| Objective1.Based on the previous research results of the research group,focusing on the oral health problems of patients in geriatric medical care institutions,establishing an evidence-based "Oral Care Program for Elderly Patients in Geriatric Medical Nursing Institutions".2.Introduce the "Oral Care Program for Elderly Patients in Geriatric Medical Nursing Institutions" into the geriatric medical nursing institutions for transformation and application research,and explore the effect of the program application.Methods1.Based on the methods of evidence-based nursing,established problems according to PIPOST model,then we systematically retrieved literature on oral care of elderly patients in geriatric medical care facilities from relevant databases and official websites at home and abroad,and conduct literature quality evaluation and evidence summary,and unify the evidence grading and recommendation strength according to the JBI evidence-based center evidence recommendation level system.2.Conduct expert consultation through email to evaluate the FAME attributes of evidence,and propose modification suggestions.Develop quality review indicators based on the ultimately included evidence,and clarify the data and tools collected for each indicator.3.Conduct a status review in a pilot institution according to the recommended items in the program,clarify the gap between the current status of oral care practice for elderly patients and the best evidence,and formulate action strategies from this point of view,ultimately formulate the "Oral Care Plan for Elderly Patients in Geriatric Medical Care Facilities".4.Using convenience sampling method,from January 2023 to February 2023,the"Oral Care Program for Elderly Patients in Geriatric Medical Nursing Institutions"was introduced into institutions for transformation and application for one month,and to evaluate and analyze the intervention effectiveness at the level of nursing staff and elderly patients.At the nursing staff level,the effects were evaluated by using the self-efficacy for providing mouth care and the attitudes for providing mouth care for providing oral care.At the level of elderly patients,the oral health assessment tool OHAT was used for effectiveness evaluation.Results1.Best Evidence Summary for Oral Care of Elderly Patients in Geriatric Medical Care FacilitiesThis study uses "elderly patients","oral care",and related search terms to systematically search for literature on oral care for elderly medical and nursing institutions in relevant databases and official websites at home and abroad.Finally,4 guidelines,4 systematic evaluations,1 expert consensus,and 6 evidence summaries were included.Quality evaluations were conducted to form the best evidence summary covering 28 evidence items at the institutional,nurse,and patient levels.2.Evaluation of FAME attribute of evidenceBy using the expert consultation method to evaluate and modify the FAME attributes of entries,this study selected experts from research fields such as elderly care,nursing management,clinical nursing,oral care,and evidence-based nursing to demonstrate the evidence.The authority coefficient of 5 experts is 0.91,indicating high reliability.A total of 11 suggestions were proposed,including deleting 1 suggestion,modifying 9 suggestions,and adding 1 suggestion.Integrate the suggestions provided by experts with the opinions of the research group,and improve the items that need to be modified to better align with the implementation status of oral care for patients in elderly medical care institutions.On this basis,19 pieces of evidence covering 5 themes including admission assessment,education and training,planning,implementation of nursing,and preventive measures were integrated and formed.Based on the best available evidence,the members of the research group have developed a total of 41 quality review indicators and clarified the collection methods and tools for each indicator,which can be comprehensively reviewed and provide reference for change.3.Review the current situation to determine the obstacle factors and make the final oral care programAfter reviewing the current situation,the implementation rate of indicators 2,10,15,17,19,21,22,and 41 is low.A total of 8 obstacle factors have been summarized,including 3 at the system level and 5 at the nursing staff and patient level.By reviewing literature and guidelines,analyzing obstacle factors,and based on this,formulating action strategies,a total of 27 items of "Oral Care Plan for Patients in Elderly Medical Nursing Institutions" covering 5 themes including admission assessment,education and training,planning,implementation of nursing,and preventive measures were ultimately formulated.4.Implementation and effect evaluation of evidence-based practice program were conductedBy conducting qualitative interviews with nursing staff in geriatric care facilities where the protocol was transformed,A total of three themes were summarized:the implementation of oral nursing program improved the nursing staffs emphasis on the assessment of the elderly’s oral condition,the standardized training in the program strengthened the nursing staff’s grasp of oral knowledge and oral nursing operation process,and the implementation of oral nursing program improved the satisfaction of patients and their families.The effects of intervention using SE-PMC and A-PMC were evaluated in the quasi-experimental study.Before intervention(baseline)and after intervention(1 month),the total scores of SE-PMC and A-PMC showed an increasing trend,and the scores and total scores of each dimension were higher than before intervention,and the difference was statistically significant(P<0.001).For elderly patients,the oral health assessment tool OHAT was used to evaluate the effect of intervention.The total score of OHAT showed a decreasing trend before intervention(baseline)and after intervention(1 month).The proportion of "healthy mouth(0～3 points)" increased from 15.09%to 42.09%,"moderate mouth(4～8 points)" decreased from 69.10%to 45.01%,and "unhealthy mouth(9～16 points)"decreased from 15.82%to 12.90%.Conclusions1.The oral care program for elderly patients in geriatric medical nursing institutions is based on the best evidence summary,combined with actual situations and expert evaluation.The process is scientific,rigorous,and standardized,which can provide evidence-based reference for nursing practice.2.The oral care program for elderly patients in geriatric medical nursing institutions can prevent or improve the oral health status of patients,improve oral health-related quality of life,and is beneficial to the prognosis of elderly patients.3.This program can improve the self-efficacy and attitude of nursing staff in providing oral care for elderly patients,and promote the continuous improvement of service quality in geriatric medical care facilities. |
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