A Cross-sectional Study About Analysis And Exploration On The Evidence Quality And Clinical Application Of TCM Nursing Program For Stroke Acute Phase And Recovery Phase

Objiective and SignificanceThe main objective of this study is to explore and analyze the evidence quality and clinical application of TCM Nursing Program for Stroke Acute Phase and Recovery Phase(Abbreviation is The Program)which were published by SATCM of China.It is hoped that this study can provide scientific reference for the revision and optimization of TCM Nursing Program analysis,and promote the formation of evidence-based TCM nursing practice guidelines.MethodsThe study is a cross-sectional study and the research adopts different methods:The literature analysis is used to analyze the evidence of The Program.And the clinical investigation and interview is used to explore the clinical application of The Program1.The analysis on the evidence:①In order to make a comprehensive analysis of the Common Symptoms and TCM Nursing Technology which list in The Program.Quantitative analysis is conducted on the literature of traditional Chinese medicine nursing of cerebral infarction.The frequency of the keywords on Symptom and TCM nursing technology in the literature is measured and compared with the content of The Program.② The literature quality evaluation and the content analysis is used to carry on the scientific analysis to the Common Symptom and the TCM Nursing Technology which listed in The Program.The search strategy is set with the content of The Program.And the quality of the including literatures are evaluated by JBI Critical Appraisal Tool 2.The exploration on the clinical application:The2.investigation and interview is conducted in 2 grade 3 and first-class hospital of traditional Chinese medicine in Beijing.① The investigation use the self-designed questionnaire "the quality and clinical application of TCM nursing program for advantage——stroke questionnaire",Before the investigation we have invited 7 experts to evaluate the Content validity index(C VI)of the self-designed questionnaire.The results are analyzed by SPSS 20 software.②The interview adopt purposive sampling to select nurses who are related to The Program and the interview outline is set based on PARIHS framework.The collected data analysis refer to the Colaizzi and category analysis method.And the classification and integration of all codes refer to the core elements and the specificonnotation of the PARIHS framework.Results1.The analysis on the evidence:① The results of the classification statistics show that 20 kinds of keywords of "symptoms".There are 8 kinds of Symptoms listed in The program,which are the same as the keyword analysis.There are only 1 kind of symptom called"Excessive phlegm and tachypnea" which listed in The Program but not in the keywords analysis.There are 12 kinds of symptoms in the keywords analysis but not in The Program and the top five is:Mood disorders,neurological disorders,cognitive dysfunction,pressure sores and false bulbar paralysis.The results of the classification statistics show that 24 kinds of keywords of "TCM nursing technology".There are 14 kinds of TCM nursing technologies listed in The program,which are the same as the keyword analysis.There are only 1 kind of TCM nursing technology called "Acupoint tapping" which listed in The program but not in the keywords analysis.There are 10 kinds of TCM nursing technologies in the keywords analysis but not in The Program and the top five is:Exercise therapy,massage,cerebral circulation therapeutic apparatus,acupoint injection and drug-osmos introduction with intermediate frequency.②There are 26 PICOs refer to The program.The literature search results show that there are 5 PICOs without find any literature which is "ConsciousnessPillow","Excessive phlegm and tachypnea-acupoint stiking therapy","High temperaturemassage","Hemiplegia-acupoint tapping " and "urinary and fecal incontinence-Chinese medicine plaster ".The other 21 PICOs is totally including 252 literature,among which including 149 randomized control trial,63 case series,17 quasi-experiment,12 case report and 11 expert experience.The comparison between the literature analysis results and the content of The program show that there are literature evidences to support the Common Symptoms and TCM Nursing Technology which listed in The Program.But there are differences between the results of literature analysis results and the content of the program,specifically in stroke staging for symptoms and TCM nursing technology,as well as the operation details,safety index and efficacy evaluatio n of TCM nursing technology.2.The exploration on the clinical application:①The I-CVIs of the questionnaire is all above 0.86,and the S-CVI/Ave is 0.94.The results of the questionnaire showed that the quality of The Program is fairly low.The overall quality of The Program show that there are 59.18%people think The Program better than the original standards of care.And there are only less than half respondents think The program better than "Specialist Nursing Guideline”(48.98%),"experience of the specialist"(48.98%)and "latest clinical scientific research"(46.94%).The quality of each part of The Program show that the lowest recognition is"Common symptom"(36.70%)and "Classification of syndromes"(36.70%):The clinical application of The Program is good,although the scores low in match with clinical work patterns,and there are less than half respondents think The program match the clinical situation(44.90%)and the clinical work mode(44.90%).And there are only less half respondents accept the clinical efficiency(44.90%)and clinical simplicity(40.82%)of The Program.②We interviewed 20 nurses and translated all content of the interview into text data.A total of 107 codes were obtained after unified coding.The results show that there are 11 thematic categories were organized under 3 major themes.To be specific,the first major theme is "On the content of The Program" including 4 thematic categories:lack of evidence sources description,different from the experience of nursing,not focus on the patient preference and not match the clinical work situation.The second major theme is "On the implementation of The Program" including 2 thematic categories:the implementation type is task-based method and the process of the imple mentation is rigid and out of the clinical situation.The third major theme is "On the application of the The program" including 5 thematic categories:improve the ability of TCM nursing and enhance the cultural atmosphere of TCM,Stimulate the enthusiasm of clinical application and research of TCM nursing,Promote exchanges and cooperation between doctors and nurses,Lack of feasible clinical control mode and Unreasonable effect evaluation method.Refer to PARIHS framework,the core element of evidence is low,context is medium and facilitation is low.ConclusionThere is a certain amount of evidence of TCM nursing research in cerebral infarction which related to The program.And there some literature evidence to support most of the Common Symptoms and TCM Nursing Technology which list in The Program.Although the quantity and quality of the literature evidence is low,it can be used as a reference for revising the content of The Program.Implementation and application of The Program is still in the exploratory stage and nurses call for the introduction of more flexible and efficient way to promote the application and implementation of The Program.In summary,we can optimize The Program with evidence-based thinking.Specifically,improve the contents of The Program based on the literature evidence as well as adjust the implementation and application of The Program refer to the evidence-based practice mode.