| ObjectiveBased on the concept of Evidence-Based Nursing,an early ambulation program for patients undergoing abdominal radical hysterectomy was constructed.The program was applied to clinical practice to evaluate the application effect of the program,and to provide systematic guidance for early postoperative activities of patients undergoing abdominal radical hysterectomy.Methods1.The construction of the early ambulation program.According to the PIPOST model,the clinical problems were established,and a program construction team was established to systematically retrieve the relevant literature on early ambulation of patients undergoing abdominal radical hysterectomy from the guide network,database and related professional websites.After literature screening,literature quality evaluation,evidence extraction and summary,and evidence level evaluation,the best evidence summary of early ambulation program of patients undergoing abdominal radical hysterectomy has formed.Select the best evidence combined with clinical practice to further search the literature,and form the draft of the early ambulation program.Gynecological nursing and medical experts were selected to consult the draft of the early ambulation program,and the program items were modified and deleted according to the expert opinions,and eventually form the management program of the early ambulation program for patients after abdominal radical hysterectomy.2.The evaluation of the clinical effect on early ambulation program.This study is a quasi-experimental study.According to the eligibility criteria,43 patients underwent abdominal radical hysterectomy from March to May 2022 in three wards of gynecology in a tertiary general hospital in Henan Province were assigned to the control group.43 patients underwent abdominal radical hysterectomy from June to August 2022 in the same three gynecological wards were assigned to the intervention group.The control group received routine perioperative nursing of gynecology,and the intervention group was given early ambulation program constructed in this study in addition to routine nursing measures.We compared the first-time mobilization,first exhaust time,first defecation time,thelength of hospital,the distance of exercise and pain scores at three days after surgery between the two groups.SPSS25.0 software was used for statistical analysis.The statistical description was expressed as mean±standard deviation,frequency,and percentage.Statistical analysis was performed using t test or rank sum test,χ~2test or Fisher exact probability method,and generalized estimation equation.All statistical results were statistically significant at P<0.05.Results1.The construction of the early ambulation program.After systematic literature retrieval,11 articles were finally included.20 recommendations of early ambulatin after abdominal radical hysterectomy were formed,including preoperative health education,postoperative position management,early ambulation evaluation and early ambulation plan.Two rounds of consultation were conducted on 12 experts.The positive coefficients of the two rounds of experts were 100%and 91.6%,the authority coefficients of the two rounds of experts were0.95,and the Kendall’s coordination coefficients(W)of the two rounds of experts were0.141 and 0.361,respectively.The P value of significance test was<0.01.In the two rounds of consultation,the items with importance mean≥3.5 and coefficient of variation(CV)<0.25were retained,and the contents of the items were modified in combination with expert opinions,the"early ambulation program for patients undergoing abdominal radical hysterectomy"was finally formed,including 3 first-level indicators,11 second-level indicators and 30 third-level indicators.2.The evaluation of the clinical effect on early ambulation program.The intervention group finally included 42 people,and the control group finally included 41 people.(1)There was no significant difference in age,BMI,education level,occupation,marital status,menopausal status,medical insurance type,basic disease,disease type,operation time,intraoperative bleeding and blood transfusion between the two groups(P>0.05).(2)Comparison of the first-time mobilization.53.7%of the patients in the control group got out of bed within 24 hours after operation,and 76.2%of the patients in the intervention group got out of bed within 24 hours after operation.There was significant difference in the first-time mobilization between the two groups(P<0.05).(3)Comparison of the distance of exercise.The distance of exercise at three days after surgery of the intervention group was higher than that of the control group,and the difference was statistically significant(P<0.05).The generalized estimation equation was used to analyze the changes of the distance of exercise at three days after surgery between the two groups.The results showed that there was no group effect on the distance of exercise at three days after surgery between the two groups(F group=3.575,P>0.01),and no group-by-time interaction between the two groups(F interaction=3.958,P>0.01).There was a time effect(F time=47.823,P<0.001).(4)Two-minute walk test.There was no significant difference in the results of two-minute walking test between the two groups one day before operation(P>0.05).There was significant difference in the results of two-minute walking test between the two groups on the third day after operation(P<0.05).(5)The first ambulation assistance and emergencies.There was significant difference in the assisted way of first-time mobilization between the two groups(P<0.05).There was no significant difference between the two group in the incidence of adverse events during the first-time mobilization(P>0.05).(6)There was significant difference in first exhaust time(42.33±15.92h vs.49.77±16.85h,P<0.05),the first defecation time(64.29±15.51h vs.73.79±22.30h,P<0.05),the hospitalization time(12.24±2.77d vs.13.78±2.98d,P<0.05)and the postoperative catheter carrying time between the two groups(P<0.05).There was no significant difference in the removal time of drainage tube between the two groups(P>0.05).(7)There was no significant difference between the intervention group and the control group in pain scores at three days after surgery(P>0.05).The generalized estimation equation was used to analyze the changes in pain scores at three days after surgery between the two groups,and the results showed that there was no group effect on pain scores at three days after surgery between the two groups(F group=3.899,P>0.01).There was no group-by-time interaction between time and group(F interaction=2.310,P>0.01),and there was a time effect(F time=51.221,P<0.001).ConclusionThe construction of early activity program for patients undergoing radical resection of abdominal cervical cancer is systematic and specific.The application in clinical practice can shorten the first time of getting out of bed after transabdominal radical hysterectomy,improve the postoperative activity distance,and improve the postoperative activity endurance and physical fitness of patients.The application in clinical practice can promote the recovery of gastrointestinal function,shorten the postoperative exhaust defecation time,without increasing postoperative active pain,and shorten catheter carrying time and hospitalization time. |
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