: umbrella review and clinical guideline development. 运动干预对妊娠和产后妇女尿失禁和盆腔器官脱垂的有效性:总括综述和临床指南制定。
IF 2.7 4区 医学 Q2 HEALTH CARE SCIENCES & SERVICES Pub Date : 2023-12-01 DOI: 10.1097/XEB.0000000000000391
Iina Ryhtä, Anna Axelin, Heidi Parisod, Arja Holopainen, Lotta Hamari

Introduction and aims: Dysfunction related to pelvic floor muscles (PFM) is common among pregnant and postpartum women and can cause symptoms such as urinary incontinence or pelvic organ prolapse (POP). As part of developing a nationwide clinical practice guideline for nursing in Finland, the aim of this umbrella review is to summarize the existing evidence about the effectiveness of exercise interventions on urinary incontinence and POP in pregnant and postpartum women. To promote knowledge translation, recommendations for health care professionals are presented.

Methods: We conducted an umbrella review to summarize the existing evidence. The JBI methodology for umbrella reviews was used to guide the review. The level of evidence was evaluated using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach, and recommendations based on the evidence were formulated by a clinical guideline working group.

Results: Altogether, 9 systematic reviews, reporting findings from 89 original studies, were included. The methodological quality of the reviews was evaluated using JBI's checklist. The highest level of evidence was found for preventing the symptoms of postpartum urinary incontinence through exercise and pelvic floor muscle training (PFMT) during pregnancy. Moderate-level evidence showed that exercise and PFMT are likely to reduce the symptoms and severity of urinary incontinence, but the level of evidence was low on PFMT reducing the symptoms of POP.

Conclusion: We recommend encouraging and guiding pregnant and postpartum women to exercise and train PFM. We also recommend identifying pregnant and postpartum women with symptoms of PFM dysfunction and directing them to a physiotherapist or other health care professional specializing in pelvic floor function.

引言和目的:与盆底肌(PFM)相关的功能障碍在孕妇和产后妇女中很常见,并可能导致尿失禁或盆腔器官脱垂(POP)等症状。作为制定芬兰全国护理临床实践指南的一部分,本综述的目的是总结关于运动干预对孕妇和产后妇女尿失禁和POP有效性的现有证据。为了促进知识翻译,提出了对卫生保健专业人员的建议。方法:我们进行了一项总括性审查,以总结现有的证据。综合审查采用了JBI方法来指导审查。证据水平采用建议、评估、发展和评估分级(GRADE)方法进行评估,临床指南工作组根据证据制定建议。结果:共纳入9项系统综述,报告了89项原始研究的结果。使用JBI的检查表对审查的方法质量进行了评估。在怀孕期间,通过运动和盆底肌肉训练(PFMT)预防产后尿失禁症状的证据最高。中等程度的证据表明,运动和PFMT有可能减轻尿失禁的症状和严重程度,但PFMT减轻POP症状的证据水平较低。结论:我们建议鼓励和指导孕妇和产后妇女锻炼和训练PFM。我们还建议识别有PFM功能障碍症状的孕妇和产后妇女,并指导她们去找物理治疗师或其他专门研究盆底功能的医疗保健专业人员。
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引用次数: 0
Nurse-led speech therapist referral initiative for older adult patients at risk of dysphagia: a best practice implementation project. 护士主导的针对有吞咽困难风险的老年患者的言语治疗师转诊倡议:一个最佳实践实施项目。
IF 2.3 4区 医学 Q2 Medicine Pub Date : 2023-12-01 DOI: 10.1097/XEB.0000000000000384
Adeline Nyong Siew Khor, Westine Wei Lin Juay, Yi Yan Wong, Nur Elydia Binte Omar, Yajing Liu, Yingying Kong, Mien Li Goh

Introduction and objectives: Dysphagia is common among older patients, affecting their nutritional status, hospital readmission, length of hospital stay, and hospitalization costs. Nurses can play a key role in early identification of dysphagia through systematic screening. This project sought to (i) achieve 80% compliance among nurses in using the 4-point questionnaire test (4QT) swallow screening test on patients and (ii) ensure all patients screening positive for dysphagia were referred to a speech therapist within 1 day.

Methods: A short swallow screening tool was adapted from an evidence-based screening tool, the 4QT, by a team of speech therapists, a geriatrician, and a geriatric trained nurse. Ward nurses were then trained on using the tool to screen older patients upon admission or transfer to another ward. The project used the JBI Evidence Implementation Framework, which involved pre and post audits and feedback to evaluate compliance with best practice.

Results: Compliance increased in the use of the short swallow screening tool, rising from 64% ( n  = 25) in the baseline audit to 71% ( n  = 34) in the follow-up audit. However, there was a decrease in the referral of patients who screened positive for dysphagia to speech therapists, with the rate dropping from 92% ( n  = 12) to 86% ( n  = 12). All patients ( n  = 12) from both baseline and follow-up audits were referred to a speech therapist within 1 day of admission/transfer post-implementation compared with 70% ( n  = 7) at pre-implementation.

Conclusions: This project applied evidence-based recommendations to clinical practice and improved patient outcomes. The nurses facilitated timely referrals to speech therapists for further assessment and intervention, which was useful in the clinical context. The nurses continue to use the screening tool routinely to prevent dysphagia complications among geriatric patients.

引言和目的:吞咽困难在老年患者中很常见,影响他们的营养状况、再次入院、住院时间和住院费用。护士可以通过系统筛查在早期识别吞咽困难方面发挥关键作用。该项目旨在(i)护士对患者使用4点问卷测试(4QT)吞咽筛查测试的依从性达到80%,以及(ii)确保所有吞咽困难筛查呈阳性的患者在1天内转诊至言语治疗师。方法:一组言语治疗师、一名老年病学家和一名受过老年医学培训的护士根据循证筛查工具4QT改编了一种短咽筛查工具。然后,病房护士接受了使用该工具在入院或转移到另一个病房时对老年患者进行筛查的培训。该项目使用了JBI证据实施框架,其中包括事前和事后审计和反馈,以评估对最佳做法的遵守情况。结果:短咽筛查工具的依从性从64%(n = 25)增加到71%(n = 34)在后续审计中。然而,将吞咽困难筛查呈阳性的患者转诊给言语治疗师的人数有所减少,转诊率从92%(n = 12) 至86%(n = 12) 。所有患者(n = 12) 在基线和随访审计中,在入院/转院后1天内转诊给言语治疗师,而70%(n = 7) 结论:该项目将循证建议应用于临床实践,改善了患者的预后。护士们为及时转诊给言语治疗师进行进一步评估和干预提供了便利,这在临床上很有用。护士们继续常规使用筛查工具来预防老年患者的吞咽困难并发症。
{"title":"Nurse-led speech therapist referral initiative for older adult patients at risk of dysphagia: a best practice implementation project.","authors":"Adeline Nyong Siew Khor, Westine Wei Lin Juay, Yi Yan Wong, Nur Elydia Binte Omar, Yajing Liu, Yingying Kong, Mien Li Goh","doi":"10.1097/XEB.0000000000000384","DOIUrl":"10.1097/XEB.0000000000000384","url":null,"abstract":"<p><strong>Introduction and objectives: </strong>Dysphagia is common among older patients, affecting their nutritional status, hospital readmission, length of hospital stay, and hospitalization costs. Nurses can play a key role in early identification of dysphagia through systematic screening. This project sought to (i) achieve 80% compliance among nurses in using the 4-point questionnaire test (4QT) swallow screening test on patients and (ii) ensure all patients screening positive for dysphagia were referred to a speech therapist within 1 day.</p><p><strong>Methods: </strong>A short swallow screening tool was adapted from an evidence-based screening tool, the 4QT, by a team of speech therapists, a geriatrician, and a geriatric trained nurse. Ward nurses were then trained on using the tool to screen older patients upon admission or transfer to another ward. The project used the JBI Evidence Implementation Framework, which involved pre and post audits and feedback to evaluate compliance with best practice.</p><p><strong>Results: </strong>Compliance increased in the use of the short swallow screening tool, rising from 64% ( n  = 25) in the baseline audit to 71% ( n  = 34) in the follow-up audit. However, there was a decrease in the referral of patients who screened positive for dysphagia to speech therapists, with the rate dropping from 92% ( n  = 12) to 86% ( n  = 12). All patients ( n  = 12) from both baseline and follow-up audits were referred to a speech therapist within 1 day of admission/transfer post-implementation compared with 70% ( n  = 7) at pre-implementation.</p><p><strong>Conclusions: </strong>This project applied evidence-based recommendations to clinical practice and improved patient outcomes. The nurses facilitated timely referrals to speech therapists for further assessment and intervention, which was useful in the clinical context. The nurses continue to use the screening tool routinely to prevent dysphagia complications among geriatric patients.</p>","PeriodicalId":48473,"journal":{"name":"Jbi Evidence Implementation","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41104988","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Making implementation work. 使实施工作发挥作用。
IF 2.3 4区 医学 Q2 Medicine Pub Date : 2023-09-01 DOI: 10.1097/XEB.0000000000000383
Craig S Lockwood
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引用次数: 0
Planning an implementation science training program for advanced practice registered nurses. 策划实施科学的高级执业注册护士培训方案。
IF 2.3 4区 医学 Q2 Medicine Pub Date : 2023-09-01 DOI: 10.1097/XEB.0000000000000376
Sharisse Hebert, Chloe Gaines, Ruby Benjamin-Garner, Jerrel Moore

Background: A gap exists between scientific discovery and implementation and adoption of research findings in healthcare and public health practice. This gap is due to the fact that research on treatment efficacy and safety in clinical trials ends prematurely with the publication of results, leaving a lack of knowledge of treatment effectiveness in real-world clinical and community settings. Comparative effectiveness research (CER) can facilitate the translation of research findings, reducing the gap between discovery and adoption into practice. Getting CER findings to patients and healthcare providers requires efforts to disseminate and train providers to successfully implement and sustain change in the healthcare setting. Advanced practice registered nurses (APRNs) are instrumental in the implementation of evidence-based research in primary care settings and an important group to target for the dissemination of research findings. There are numerous implementation training programs, but none focus specifically on APRNs.

Objective: The objective of this article is to describe the infrastructure established to develop a 3-day implementation training program for APRNs and an implementation support system.

Method: A description of the processes and strategies is provided, including stakeholder engagement through focus groups and the formation of a multistakeholder program planning advisory team, which includes APRNs, organization leaders, and patients. The program also includes curriculum development and program planning as well as the development of an implementation toolkit.

Results: Stakeholders were instrumental in shaping the implementation training program, including the content of the curriculum and the program agenda. In addition, the unique perspective of each stakeholder group contributed to the selection of the CER findings disseminated through the intensive training program.

Conclusion: It is important that strategies to address the lack of implementation training opportunities for APRNs be discussed and disseminated within the healthcare community. This article discusses the plan to address implementation training for APRNs through the development of an implementation curriculum and toolkit for APRNs.

背景:在卫生保健和公共卫生实践中,科学发现与研究成果的实施和采用之间存在差距。这一差距是由于临床试验中治疗有效性和安全性的研究随着结果的发表而过早结束,导致缺乏对现实世界临床和社区环境中治疗有效性的了解。比较有效性研究(CER)可以促进研究成果的转化,减少从发现到采用到实践之间的差距。将CER结果传达给患者和医疗保健提供者需要努力传播和培训提供者,以成功实施和维持医疗保健环境中的变化。高级执业注册护士(APRNs)在初级保健机构实施循证研究方面发挥着重要作用,也是研究成果传播的重要目标群体。有许多实施培训项目,但没有一个专门针对aprn。目的:本文的目的是描述为开发为期3天的aprn实施培训计划和实施支持系统而建立的基础设施。方法:提供了过程和策略的描述,包括通过焦点小组的利益相关者参与和多利益相关者项目规划咨询团队的形成,其中包括APRNs,组织领导者和患者。该项目还包括课程开发和项目规划以及实施工具包的开发。结果:利益相关者在制定实施培训计划方面发挥了重要作用,包括课程内容和计划议程。此外,每个利益相关者群体的独特视角有助于通过强化培训计划传播的CER结果的选择。结论:在医疗保健社区内讨论和传播解决APRNs缺乏实施培训机会的策略是很重要的。本文讨论了通过开发aprn的实现课程和工具包来解决aprn的实现培训的计划。
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引用次数: 0
Clinical decision support in promoting evidence-based nursing in primary healthcare: a cross-sectional study in Finland. 临床决策支持在促进循证护理初级保健:芬兰的横断面研究。
IF 2.3 4区 医学 Q2 Medicine Pub Date : 2023-09-01 DOI: 10.1097/XEB.0000000000000375
Lotta Hamari, Heidi Parisod, Hannele Siltanen, Kristiina Heikkilä, Tiina Kortteisto, Ilkka Kunnamo, Heidi Pukkila, Arja Holopainen

Introduction and aims: The aim was to explore clinical decision support (CDS) use in the practice of primary healthcare nurses. The objectives were to recognize to what extent nurses (registered nurses, public health nurses, and practical nurses) use CDS, what factors were associated with the CDS used, what kind of organizational support nurses need, and what were nurses' views about CDS development needs.

Methods: The study was conducted with a cross-sectional study design, using an electronic questionnaire developed for this purpose. The questionnaire contained 14 structured questions and nine open-ended questions. The sample consisted of randomly selected primary healthcare organizations ( N  = 19) in Finland. Quantitative data were analyzed using cross-tabulation and Pearson's chi-squared test, and qualitative data with quantification.

Results: A total of 267 healthcare professionals (age range 22-63 years) volunteered to participate. Participants were mainly registered nurses, public health nurses, and practical nurses (46.8, 24, and 22.9%, respectively). Overall, 59% of the participants had never used CDS. The majority (92%) found it necessary to develop nursing-specific content for CDS. The most commonly used features were medication recommendations and warnings (74%), reminders (56%), and calculators (42%). Half of the participants (51%) had not received training on the use of CDS. The older age of participants was associated with the feeling of not having enough training to use CDS ( P  = 0.039104). Nurses felt that CDS was helpful in their clinical work and decision-making, promoting evidence-based practice, and narrowing the research-into-practice gap, improving patient safety and the quality of care, and helping those who are new in their work.

Conclusion: CDS and its support structures should be developed from a nursing perspective to achieve the full potential of CDS in nursing practice.

简介和目的:目的是探讨临床决策支持(CDS)在初级保健护士的实践中使用。目的是了解护士(注册护士、公共卫生护士和实习护士)使用CDS的程度,与CDS使用相关的因素,护士需要什么样的组织支持,以及护士对CDS发展需求的看法。方法:本研究采用横断面研究设计,使用为此目的开发的电子问卷。调查问卷包含14个结构化问题和9个开放式问题。样本包括芬兰随机选择的初级卫生保健组织(N = 19)。定量资料采用交叉表法和Pearson卡方检验,定性资料采用定量分析。结果:共有267名医疗保健专业人员(年龄22-63岁)自愿参加。参与者主要为注册护士、公共卫生护士和执业护士(分别为46.8%、24%和22.9%)。总体而言,59%的参与者从未使用过CDS。大多数人(92%)认为有必要为CDS制定护理特定内容。最常用的功能是药物建议和警告(74%),提醒(56%)和计算器(42%)。一半的参与者(51%)没有接受过使用CDS的培训。年龄较大的参与者感觉没有足够的训练来使用CDS (P = 0.039104)。护士认为,CDS有助于他们的临床工作和决策,促进循证实践,缩小研究与实践之间的差距,提高患者安全和护理质量,并帮助那些新来的人。结论:应从护理的角度发展CDS及其支持结构,以充分发挥CDS在护理实践中的潜力。
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引用次数: 0
Practice and effect evaluation of early restrictive fluid resuscitation strategy in the nursing care of patients with sepsis in the emergency department: a retrospective cohort study. 早期限制性液体复苏策略在急诊脓毒症患者护理中的实践与效果评价:一项回顾性队列研究。
IF 2.3 4区 医学 Q2 Medicine Pub Date : 2023-09-01 DOI: 10.1097/XEB.0000000000000365
Xiaqing Hu, Jie Zhang, Peipei Wang, Xin Dai

Objective: To explore the practice and effect evaluation of the early restrictive fluid resuscitation strategy in the nursing care of patients with sepsis in the emergency department.

Methods: A total of 239 sepsis patients, who were treated in the emergency department of our hospital from January to September 2020, were selected as the participants of this study, and a retrospective analysis was performed. According to different methods of fluid resuscitation, they were divided into an improved group and a control group. One hundred and twelve patients who received restrictive fluid resuscitation were in the improved group; another 127 patients who received adequate fluid resuscitation were in the control group. The ICU stay time, ventilator use time, and 28-day mortality rate of the two groups were observed. The hemodynamic indices, acute physiology and chronic health evaluation (APACHE) II score, sequential organ failure assessment (SOFA) score, and complications of the two groups before and after treatment were compared.

Results: After treatment, in the improved group, the APACHE II and SOFA scores were lower than in the control group, fluid replacement decreased, lactate clearance increased, ICU admission time shortened and the proportion of ventilator time to ICU admission time decreased. The incidence of acute respiratory distress syndrome (ARDS), cTn I and brain natriuretic peptic in the improved group were significantly lower than those in the control group. From the dimension within the group, the APACHE II score, SOFA score, heart rate and shock index were lower after treatment than before treatment in both the improved and control groups.

Conclusion: Restricted fluid resuscitation can effectively alleviate the condition of emergency sepsis patients, improve hemodynamics, reduce the incidence of ARDS, and prevent patient deaths. It is worthy of clinical application.

目的:探讨早期限制性液体复苏策略在急诊科脓毒症患者护理中的实践及效果评价。方法:选取2020年1 - 9月在我院急诊科就诊的脓毒症患者239例为研究对象,进行回顾性分析。根据液体复苏方法的不同分为改善组和对照组。改良组为限制性液体复苏112例;另外127例接受充分液体复苏的患者为对照组。观察两组患者ICU住院时间、呼吸机使用时间及28天死亡率。比较两组患者治疗前后血流动力学指标、急性生理与慢性健康评价(APACHE)ⅱ评分、序期器官衰竭评价(SOFA)评分及并发症发生情况。结果:治疗后,改良组患者APACHEⅱ评分和SOFA评分低于对照组,补液量减少,乳酸清除率提高,ICU住院时间缩短,呼吸机时间占ICU住院时间的比例降低。改善组急性呼吸窘迫综合征(ARDS)、cTn I、脑利钠肽发生率均显著低于对照组。从组内维度看,改善组和对照组治疗后APACHEⅱ评分、SOFA评分、心率和休克指数均低于治疗前。结论:限制性液体复苏可有效缓解急诊脓毒症患者病情,改善血流动力学,降低ARDS发生率,预防患者死亡。值得临床推广应用。
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引用次数: 0
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Jbi Evidence Implementation
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