| Objective:To screen the evidence related to the prevention and management of postoperative pulmonary complications in patients undergoing elective craniotomy,and summarize the best evidence to form an evidence-based nursing scheme;The feasibility and effectiveness of the evidence-based nursing scheme were evaluated through empirical research.Methods:This study was conducted in the following three steps:literature retrieval,evidence synthesis and evidence application.(1)Literature search:Chinese and English searches were conducted with the keywords"craniotomy,pulmonary complications,pneumonia,atelectasis,clinical guidelines,clinical decisions,expert consensus,systematic evaluation,meta" et al.We searched the National Institute for Clinical Excellence(NICE)guide database,Uptodate,Cochranelibrary,JBI evidence-based health care international cooperation center library,Chinese Medical Association Guide database,PubMed,Web of science,Yimaitong,VIP,CNKI,Wanfang,and Sinomed for relevant evidence published from the establishment of the database to may 2021.The literature types are guidelines,expert consensus,clinical decision-making,and systematic evaluation.(2)Evidence synthesis:AGREEⅡ evaluation standard,JBI expert consensus document quality(2017)evaluation standard,evidence summary evaluation standard and AMSTAR2 evaluation standard were used to evaluate the document quality.High quality literature was included to systematically summarize the best evidence for PPCs prevention and management in patients undergoing elective craniotomy.Understand the gap between evidence and clinical practice through investigation,refine the barriers and facilitators factors in clinical practice,and formulate action strategies.The team members construct the first draft of evidence-based nursing scheme according to the actual situation of neurosurgery.The scheme was revised and improved through two rounds of expert correspondence,then the"evidence-based nursing practice scheme for the prevention and management of perioperative pulmonary complications in patients undergoing elective craniocerebral surgery" was formed.(3)Evidence application:The patients who underwent elective craniotomy in the neurosurgery department of a third-class hospital in Anhui Province were enrolled according to the inclusion criteria.Patients who meet the inclusion criteria will be naturally admitted to two independent wards of neurosurgery.The experimental group received the evidence-based nursing scheme,The control group received the traditional nursing scheme.The observation group used the evidence-based nursing practice scheme for the prevention and management of postoperative pulmonary complications to carry out nursing intervention for the patients.The two researchers independently collected the preoperative,intraoperative and postoperative data of the patients’ cases and independently entered them into the excel table,After verification,SPSS23.0 statistical software was used to analyze the relevant data,and the differences between the two groups in the incidence of pulmonary complications,length of stay,satisfaction of patients and their caregivers were compared(P<0.05).Results:(1)Literature search and evidence synthesis results:25 literatures were finally included,including 4 guidelines,9 expert consensus,9 systematic evaluations,and 3 clinical decision-making.The evaluation results showed that the scores of 2 guidelines in each field were more than 60%,the scores of the remaining 2 guidelines in 5 fields were more than 60%,and that of 1 field was more than 30%.In the expert consensus,the quality evaluation of 5 expert consensus documents is yes,and 3 of them are not clear in Item 6.Clinical decision 3 clinical decision items 5 were all "No".One article was evaluated as "partially yes" in Item 9,and one article was evaluated as "partially yes" in Item 7.Other options are evaluated as "yes".In the systematic evaluation,all items of 9 systematic evaluation documents were "yes".After strict literature quality evaluation,the evidence level and recommendation level are given.Construct 17 aspects and 28 pieces of evidence.By two rounds of expert consultation,the scheme was simplified,revised and improved.Finally,10 aspects and 28 items of evidence-based nursing plan for prevention and management of postoperative pulmonary complications in elective craniocerebral surgery were formed.(2)Application of evidence:A total of 500 patients were included in this study.The overall effective data was 490 Cases,and the overall effective rate was 98.00%.The effective data of the observation group were 247 cases,and the effective rate was 98.80%.The effective data of the control group were 243 cases,and the effective rate was 97.20%.Among 490 patients,143 patients developed PPCs,with an incidence of 29.18%,including 121 cases of pneumonia,11 cases of atelectasis,5 cases of respiratory failure and 6 cases of ARDS.There was no significant difference in baseline data between the two groups(P>0.05).The incidence of postoperative pulmonary complications in the two groups after intervention(χ2=7.835,P=0.005),Length of hospitalization(t=-2.12,P=0.030),patient satisfaction(t=3.17,P<0.001),caregiver satisfaction(t=4.24,P<0.001).After the application of the evidence-based practice program,the implementation rate of all the review indicators has significantly improved.Except for the implementation rate of review indicator 11,which is 87.04%,the implementation rate of other review indicators is more than 90%.Conclusion:Based on the JBI evidence-based health care model,this study constructed the evidence-based nursing scheme for the prevention and management of postoperative pulmonary complications in patients undergoing elective craniotomy,and applied it to the clinic.The results show that this evidence-based nursing scheme can effectively reduce the incidence of PPCs,shorten the hospitalization time,and improve patient satisfaction.In the implementation process,the overall implementation rate of nurses’ evidence-based nursing measures was better.To provide reference and evidence-based basis for the prevention and management of postoperative pulmonary complications in patients undergoing elective craniotomy. |
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