| Objective: In recent years,gastrointestinal bleeding caused by cirrhosis has become one of the common diseases in clinical medicine.TIPS(transjugular intrahepatic portosystemic shunt)is an effective treatment,but there is still a lack of scientific and accurate nursing management.To analyze the content and obstacle factors of disease nursing management through current situation investigation;to systematically retrieve and review the literature evidence such as clinical nursing research and guidelines for cirrhosis gastrointestinal bleeding,and to construct a ’ TIPS nursing program for cirrhosis gastrointestinal bleeding ’;the clinical pilot application was carried out to promote the scientific nature of the nursing practice of TIPS for gastrointestinal bleeding in cirrhosis,ensure the safety of patients and improve the quality of nursing.Methods:(1)Part 1 : Cross-sectional study : A mixed study design was used to select the wards of patients in a large tertiary hospital to collect case information that met the inclusion and exclusion criteria for investigation and analysis;secondly,through participatory observation of nursing activities and semi-structured interviews with multidisciplinary health care personnel and patients,the role and function of nursing and the obstacles to implementation were analyzed and discussed.(2)Part 2 : Construction of nursing plan : Based on the data results and obstacle integration and induction factors in the current survey,the evidence chain system was searched for the diagnosis and treatment of gastrointestinal bleeding in cirrhosis and nursing related guidelines.According to the JBI standard,GRADE II and other evidence evaluation tools for evaluation and classification.After two rounds of expert consultation,the content of the plan was determined to form a ’ TIPS patient care plan ’ that is easy to understand,clinically operable,and convenient for clinical nursing staff to use;(3)Part 3 : based on the previous research results and the requirements of the research institute in the field,a quasi-experimental study was conducted according to the PDSA cycle to further explore the obstacles and contradictions of nursing work,so as to facilitate the improvement of nursing quality cycle.Results:(1)Part 1: Cases were extracted from 65 men and 35 women with a mean age of(53.84 ± 12.11)years.Of these,type B cirrhosis predominates(72%),with the highest incidence(74%)occurring over 5 to 10 years.The proportion of moderate and severe esophageal varices was highest(36% and 37%,respectively).Secondly,comorbidities such as anemia and diabetes were more common(57 per cent).In addition,the Child-Pugh scale had the highest proportion of patients(75%)with a C rating.Seven nursing articles were selected from category I and 34 from category II;The number of effective long-term medical advice was 2 in Category 1 and 9 in Category 2.Provisional medical orders in category 1,category 2,category 12,form the basis for the construction of the clinical care pathway entries.Participatory observation of care in the field,accompanied by semi-structured interviews with 20 senior clinical paramedics,head nurses,operating room doctors,and so on,with a focus on basic illness care,nursing and continuity of care issues,and in-depth interviews with patients about illness awareness,experiences and needs.Although the findings are consistent with the content of the evidence,there are still some gaps,and three barriers are extracted: 1)the multidisciplinary team care plan is missing,and there is a need to refine the effective communication mechanism between the patient and nurse.(2)Lack of evidence-based and clinically transformational carer thinking and inadequate use of specialist assessment and decision support tools;(3)It follows the traditional model of clinical nursing management but demand for illness care tends to be diverse;(2)Part II results: Based on Mesh’s theme of "Cirrhosis of the liver," "gastrointestinal bleeding," "liver cirrhosis," "TIPS," and associated search terms,were retrieved from computerized decision systems and multiple evidence-based databases,guides,and disease professional association Web sites and ultimately incorporated into 20 articles in the literature,including 7 guidebooks and 5 expert consensus articles.Six main themes were identified,with 32 items of evidence covering assessment and monitoring of illness,posture and activity,treatment and medication,diet and medication,health education and continuity of care.Following two rounds of expert elicitation by Delphi,155 indicators were identified,including eight patient inclusion and exclusion criteria,26 care items and 117 care items.On this basis,the TIPS Patient Care Program was established.(3)Results of Part III: Both groups were equally matched with respect to background information such as gender,age,disease course,and type of cirrhosis(P > 0.05).However,there was no significant difference in the incidence of complications between the experimental and control groups(P < 0.05),and the incidence of portal vein thrombosis was significantly less in the control group.Furthermore,in terms of self-care,both patient groups were measured pre-and post-intervention.The results showed a significant increase in scores in all domains post-intervention(15.69 ± 3.21),(15.67 ± 2.45),(23.67 ± 2.67)and(25.67 ± 4.02),respectively,with a statistically significant reduction in length of stay in the hospital compared with the treatment plan.Conclusion: Based on the concept of evidence-based nursing and combined with the theory of nursing specialty,this paper constructs an ’ evidence-based nursing program for TIPS of liver cirrhosis with gastrointestinal bleeding based on evidence-based concept ’ suitable for TIPS of liver cirrhosis with gastrointestinal bleeding in China through the best evidence summary and expert correspondence method,so as to improve the disease care process and provide action basis for the implementation of care activities by liver disease intervention specialist nurses for clinical reference.The successful implementation of the ’ TIPS nursing program ’ can reduce the incidence of complications,improve patients ’ self-management ability,reduce hospitalization days and costs,and reduce the economic toxicity of patients and families due to diseases. |
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