Evidence review and analysis of barriers to post-extubation dysphagia rehabilitation interventions for tracheally intubated patients in ICU
Objective To understand the current state of evidence-based clinical application of rehabilitation interventions for post-extubation dysphagia in tracheally intubated patients in the intensive care unit(ICU),to analyze the barriers and facilitators of evidence-based practice using the 4M1E Factor Analysis of the Cause&Effect/Fishbone Diagram,and to explore change strategies to inform the clinical translation of evidence.Methods Using the evidence-based continuous quality improvement model as a theoretical guide,evidence was retrieved,evaluated and summarized,and review indicators were developed.A convenience sampling method was used to select 20 patients with post-extubation dysphagia and all 30 ICU healthcare workers as study subjects who met the inclusion and exclusion criteria in the ICU of a tertiary hospital in Lanzhou,Gansu Province,from June to July 2023.Barriers and facilitators were analyzed and change strategies were devel-oped based on the results of the baseline review.Results A total of 35 review indicators were developed.The results of the baseline review showed that only 8 had an implementation rate of more than 60%and 11 had rate of 0.Barriers mainly included a wide range of departments,large number of staff,and two difficulties,that is,the department's current training content did not yet include content related to post-extraction dyspha-gia,and the healthcare staff were faced with a high intensity of work.Facilitating factors included a strong learning atmosphere in the practice unit,and the availability of training equipment such as a demonstration room and an electronic projector in the practice unit.Strategies for change included the formation of a multi-disciplinary team and the development of a post-extraction dysphagia training program.Conclusion There is still a large gap between the evidence of postextubation dysphagia in patients with tracheal intubation in the ICU and that of clinical practice;scientific and comprehensive assessment of barriers and facilitators in prac-tice and development of appropriate strategies for change can effectively facilitate the translation of evidence into clinical practice.
国家科技期刊平台
NSTL
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