Construction And Application Of Evidence-based Nursing Practice Program For Nutritional Risk Management Of Stroke Patients With Dysphagia In Pension Institutions

Objective:The overall purpose of this study is to combine the available evidence with clinical conditions to construct and applicate “evidence-based nursing practice program for nutritional risk management of stroke patients with dysphagia in pension institutions”.Specifically to(1)clarify the existing problems of nutritional risk management of stroke patients with dysphagia in pension institutions.(2)summarize the best evidence of nutritional risk management of stroke patients with dysphagia.(3)clarify the applicability of the best evidence in pension institutions.(4)evaluate the application effect of evidence-based nursing practice program for nutritional risk management of stroke patients with dysphagia in pension institutions.Methods:This study uses knowledge transformation model as the theoretical guide.(1)Phenomenological study method was used to explore the status of nutritional risk management of stroke patients with dysphagia in pension institutions and identify the existing problems.(2)According to the “6S”evidence resource model,the clinical decision support,guidelines,systematic reviews and expert consensus on the nutritional risk management of stroke patients with dysphagia in domestic and foreign databases and related websites were retrieved from top to bottom.After the quality evaluation of the included literature,evidence extraction and summary analysis were performed.(3)Combining phenomenological study with best evidence,to construct evidence-based nursing practice program for nutritional risk management of stroke patients with dysphagia in pension institutions.After revising by Delphi Delphi expert correspondence method,the final program formed.(4)Through implementing the evidence-based nursing practice program by self-control method,to evaluate the rate of review indicators,the nutritional risk score and the incidence of aspiration pneumonia of stroke patients with dysphagia.Results:(1)A total of 4 doctors,11 nurses,8 pension caregivers and 12 stroke patients with dysphagia were interviewed.The existing problems of nutritional risk management of stroke patients with dysphagia in pension institutions can be summarized into 5 categories which included patient factor,elderly care worker factor,family support factor,medical and health service factor,policy factor,with 11 themes.(2)Through systematic searching and screening,16 articles were finally included.Among them,there were 9 guidelines,1 evidence summary,2systematic reviews and 4 expert consensus were selected.The use of various types of evaluation tools showed that the quality of the included literature was generally good.Finally,46 pieces of evidence were summarized,26 were recommended for grade A and 20 for grade B.(3)Based on two rounds of Delphi expert consultation,the nursing practice program for nutritional risk management of stroke patients with dysphagia in pension institutions was determined to seven aspects,which included team building,screening and assessment for dysphagia,nutrition risk screening,nutrition assessment,enteral nutrition,nutrition monitoring,knowledge training,with a total of 7 first-level items,25 second-level items and 52 third-level items.Two rounds of expert consultation were conducted,the expert positive coefficient wrer 82.61 % and 89.47 %,the authority coefficients were 0.879 and 0.862,the Kendall′s W were 0.175 and 0.254 respectively,(P<0.01).Expert opinions converged to form the final program.(4)After the implementation of evidence-based nursing practice program,the implementation rate of each review indicator was 64.29～100%.The nutritional risk score and the incidence of aspiration pneumonia of stroke patients with dysphagia were statistically significant(P<0.05).Conclusion:(1)The pension institution need to attach importance to Multidisciplinary professional care team building,train nutrition specialists;strengthen nutrition education for nurses,care caregivers,patients with dysphagia in pension institutions;improve nutritional risk management of stroke patients with dysphagia,promote policy support and implement nutrition risk management effectively.(2)46 pieces of evidence included team building,screening and assessment for dysphagia,nutrition risk screening,nutrition assessment,nutrition planning,enteral nutrition,parenteral nutrition,nutrition monitoring,knowledge training,which providing evidence-based basis for the construction of evidence-based nursing practice program.(3)The evidence-based nursing practice program demonstrated by Delphi method was comprehensive,specific and strong operability,which providing decision-making basis for practitioners and managers of pension institutions.(4)The evidence-based nursing practice program improved nurse and care caregivers cognition and compliance of nutritional risk management in stroke patients with dysphagia,reduce the nutritional risk score and the incidence of aspiration pneumonia of stroke patients with dysphagia.And it can provide clinical decision basis for continuous quality improvement of nutritional risk management of stroke patients with dysphagia in pension institutions.