The Evidence-based Research On The Construction Of Home Care Practice Plan For Stroke Patients

Objective:1.This study summarizes the relevant evidence of home care evaluation,management and intervention for stroke patients,and provides an evidence-based basis for the development of a home care management plan.2.This study provides a comprehensive guidance program for clinical nursing follow-up by building a scientific home care practice plan for stroke patients.3.We introduce the plan into clinical practice,evaluating the significance and feasibility of the plan,and identify the obstacles and promoting factors for implementation.Methods:1.This study retrieved domestic and international databases according to the 6S evidence model,and the system was used to evaluate the guidelines by using AGREE II.We used the Australian JBI evidence-based health care center expert consensus evaluation standard(2017)to evaluate the expert consensus.The rest of the literature were evaluated according to the original literature type,and the literature content was summarized to form the best evidence.2.We prepared the first draft of home care practices for patients with stroke according to the best evidence.After two rounds of Delphi expert consultation,the first draft was modified,and finally we constructed an evidence-based home care practice plan for stroke patients.3.We evaluated the clinical significance and operability of the implementation of the plan through clinical investigation,and identified the obstacles and promoting factors of the implementation of the plan through semi-structured interviews.Results:1.The evidence summary of family management of stroke patients: a total of 10 pieces of literature were included,including 7 guidelines and 3 experts consensus.A total of 50 recommendations were summarized,including organization management,nursing objectives,evaluation timing,evaluation methods,patient evaluation,patient management,social support system,stroke remote service and health education.2.Construction of home care practice plan for stroke patients: we summarized the recommended opinions to form the first draft of the home care practice plan for stroke patients.In the first round of expert consultation,except for the "1.4,5.5,5.6,5.7,6.4" coefficient of variation more than 0.25,others were lower than that.According to the expert opinion,the contents of the items were modified,and the coefficient of variation in the second round was less than 0.25.In the first round of expert consultation,Kendall’s w coefficients of the first level items and the second level items were 0.326 and 0.442,respectively(P < 0.001).After the items were modified and deleted,Kendall’s w coefficients of the first level items and the second level items in the second round of expert consultation were 0.422 and 0.456,respectively(P < 0.001).3.Evaluation of the clinical applicability of the plan: through the clinical investigation of 14 nurses who were most relevant to stroke practice,the results showed that the scores of clinical significance and feasibility of the program items were more than 75%;The interviewees thought that the obstacles to the implementation of the plan included the limited level of professional practice,the limitation of support equipment and the patient factors,et al,and the promoting factors were the cohesion and supervision within the system.Conclusion:1.Based on evidence and Delphi expert consultation,this study constructs the home care practice plan for stroke patients,and forms the evaluation list and practice flow chart on this basis,which defines the evaluation object,time,family management and other contents.The plan is comprehensive and scientific.2.The clinical significance and operability of the plan are strong,but there is a gap between some items and clinical practice.We suggest that the interaction between objective environment and social dynamic factors should be fully considered in the application process.