| Background:Patients after upper gastrointestinal surgery are at high risk of nutritional risk due to impaired intake,surgical trauma and stress/inflammatory response.Early enteral nutrition is very important for any postoperative patients with nutritional risk,particularly patients after upper gastrointestinal surgery.However,feeding intolerance is one of the most common problems during enteral feeding,which affects the recovery and prognosis of patients.Currently,abroad has developed several evidence-based guidelines to provide clear advice and guidance for the prevention and management of feeding intolerance.However,there is a gap between our clinical practice and the best evidence,so it is crucial to develop an evidence-based nursing program of feeding intolerance suitable for China’s clinical situation;and how to introduce the best evidence into clinical practice for application of feeding intolerance also needs to be explored.Objective:This study aimed at describing and analyzing the current practice status of feeding intolerance in patients after upper gastrointestinal surgery in China,systematically reviewing,evaluating and synthesizing relevant evidence related to prevention and management of feeding intolerance,evaluating the evidence-based practice process,exploring the level of knowledge,attitude and practice of nursing staff towards feeding intolerance,developing the evidence-based nursing program for prevention and management of enteral feeding intolerance in patients after upper gastrointestinal surgery,describing process of gradual introduction of the evidence into into enteral nutrition management in the pilot ward,and evaluating its feasibility and effectiveness.Methods:This study takes the updated JBI model of evidence-based healthcare in 2016 as the theoretical framework.Evidence on prevention and management of feeding intolerance was evaluated and integrated by a systematic review and a content analysis.A survey was conduct to explore the gap between clinical practice and the evidence,and select the appropriate evidence.And then the program of prevention and management of enteral feeding intolerance in patients after upper gastrointestinal surgery was formulated based on the best evidence.The evidence-based nursing program was applied into the clinical practice by education programs and evaluation of process.Then a before-after study was conduct to evaluate its feasibility and effectiveness.Results:(1)A total of 4 evidence-based clinical practice guideline,1 expert consensus,3evidence summaries and 2 systematic reviews were included.Finally,best evidence summary for prevention and management of enteral feeding intolerance in patients after upper gastrointestinal surgery with 22 items in 6 aspects including evaluation,nutrition formula,feeding protocol,drug use,prevention,and treatment was developed.(2)Based on the survey for applicability and feasibility of the evidence,8 items were eliminated(except for nurses’ authority,lack of relevant skills and resources).Expert Meeting Law was conduct to revise and improve the evidence-based practice program,and the final version of the prevention and management of enteral feeding intolerance program after upper gastrointestinal surgery was formulated.(3)Based on the results of the baseline survey,the evidence-based practice group discussed and analyzed the obstacles in evidence-based practice,including the organizational level(lack of assessment tools and standardized processes,and incomplete educational materials)and the nurse level(such as lack of related knowledge),the patient level(low willingness to cooperate).Implementation rates of 11 audit indicators were between 0～78.57%,and most of the evidence have not been fully applied in pilot ward.(4)After application of the program,the incidence of abdominal distension and diarrhea were significantly decreased(P<0.05);there was no difference in the incidence of abdominal pain,nausea and vomiting(P>0.05);no cases of aspiration found.The time to first passage of flatus and first defecation were significantly reduced(P<0.05).Nurses’ scores for knowledge,attitude and practice on prevention and management of feeding intolerance were significantly improved(P<0.05);Implementation rates of the 11 audit indicators were greater than 80%.Conclusion:(1)The level of knowledge,attitude and practice of nursing staff towards feeding intolerance need to be improved,and the practice of clinical nursing staff on prevention and management of feeding intolerance in patients after upper gastrointestinal surgery has shortcomings.(2)Based on the combination of best available evidence,specific situation and intention of stakeholders,the program for prevention and management of feeding intolerance in patients after upper gastrointestinal surgery was formulated.The program is effective and feasible to a certain extent in domestic clinical situations.(3)A before-after study was implemented to evaluate the effect of the program.The evidence-based practice project can regulate behaviors of nurses,promote the improvement of nurses’ knowledge level,reduce the incidence of feeding intolerance,and expand nurses’ evidence-based thinking. |
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