直肠癌患者化疗相关性腹泻的循证实践研究
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摘要
目的将化疗相关性腹泻(chemotherapy induced diarrhea,CID)循证证据应用于直肠癌化疗患者的临床护理中,开展循证护理实践,促进临床护理质量持续改进。方法检索数据库获取CID的最新、最佳证据,组建证据应用团队,制订审查指标及审查方法。开展基线审查,分析障碍因素,制订证据应用策略,并将其应用于临床。在证据应用后再次进行审查,主要评价各审查指标的执行率、护士与患者对CID相关知识的掌握情况及患者CID的发生情况。结果在系统层面,构建了多学科合作方式,完善了CID的管理流程,促进了最新、最佳证据的临床应用,编制了基于证据的健康教育手册,对科室内相关人员进行了培训。在护士层面,护士CID相关知识问卷的回答正确率由53.64%提升到92.70%,6条审查指标的执行率分别提升至87.88%、89.65%、64.28%、78.57%、100.00%、100.00%。在患者层面,患者CID相关知识问卷的回答正确率由53.06%提升至81.28%,腹泻发生率由43.90%下降至42.42%。结论 CID循证实践提升了护士和患者CID的相关知识,规范了临床护理人员处理CID的流程,完善了医院相关管理制度,对提升护士的循证实践意识、护理质量等有较好的意义。
Objective To apply the evidence-based practice of chemotherapy induced diarrhea(CID) in the patients with rectal cancer, carry out evidence-based nursing, and promote the continuous improvement of nursing quality. Methods The latest high-quality evidences were retrieved from databases. The application team was built up to develop the review indicators and review methods. Baseline review was conducted to analyze the application barriers and available resources, and the evidences were introduced into clinic. Re-review was carried out to evaluate the implementation rate, CID-related knowledge of patients and nurses, and incidence of CID. Results The evidence-based practice of CID could be used to develop a multi-disciplinary cooperation method, improve management process of CID, promote the application of the latest best evidences, compile the manuals of evidence-based health education, and train the relevant staff. Regarding the nurses, the correct rate of questionnaire increased from 53.64% to 92.70%. The implementation rates of six review indicators increased to 87.88%, 89.65%, 64.28%, 78.57%, 100.00%,100.00%, respectively. Regarding the patients, the correct rate of questionnaire increased from 53.06% to81.28%. The incidence of diarrhea decreased from 43.90% to 42.42%. Conclusion The evidence-based practice of CID can significantly improve the related CID knowledge of patients and nurses, standardize the management process of CID, and improve relevant hospital management system.
Objective To apply the evidence-based practice of chemotherapy induced diarrhea(CID) in the patients with rectal cancer, carry out evidence-based nursing, and promote the continuous improvement of nursing quality. Methods The latest high-quality evidences were retrieved from databases. The application team was built up to develop the review indicators and review methods. Baseline review was conducted to analyze the application barriers and available resources, and the evidences were introduced into clinic. Re-review was carried out to evaluate the implementation rate, CID-related knowledge of patients and nurses, and incidence of CID. Results The evidence-based practice of CID could be used to develop a multi-disciplinary cooperation method, improve management process of CID, promote the application of the latest best evidences, compile the manuals of evidence-based health education, and train the relevant staff. Regarding the nurses, the correct rate of questionnaire increased from 53.64% to 92.70%. The implementation rates of six review indicators increased to 87.88%, 89.65%, 64.28%, 78.57%, 100.00%,100.00%, respectively. Regarding the patients, the correct rate of questionnaire increased from 53.06% to81.28%. The incidence of diarrhea decreased from 43.90% to 42.42%. Conclusion The evidence-based practice of CID can significantly improve the related CID knowledge of patients and nurses, standardize the management process of CID, and improve relevant hospital management system.
引文
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[2] BENSON A B, AJANI J A, CATALANO R B, et al. Recommended guidelines for the treatment of cancer treatment-induced diarrhea[J]. J Clin Oncol, 2004,22(14):2918-2926.
[3] STEIN A, VOIGT W, JORDAN K. Chemotherapy-induced diarrhea:pathophysiology,frequency and guideline-based management[J]. Ther Adv Med Oncol, 2010,2(1):51-63.
[4] RICHARDSON G, DOBISH R. Chemotherapy induced diarrhea[J]. J Oncol Pharm Pract,2007,13(4):181-198.
[5]胡雁.循证护理学[M].北京:人民卫生出版社, 2012.
[6] ANDREYEV J, ROSS P, DONNELLAN C, et al. Guidance on the management of diarrhoea during cancer chemotherapy[J]. Lancet Oncol, 2014, 15(10):e447-e460.
[7] RAHMAN M. Chemotherapy:Diarrhea Management. Recommend Practices[EB/OL].The Joanna Briggs Institute EBP Database. JBI 2061.(2014-08-05)[2016-04-09].http://ovidsp.tx.ovid.com/sp-3.19.0a/ovidweb.cgi.
[8] RAHMAN M. Chemotherapy:Diarrhea Management. Evidence Summary[EB/OL].The Joanna Briggs Institute EBP Database.JBI 965.(2014-08-05)[2016-04-09].http://ovidsp.tx.ovid.com/sp-3.19.0a/ovidweb.cgi.
[9] The Joanna Briggs Institute Levels of Evidence and Grades of Recommendation Working Party. Supporting Document For Joanna Briggs Institute Levels of Evidence and Grades of Recommendation[J]. The Joanna BriggsInstitute.2014. http://jonnabriggs,org/jbi-approach.jtml#tabbed-nav=Levels-of-Evidence.
[10] US Department of Health and Human Services. Common terminology criteria for adverse events(CTCAE)version 4.0. http://evs.nci.nih.gov/ftp1/CTCAE/CTCAE_4.03_2010-06-14_QuickReference_5x7.pdf.
[11] Care Guide:Chemotherapy-Induced Diarrhea(CID)[EB/OL].Chemotherapy Induced Diarrhea, Care Guide Update-FINAL12/2010. http://www.doc88.com/p-6601591104272.html.
[12] BAKER R, CAMOSSO-STEFINOVIC J, GILLIES C, et al. Tailored interventions to address determinants of practice[J/OL].Cochrane Database Syst Rev, 2015,(4):CD005470[2015-04-29].https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD005470.pub3/full.
[13] LUCYLYNN L. Evidence Implementation Strategy:Audit and Feedback[EB/OL].The Joanna Briggs Institute EBP Database.JBI14577(2016-01-19)[2017-04-22]. http://ovidsp.tx.ovid.com/sp-3.24.1b/ovidweb.cgi.