癫痫患儿服药依从性提升的循证护理审查指标制定及障碍因素分析
Evidence-based nursing audit indicators and analysis of barriers to improve medication compliance in children with epilepsy
王芳萍 1叶敬花 1田小琴 1王兴雅楠 1孙琳琳 1敖玲 1王耀叶 1王颖雯2
作者信息
- 1. 518038,广东深圳,深圳市儿童医院神经内科
- 2. 复旦大学附属儿科医院护理部
- 折叠
摘要
目的 开展癫痫患儿服药依从性提升的循证护理实践,根据最佳证据制定审查指标,分析障碍因素,为其临床应用提供参考.方法 检索癫痫患儿服药依从性提升的最佳证据并制定审查指标,采用便利抽样法,选取2023年11～12月深圳市儿童医院神经内科24名护士、19名医生,63例癫痫患儿作为研究对象在临床开展现状审查,采用"i-PARIHS框架下的证据应用障碍识别评估清单"对审查结果进行障碍因素分析,并制定相应的干预策略.结果 本研究共纳入14条最佳证据,制定13个审查指标,其中3条审查指标依从性超过90％,2条审查指标依从性为0％,8条审查指标依从性低于90％.障碍因素分析发现,变革层面存在证据转化不足、缺乏相关制度和流程、无开展同伴支持教育组织政策及闭环沟通不畅等问题;变革接受者层面,护士、癫痫患儿及家属缺乏必要的知识培训,高强度的临床工作压力引发了医疗人员的心理抵触,患儿及家属存在对癫痫疾病的羞耻感;组织环境层面,首次在科室开展循证实践,团队缺乏相关经验.结论 癫痫患儿服药依从性的最佳证据与临床实践存在较大的差距,应当融合临床专业的判断力与基线审查结果,深入探究障碍因素,并据此制定具体的行动方案,以促进证据的有效应用.
Abstract
Objective To carry out evidence-based nursing practice for improving medication compliance in children with epilepsy to develop audit indicators based on the best evidence,analyze barrier factors and provide the reference for their clinical application.Methods The best evidence for improving medication compliance in children with epilepsy was retrieved.Review audit indicators were developed.Convenience sampling was used to select 24 nurses,19 doctors,and 63 children with epi-lepsy from the department of neurology,Shenzhen Children's Hospital from November to December 2023 as the research subjects for clinical status review.The audit results were analyzed by"the obsta-cle identification and assessment list of evidence application under under i-PARIHS Framework"to ob-tain the obstacle factors and develop corresponding intervention strategies.Results This study includ-ed 14 best evidence items and developed 13 audit indicators,of which,3 audit indicators had a compli-ance rate of over 90％,2 review indicators with a compliance rate of 0％and 8 audit indicators with compliance rate of less than 90％.Obstacle factor analysis revealed that there were issues with insuffi-cient evidence conversion,lack of relevant systems and processes,absence of peer support education organization policies and poor closed-loop communication at the level of change.At the level of change recipients,the nurses,the children with epilepsy and their families did not have any training for neces-sary knowledge,and highly intensive clinical work pressure had caused psychological resistance among medical personnel.The children and their parents had a sense of shame towards epilepsy.At the or-ganizational environment level,the evidence-based practice was conducted for the first time in the de-partment,but the team lacked relevant experience.Conclusion There is a significant gap between the best evidence of medication compliance in children with epilepsy and clinical practice.It is necessary to integrate clinical professional judgment and baseline audit results,explore obstacles in depth and de-velop specific action plans based on this to promote the effective application of evidence.
关键词
癫痫/儿童/服药依从性/循证护理/最佳实践/障碍因素分析Key words
epilepsy/children/medication compliance/evidence-based nursing/best prac-tices/analysis of obstacle factors引用本文复制引用
基金项目
深圳市"医疗卫生三名工程"项目(SZSM202311028)
出版年
2024
NETL
NSTL
万方数据