| Objective1.Search for the evidences related to the bladder training based on the evidence concept for the patients with neurogenic bladder retention,which are evaluated and integrated to construct the strategy for bundles of care.2.The strategy for bundles of care is applied to the clinical so as to verify the application effect on patients with neurogenic bladder retention.Methods1.The specific problems were established based on the evidence nursing concept,and searched for the relevant literatures about the bladder function training of patients with neurogenic bladder retention from the top to bottom according to the"6S"retrieval model of evidence.The selected literatures were screened and collate,and the appropriate quality assessment tools were used to evaluate their scientificity and rigorism.The evidences were collected and summarized from the suitability,effectiveness and clinical significance of the included literatures to construct the strategy for bundles of care on patients with neurogenic bladder retention.2.The bundles of care are applied to the patients with neurogenic bladder retention and the application effect was evaluated by the method of quasi-experimental study.46patients with neurogenic bladder retention from July 2019 to December 2019 were enrolled as control group and other 48 patients from January 2020 to October 2020 were enrolled as the trial group.The patients in the control group are treated with strict aseptic downward indwelling catheterization technology,and the catheter was placed in the patient’s bladder with guiding the patients to clean the perineal every day,and the water intake was increased appropriately through drinking water and diet.The intervention lasted for four weeks,and the catheter was replaced once in the second week;The bundles of care were applied to the patients in the..trial group and the outcomes of the residual urine..volume,incidence of urinary tract..infection,self-urination volume and neurogenic bladder symptom score are evaluated for the implement effects.3.SPSS21.0 was used for data analysis.The measurement data were described by means±standard deviation(x±s)or median(upper and lower quartiles)according..to the normality of the..data,and the homogeneity of variance was analyzed.Independent sample t test method was used for inter group comparison,and paired t test method was used for intra group comparison.Data..transformation or the..nonparametric test method was adopted if the data not meet the requirements of normal distribution.The counting data and grade data were described through the pass rate,composition ratio or relative ratio and tested by X~2 test method or Wilcoxon test method.The test standardα=0.05and the difference was statistically significant with P<0.05.Result1.Seven articles were screened in this study including guidelines,1 evidence summary and 3 systematic reviews.The evidences were extracted from the relevant contents of these 7 articles and analyzed from the four aspects of feasibility,suitability,effectiveness and clinical significance by the experts invited.Finally,9 pieces of evidence were included covering three aspects of evaluation,management and health education.2.Comparison of general information between the experimental group and the control group:there was no significant difference in the general information which was comparable(P>0.05),including gender,age,diagnosis,education level,marital status,occupation,past medical history,average monthly income of family members,payment method of medical insurance and other general information.3.Comparison of residual urine volume between the experimental group and the control group:the residual urine volume of the experimental group before intervention was 334.56±55.34;the residual urine volume of the control group before intervention was 342.59±65.20,there was no statistical significance(P>0.05)which was comparable.After the intervention,the residual urine volume was significant difference(P<0.01)as the value of 130.40±46.57 in the experimental group and 181.24±59.56in the control group.4.Comparison of the incidence of urinary tract infection between the experimental group and the control group:the incidence of urinary tract infection in the experimental group was 12.5%and the incidence of urinary tract infection in the control group was39.1%.After the intervention,the incidence of urinary tract infection in the experimental group was significantly lower than that in the control group with the difference was statistically significant(P<0.05).5.Comparison of self-urination volume between the experimental group and the control group:the self-urination volume of the experimental group before intervention was 20(6.25,57.5)and the self-urination volume of the control group before intervention was40(10,60),which was comparable with no statistically significant(P>0.05).After the intervention,the self-urination volume of the experimental group was 208.96±60.43,and that of the control group was 124.78±67.09 which was with significant difference(P<0.01).6.Comparison of neurogenic bladder symptom scores between the experimental group and the control group:the total score of the experimental group before intervention was21.771±2.746 and the total score of the control group before intervention was 21.370±2.507,which was comparable with statistical significance(P>0.05).After the intervention,the total score of the experimental group was 20.063±2.530 and the total score of the control group was 23.587±2.926 which was with significant statistical significance.There was no significant difference in incontinence dimension between the two groups(P>0.05)and the scores of storage and emptying,consequence,quality of life and total score in the intervention group were lower than those in the control group,and the difference was statistically significant(P<0.05).Conclusion1.The bundles of care for the bladder function training of the patients with neurogenic bladder retention were built based on evidence-based nursing concept which was applied to the patients feasibly.2.The application of the bundle of care can reduce residual urine volume and urinary tract infection rate,improve self-urination,relieve neurogenic bladder symptoms,improve quality of life and promote bladder function in patients with neurogenic bladder urologic retention. |
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