Prone Position Nursing Plan For Traumatic Brain Injury Complicated With Hypostatic Pneumonia

ObjectiveThis study aims to systematically search,evaluate,and synthesize evidence from both domestic and international sources.The goal is to develop a comprehensive nursing care plan in prone position for patients with traumatic brain injury complicated by hypostatic pneumonia and to evaluate its effectiveness and safety.Methods1.Evidence synthesis:The relevant research on prone positioning nursing interventions for patients with traumatic brain injury complicated by hypostatic pneumonia was systematically searched from domestic and international sources.Through literature quality evaluation and content integration analysis,the best evidence entries were formed by using the JBI Levels of Evidence and Grades of Recommendation.2.Evidence-based nursing plan:An initial draft was prepared,and through two rounds of Delphi expert consultation,combined with the opinions of clinical physicians and nursing experts,the nursing plan was eventually formed.3.A clinical trial was conducted in the neurosurgery department from January2022 to February 2023,with 31 eligible patients allocated to the experimental group and 31 patients assigned to the control group.Baseline and post-intervention data were collected for several outcomes,including sputum clearance,viscosity,arterial blood gases（Pa O₂and Pa CO₂）,clinical pulmonary infection score（CPIS）,and complication rates.Results1.A total of 12 studies were included,consisting of 2 clinical guidelines,1expert consensus,and 9 trials,resulting in 22 best evidence entries across 6dimensions,including patient assessment,implementation process,prevention of complications,timing of discontinuation,efficacy assessment index,and personnel management.2.Based on the previous evidence and content analysis,the“Prone Position Nursing Care Plan for Patients with Traumatic Brain Injury Complicated by Hypostatic Pneumonia”was finally developed through Delphi expert consultation,consisting of 47 items across 6 dimensions.The experts’authority coefficient in the first round of consultation was 0.82,with a coefficient of variation between 0.00～0.23and a Kendall’s harmony coefficient of 0.17.In the second round,the experts’authority coefficient was 0.80,with a coefficient of variation between 0.00～0.18 and a Kendall’s harmony coefficient of 0.17.3.（1）There were no statistically significant differences between the two groups in terms of age,gender,education,ethnicity,type of health insurance,cause of injury,and past medical history（P>0.05）,which were comparable at baseline.（2）Sputum clearance:After one week of intervention,both groups showed improved sputum clearance.In the intervention group,significant improvement was seen in 11 cases,improvement in 18 cases,and no effect in 2 cases.In the control group,significant improvement was seen in 3 cases,improvement in 24 cases,and no effect in 4 cases.The difference was statistically significant（P<0.05）,with the intervention group showing a more significant improvement.（3）Sputum characteristics:There was no statistically significant difference in sputum viscosity between the two groups before the intervention（P>0.05）.After the intervention,there was a statistically significant difference in sputum viscosity between the two groups（P<0.05）with a higher number of cases in the intervention group having viscosity grade I compared to the control group.The difference was statistically significant（P<0.05）.（4）Arterial blood gas analysis:There was no statistically significant difference in Pa O₂（68.58±6.02 vs68.32±4.61,P>0.05）and Pa CO₂（47.92±3.45 vs 48.34±2.99,P>0.05）between the intervention group and the control group before the intervention.After the intervention,both groups showed an increase in Pa O₂（80.90±7.85 vs 77.01±4.95,P<0.05）and a decrease in Pa CO₂（41.41±4.15 vs 43.96±3.43,P<0.05）.The difference was statistically significant,and the intervention group showed a more significant improvement in the arterial blood gas parameters.（5）Clinical Pulmonary Infection Score（CPIS）:Before the intervention,there was no statistically significant difference in CPIS scores between the intervention group and the control group（6.13±1.15 vs6.45±1.23,P>0.05）.After the intervention,both groups showed a decrease in CPIS scores,with the intervention group having a lower score than the control group（4.39±1.17 vs 5.29±1.47）.The difference was statistically significant（P<0.05）.（6）There were fewer cases of complications in the intervention group compared to the control group,the difference was not statistically significant（P>0.05）.Conclusion1.This study conducted evidence synthesis and two rounds of Delphi expert consultation through evidence-based methods and constructed a prone position nursing care plan based on the best evidence.This guaranteed the scientificity,standardization,and feasibility of the nursing plan,and provided theoretical guidance for its application in clinical practice.2.This study clinically validated the effectiveness and safety of the prone position nursing care plan,effectively promoting the process of translating the best evidence into clinical practice,and providing a reference for expanding the application of the prone position in clinical nursing.