| ObjectivesIn this study,by reviewing medical records,literature and Delphi expert correspondence,the perioperative TCM clinical nursing pathway program of modified radical mastectomy based on the concept of rapid rehabilitation surgery was constructed,in order to provide reference for better applying the concept of rapid rehabilitation surgery to perioperative nursing of breast cancer,accelerating postoperative rehabilitation of patients,standardizing nursing process and promoting the improvement of nursing service quality.Methods1.Review of medical records of patients undergoing modified radical mastectomy: The medical records of patients who underwent modified radical mastectomy in the Department of Breast and Thyroid Surgery of Shandong Hospital of Traditional Chinese Medicine from January 2020 to June 2021 were retrospectively analyzed.Effective medical orders were extracted based on the "Pareto rule"(28 principle),which were used as the general nursing items of traditional Chinese medicine CNP in the perioperative period of modified radical mastectomy.2.Summary of the best evidence for ERAS care in patients undergoing modified radical mastectomy: To put forward evidence-based questions and systematically search all evidence related to perioperative ERAS nursing measures in relevant databases and professional websites at home and abroad,including expert consensus,clinical guidelines,evidence summary,systematic review or meta-analysis and original studies,etc.,from the database establishment to December 31,2022.After rigorous quality evaluation of literature,evidence extraction and evidence classification,the best evidence is summarized.ERAS nursing project of traditional Chinese medicine CNP during perioperative period of modified radical mastectomy for breast cancer.3.Delphi expert consultation: Based on the review of previous medical records and the summary of the best evidence,the preliminary draft of CNP scheme for perioperative rapid rehabilitation of traditional Chinese medicine in modified radical mastectomy was preliminarily formulated and the expert letter questionnaire was prepared after discussion by the research team.16 experts were selected for two rounds of expert letter consultation.The path contents were screened according to the rationality of the letter consultation items,and the reliability and authority of the letter consultation experts were tested.The results of the letter consultation were analyzed and discussed,and the scheme was modified and improved according to the results of the letter consultation,and the final draft of the scheme was formed.Results1.Retrospective analysis of medical records: Medical records of patients who underwent modified radical mastectomy in the Department of Breast and Thyroid Surgery of Shandong Hospital of Traditional Chinese Medicine from January 2020 to June 2021 were retrospectively analyzed.105 medical records that met the nadation standard were selected,and half(i.e.53)medical records were selected for analysis by random number table method.The average length of hospital stay was 16.43±2.74.The length of hospital stay before operation was 3.74±2.04;The average hospitalization cost was 40606.91±8421.80;There were 56 medical order treatment and nursing items commonly used,and 4 non-medical order treatment and nursing items.The content of TCM CNP text is preliminatively determined,with time as the horizontal axis and diagnosis,treatment and nursing items as the vertical axis.On the day of admission,the second day of admission-1 day before surgery,the day after surgery,the first day after surgery,the second to third days after surgery,the fourth to seventh days after surgery,the eighth day after surgery to the day of discharge,7 different stages of TCM CNP scheme.2.Summary of the best evidence: According to the formulated search strategy,the system searched domestic and foreign databases and professional websites,and a total of798 relevant literatures were obtained through preliminary search.After literature screening,a total of 9 literatures were finally included,including 1 clinical guideline,3 expert consensus,3 systematic review and 2 evidence summary.After evidence extraction and integration,the best evidence of perioperative ERAS nursing measures in 24 aspects and 48 items was finally formed in three dimensions of preoperative,intraoperative and postoperative modified radical mastectomy.3.Delphi expert consultation: After two rounds of Delphi expert correspondence consultation,the final draft of CNP program of traditional Chinese medicine for modified radical mastectomy in perioperative period based on ERAS concept was constructed.The recovery rates of the two rounds of questionnaire were 100% and 93.75%,and the expert authority coefficients of the two rounds were 0.902 and 0.908,respectively.After the first round of expert letter consultation,1 first-level indicator and 1 second-level indicators were separated,5 second-level indicators and 5 third-level indicators were added,3 second-level indicators and 10 third-level indicators were deleted,1 third-level indicator was modified,and 4 third-level indicators were merged.After the second round of expert letter consultation,three third-level indicators were split,two third-level indicators were modified and one thirdlevel indicator was deleted.Finally,8 first-level indicators,80 second-level indicators and193 third-level indicators were determined,and the final expert opinions tended to be consistent.In the first round,the expert coordination coefficients of the importance of the third-level indicators were 0.154、0.516 and 0.428,and the expert coordination coefficients of the feasibility of the third-level indicators were 0.154、0.292 and 0.504,respectively.In the second round,the expert coordination coefficients of the importance of the third-level indicators were 0.252、0.198 and 0.296,respectively,and the expert coordination coefficients of the feasibility of the third-level indicators were 0.187、0.342 and 0.360,respectively,P< 0.05,indicating that the coordination degree of the experts was high and statistically significant,and the correspondence consultation results had certain statistical significance.ConclusionBy reviewing medical records,this study effectively understood the current clinical nursing problems in the perioperative period of modified radical mastectomy and summarized clinical experience.Secondly,it summarized perioperative ERAS nursing measures for breast cancer by searching literature and summarizing the best evidence.Finally,it verified the rationality of the items through two rounds of expert correspondence consultation,and constructed eight first-level indicators.Eighty secondary indexes and 193 tertiary indexes of modified radical mastectomy perioperative rapid rehabilitation of traditional Chinese medicine CNP program.This path scheme is scientific,reliable and feasible,providing guidance basis for the clinical standard to carry out the perioperative TCM nursing work of modified radical mastectomy of breast cancer,and providing theoretical reference for the development of other clinical diseases of TCM CNP. |
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