| Objective:(1)To construct an evidence-based nursing program for nasal cavity irrigation after endoscopic sinus surgery in patients with chronic sinusitis.(2)Evaluate the effect of evidence-based nasal cavity irrigation nursing program on the recovery,comfort,quality of life and comprehensive efficacy of postoperative chronic sinusitis patients with nasal cavity mucosa,modify and improve the plan,in order to provide reference for clinical standard nasal cavity irrigation.Methods:The first part is to use qualitative interviews to understand the current status and existing problems of nasal cavity irrigation care for patients with chronic sinusitis after endoscopic sinus surgery.Selected 12 chronic sinusitis patients and 10 otolaryngologists after nasal endoscopy in an Otorhinolaryngology Head and Neck Surgery Department of a top three hospital in Shanxi Province.Through structured interviews,the current status and problems of nasal irrigation were clarified and provided a realistic basis for the project.The constructed evidence-based care plan for nasal cavity irrigation in patients with chronic sinusitis after endoscopic sinus surgery includes 7 aspects including preparation for nasal cavity irrigation,implementation process of nasal cavity irrigation,prevention of adverse reactions,treatment of irrigator,review,health education and follow-up.Recommended items,including 16 recommendations with A-level evidence and 9recommendations with B-level evidence.The third part uses randomized controlled trials to evaluate its application effects in clinical practice.From December 2019 to April 2020,66 patients with chronic sinusitis who were hospitalized in the Otorhinolaryngology Department of a Tertiary A hospital in Taiyuan City were selected and divided into the experimental group(n=33)and the control group(n =33).The experimental group adopted the constructed evidence-based nursing plan for postoperative nasal cavity irrigation care,while the control group adopted conventional methods for nursing care.The comfort visual analog scale VAS,nasal cavity and sinus outcome measures 20 SNOT-20,CT Lund-Mackay score method,nasal endoscopy Lund-Kennedy score method were selected as the evaluation tool,and the nasal cavity was washed before and after the second week.,4 weeks,12 weeks for effect evaluation,statistical analysis of the acquired data through t test,Χ 2 test and repeated measures analysis of variance,to verify the effectiveness of the evidence-based nursing program for nasal irrigation.Results:1.Through qualitative interviews,the true experience and needs of postoperative nasal irrigation in patients with chronic sinusitis are:(1)The needs of patients with insufficient information support cannot be met(2)The economic pressure of patients is high(3)The compliance of patients after discharge is low;Current nursing status and existing problems include:(1)Inadequate nasal irrigation,(2)Tight nursing human resources,(3)Imperfect continuous nursing.2.The constructed evidence-based care plan for nasal cavity irrigation in patients with chronic sinusitis after endoscopic sinus surgery includes 7 aspects including preparation for nasal cavity irrigation,nasal cavity irrigation implementation process,adverse reaction prevention,irrigator treatment,review,health education and follow-up25 Recommended items,including 16 recommendations with A-level evidence and 9recommendations with B-level evidence.3.The comparison between the two groups of study subjects’ comfort,quality of life,CT,and nasal endoscopy scores at different time points uses two independent sample t-tests.The scores obey a normal distribution and the variances are uniform.The results showed that there was no significant difference in comfort,quality of life,CT,and nasal endoscopy scores between the two groups before nasal irrigation(P>0.05);comfort,quality of life,CT,intranasal at various points after nasal irrigation The scores of the mirror were significantly reduced compared with those before washing,and the scores of the patients in the experimental group were significantly lower than the scores of the control group during the same period(P<0.05).4.The repeated measurement analysis of variance showed that the comfort(F=208.752,P<0.001),quality of life(F=471.036,P <0.001),CT(F=115.409,P<0.001)at different time points after nasal irrigation in patients with chronic sinusitis P<0.001),nasal endoscopy(F=343.043,P < 0.001)score difference is statistically significant(P<0.05),and the score shows a downward trend with time;in terms of the interaction between time and group,Comfort of the two groups of patients(F=8.856,P<0.001),quality of life(F=77.93,P<0.001),CT(F=6.16,P<0.001),nasal endoscopy(F=32.201,P<0.001)The scores are all statistically significant(P<0.05),indicating that the two groups of patients have different trends in comfort,quality of life,CT,and nasal endoscopy scores over time.The test group’s scores after the intervention have fallen more than the control group;for each time point Comfort of the two groups of patients(F=7.245,P<0.05),quality of life(F=105.943,P<0.001),CT(F=4.754,P<0.05),nasal endoscopy(F=7.035,P < 0.05)The scores were compared,and the differences were statistically significant(P<0.05).5.Comparison of the comprehensive efficacy of the two groups after 12 weeks of intervention: There was no statistically significant difference between the two groups in the treatment effect(P>0.05),but after 12 weeks of intervention,the total effective rate of the experimental group was 90.91%;the total effective rate of the control group It was75.76%,which was 15.15% higher in the experimental group than in the control group.Conclusion:1.The nasal cavity irrigation is not standardized,and it is necessary to construct an evidence-based nasal cavity irrigation care plan.2.This study is based on evidence-based,combining professional clinical experience,best research evidence,patient wishes and specific clinical conditions to construct a scientific and feasible nasal cavity irrigation care plan that is easy for patients to accept,providing a reference for the norms of clinical nursing practice.3.Evidence-based nasal cavity irrigation care plan can improve the comfort experience of patients with chronic sinusitis,improve the quality of life of patients,promote the recovery of nasal mucosal function,and improve the comprehensive treatment effect. |
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