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儿童鼻胃管末端位置判断的循证实践

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目的:将儿童鼻胃管末端位置判断的证据应用于临床实践并评价其应用效果,为规范儿科护士鼻胃管末端位置判断方法,提升导管专科护理质量提供参考.方法:遵循复旦大学循证护理中心的证据转化模式,总结儿童鼻胃管末端位置判断的相关证据,制定相应的临床审查指标、分析实施过程中的障碍因素与促进因素,构建并实施证据应用策略,比较证据应用前后鼻胃管末端位置判断准确率、鼻胃管脱管发生率,以及护士对审查指标的执行率和鼻胃管相关操作及位置判断知识的知晓率.结果:共制定了5 条审查指标,循证实践后护士对审查指标的执行率和鼻胃管末端位置判断及相关操作知识的知晓率提高,差异有统计学意义(P<0.001).鼻胃管末端位置判断准确率从54.5%提高至 97.1%,鼻胃管脱管发生率从 24.2%降低至 2.9%,差异均具有统计学意义(P<0.05).结论:儿童鼻胃管末端位置判断循证实践的实施为临床决策提供了参考,提高了护理人员循证知识水平和证据应用依从性,有效提高了患儿鼻胃管末端位置判断精准率,降低了患儿鼻胃管脱管发生率,促进了儿科专科护理质量的提高.
Evidence-based practice of assessing the location of nasogastric tubes for children
Objective:To apply the evidence of assessing the location of nasogastric tube end for children to clinical practice and evaluate its application effects,so as to provide a reference for standardizing the assessment of nasogastric tube end position of pediatric nurses and improving the quality of specialized catheter nursing.Methods:According to the evidence transformation model issued by the evidence-based nursing center of Fudan University,we summarized the evidence regarding nasogastric tube end position assessment for children to formulate the corresponding clinical indexes for assessment.After analysis of obstacle factors in the process of implementation,we figured out proper strategies to implement the evidences.Then we compared the accuracy of nasogastric tube end position assessment,the incidence of nasogastric tube detachment,the implementation rate of each index and nurses'knowledge of nasogastric tube related operation and position assessment before and after the application of evidence.Results:Five indicators were established in this study.Nurses'compliance to apply the evidence was improved as well as their knowledge of nasogastric tube insertion with the differences being statistically significant(P<0.001).The accuracy rate of nasogastric tube end position assessment for children increased from 81.81%to 97.1%and the incidence of nasogastric tube detachment reduced from 24.2%to 2.9%with statistically significant differences(P<0.05).Conclusion:Applying the evidence of assessing the location of nasogastric tube end for children not only provides reference for clinical decision making,but also improves the evidence-based nursing knowledge and adherence to evidence for nurses to effectively increase the accuracy rate to locate nasogastric tubes for children,reduce the incidence of accidental nasogastric tube detachment,which can promote the quality of pediatric nursing.

childrennasogastric tubenasal feedinggastric tube positionevidence-based practice

方继红、朱晶、王利敏、张美英、武凤芹、朱秀秀

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安徽省儿童医院护理部,230051,合肥市

安徽医科大学护理学院

安徽省儿童医院重症医学科,230051,合肥市

安徽省儿童医院儿童骨科,230051,合肥市

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儿童 鼻胃管 鼻饲 位置 循证实践

2023年度安徽省卫生健康科研项目安徽省高等学校科学研究项目

AHWJ2023A203712022AH040091

2024

中国护理管理
卫生部医院管理研究所

中国护理管理

CSTPCD北大核心
影响因子:2.545
ISSN:1672-1756
年,卷(期):2024.24(8)