| Purpose: 1.In this study,we evaluated the quality of Neurogenic bladder(NB)clinical practice guidelines(CPGs)in the nursing field,and summarized and sorted out the recommendations to select a collection of consistent and inconsistent recommendations in order to provide clinical nursing staff with We also summarized and sorted out the consistent and inconsistent recommendations to provide clinical nursing staff with rationalized suggestions,guide clinical nursing practice and standardize clinical nursing behavior.2.To analyze the extent to which the consistent recommendations of CPGs are consistent with the actual clinical nursing routines and technical operating procedures,etc.,and to understand the compliance of CPGs in the nursing field of NB.To analyze the obstructive factors and facilitating factors in the application of CPGs by nursing staff in NB-related departments.To provide reference for the future scientific and standardized formulation of NB nursing routines and technical operating procedures,and to promote the translation and practice of evidence-based nursing knowledge.Methods: 1.The CPGs quality evaluation and recommended content analysis: the quality evaluation of the methodologies and recommendations of the CPGs involving the nursing field,and the methodological quality evaluation using the Appraisal of guidelines for research and evaluation II(AGREE II).Appraisal of guidelines research and evaluationRecommendations Excellence(AGREE-REX)was used.And the consistency comparison analysis of recommendations on nursing care in CPGs of NB was conducted to obtain the set of consistent and inconsistent recommendations.A comparative analysis of CPGs detailing recommendations,strength of recommendations,and evidence base was performed.2.Study of the current clinical practice of NB’s CPGs and factors influencing evidencebased practice: Using the set of consistent recommendations obtained in the first part,the current clinical implementation of NB’s CPGs in nursing was investigated against departmental nursing routines and technical protocols,and the conformity of NB’s CPGs recommendations with clinical practice was assessed.A survey of nursing staff in departments with high admission of NB using the Evidence Application Barriers and Facilitators Scale was conducted to identify facilitators and barriers to effective evidencebased nursing practice to support the promotion of guidelines and the construction of implementation protocols for NB in the nursing field,as well as to support the update of CPGs.In this study,questionnaires were distributed to nurses in major departments admitting NB patients in eight hospitals in Gansu,Shaanxi,Sichuan,and Chongqing provinces from October 2022 to December 2022,and multi-dimensional analyses were conducted at the levels of implementation context,organizational form of evidence application,evidence factors,evidence application leaders,nurse teams,and patients.Results: 1.CPGs quality evaluation and recommendation content analysis: 17 CPGs were included,two international CPGs,four domestic CPGs,and 11 foreign CPGs.CPGs focused more on adult spinal cord injury population and general population,and less on elderly and adolescent NB organizations/institutions.A total of 14 CPGs reported evidence level grading,and 12 CPGs reported recommendation level grading.the overall quality of CPGs methodology and recommendation was not high,with standardized scores ranging from 15% to 94% for each domain in AGREE II,and "rigor","independence The standardized scores for AGREE II ranged from 15% to 94%,and the scores for "rigor,""independence," and "applicability" were less than 50%;the standardized scores for AGREE REX ranged from 13% to 78%,with relatively high scores of 56% and 42% for clinical applicability and implementability,respectively,and 29% for values and preferences.A total of 40 major recommendations were summarized and extracted from CPGs,of which 36 were basically consistent and four were contrary to the recommendations.Content analysis of the CPGs detail recommendations categorized the recommendations into nursing assessment,manual assisted voiding,behavioral therapy,intermittent catheterization,indwelling catheterization,and other therapies.2.Study on the current clinical practice of CPGs in NB and factors influencing evidencebased practice: A total of 13 clinical departments in 8 hospitals in four cities were surveyed,and 249 valid questionnaires were returned;the respondents included nurses from the departments of rehabilitation,neurology,neurosurgery,intensive care unit,urology and orthopedics,and the compliance rate of 22 main recommendations was 100%,and the compliance rate of 37 main recommendations was greater than 60%.The total score of the scale of barriers and facilitators of evidence application was 141.75±35.27,the score of implementation context in 6 subscales was 31.29±6.98,the score of organizational form of evidence application was 10.93±3.22,the score of evidence factors was 9.37±3.79,the score of factors in charge of evidence application was 38.97±8.72,the score of nurse team factors was The results of the questionnaire showed that the facilitators of the evidence application process included good implementation contexts,appropriate organizational forms of evidence application,qualified leaders and a team of nurses with good skills and actions;the barriers included insufficient resources in databases related to literature search by nursing staff,ineffective access to evidence resources,uneven quality of retrieved evidence,and poor quality of retrieved evidence.The barriers included inadequate resources of nursing staff in literature search related databases,ineffective access to evidence resources,uneven quality of retrieved evidence and inability to apply evidence in local practical contexts,and low acceptance of new protocols,poor adherence,low awareness and negative attitudes on the part of patients.Univariate analysis revealed that department,knowledge of CPGs clinical care/practice,participation in clinical practice of CPGs,training in clinical translation and application of CPGs,and previous relevant research experience were the main factors influencing the scores on the barriers to evidence application and facilitators scales.The results of multiple linear stepwise regression analysis showed that nurses in rehabilitation and orthopedics had higher and statistically different scores on the implementation context and organizational form of evidence application subscales(P <0.05),nurses with 6～10 years of work experience and nurses trained in clinical translation and application of CPGs had higher and statistically different scores on the implementation context and organizational form of evidence application subscales,respectively(P < 0.05).Conclusion: The overall quality of CPGs in NB needs to be improved,and it is necessary to conduct more in-depth research and update CPGs in a timely manner in order to improve the usefulness of CPGs and reduce the discrepancies between CPGs and practice.there are discrepancies between some of the recommendations of CPGs and clinical practice,and it is recommended to conduct dynamic and continuous quality review in the process of clinical practice of evidence.Organizing nurses to participate in training related to the clinical translation and application of CPGs,and drawing on the nursing experience of major NB departments such as rehabilitation and orthopedics,will help the clinical practice translation of evidence. |
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