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妇科恶性肿瘤患者化疗所致恶心呕吐非药物管理循证实践

Evidence-based practice of non-drug management of chemotherapy induced nausea and vomiting in patients with gynecological malignant tumors

摘要目的:将化疗所致恶心呕吐的非药物管理最佳证据用于临床实践,并评价实践效果。方法:检索国内外数据库,最终纳入14篇文献,包括3篇系统评价,3篇证据总结和8篇指南。依据JBI循证护理保健中心的基于证据的持续质量改进模式进行证据应用前后的审查,障碍因素、可利用资源及策略分析和证据应用的效果评价。2020年3—5月采用方便抽样法选取青岛大学附属医院52例妇科住院化疗患者及26名临床护士为研究对象进行基线审查。2020年6—8月选取我院42例妇科住院化疗患者26名临床护士(与之前相同)进行再审查。结果:完善了化疗所致恶心呕吐管理流程、护理常规、护理路径及化疗所致恶心呕吐风险评估及随访表,制作了基于循证的宣教视频。证据应用后护士各审查指标依从性提高,差异均有统计学意义( P<0.05)。护士妇科化疗所致恶心呕吐非药物管理循证知识问卷得分提高,差异有统计学意义( P<0.05);患者化疗所致急性恶心呕吐发生率下降,差异有统计学意义( P<0.05);患者化疗所致延迟性恶心呕吐的发生率下降,差异无统计学意义( P>0.05)。 结论:该循证实践项目的开展促进了相关流程、常规、路径等的完善,丰富了化疗所致恶心呕吐非药物止吐宣教形式和内容,规范了护士行为,提高了护士循证实践的依从性,降低了患者急性恶心呕吐的发生率。

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abstractsObjective:To apply the best evidence of non-drug management of chemotherapy induced nausea and vomiting (CINV) in clinical practice, and evaluate the effect of practice.Methods:After searching domestic and foreign databases, 14 articles were finally included, including 3 systematic reviews, 3 evidence summaries and 8 guidelines. According to the evidence-based continuous quality improvement model of Joanna Briggs Institute (JBI) Evidence-based Nursing and Health Care Center, we conducted the review before and after evidence application, obstacle factors, available resources and strategy analysis, and evaluation of the effect of evidence application. From March to May 2020, convenience sampling was used to select 52 inpatients with gynecological chemotherapy in the Affiliated Hospital of Qingdao University and 26 clinical nurses as subjects for baseline review. From June to August 2020, 42 inpatients with gynecological chemotherapy and 26 clinical nurses (same as before) were selected for re-review.Results:The management process, nursing routine, nursing path, and risk assessment and follow-up form for CINV were improved, and an evidence-based education video was produced. After application of the evidence, the compliance of nurses' review indicators improved, and the differences were statistically significant ( P<0.05) . The scores of nurses on the non-drug management evidence-based knowledge questionnaire for gynecological CINV increased, and the difference was statistically significant ( P<0.05) . The incidence of acute CINV decreased, and the difference was statistically significant ( P<0.05) . The incidence of delayed CINV decreased, and the difference was not statistically significant ( P> 0.05) . Conclusions:The development of the evidence-based practice project promotes the improvement of related processes, routines, and paths, enriches the forms and content of CINV non-drug antiemetic education, standardized nurses' behavior, improves nurses' compliance with evidence-based practice, and reduces the incidence of acute nausea and vomiting in patients.

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