Evidence-based Nursing Practice Of Swallowing Function Training For Radiotherapy Patients With Head And Neck Cancer Based On JBI Health Care Model

Objective:1.Search and obtain relevant evidence of swallowing function training for patients with head and neck tumor radiotherapy to form the "Summary of Best Evidence of swallowing function training for patients with head and neck tumor radiotherapy".2.Build the radiotherapy for head and neck cancer patients with swallowing function training of evidence-based nursing practice plan and will be the head and neck cancer radiotherapy in patients with swallowing function training.Methods:Based on the JBI evidence-based health care model,this study is divided into three stages: evidence generation and synthesis,evidence dissemination,and evidence application.1.Evidence generation and Evidence Synthesis: Through the computer system,We systematically searched National Guideline Clearinghouse(NGC),Guidelines International Network(GIN),Scottish Intercollegiate Guidelines Network(SIGN),Joanna Briggs Institute(JBI),Cochrane Library,Pub Med,UP To Date,Web of Science,Embase,CNKI,Wanfang Database,medlive for all evidence of swallowing function training in patients undergoing radiotherapy for head and neck cancer,including clinical recommended practice,guidelines,expert consensuses,systematic reviews and randomized controlled trials.The retrieval period was from the inception of database to August 2022.Two people who have received systematic evidence-based learning will screen and evaluate the retrieved literature and summarize the best evidence.2.Evidence Transfer: An expert meeting was held to analyze the best evidence for swallowing function training for patients with head and neck tumor radiotherapy item by item,and the evidence-based team revised and improved the included evidence to form the final draft of the evidence-based nursing practice plan for swallowing function training for patients with head and neck tumor radiotherapy.3.Evidence Implementation: It is mainly divided into three stages.In the first stage,the evidence-based team determines specific review indicators based on the final evidence-based nursing practice plan,identifies the main problems and supporting factors in the implementation of the plan,and determines solutions;In the second stage,a baseline review is conducted before the application of evidence;In the third stage,evidence introduction is a practical transformation,evidence-based nursing practices are implemented in clinical settings,and the results of baseline review and evidence application are compared.Results:1.Evidence generation and Evidence Synthesis: Through screening the evidence related to swallowing function training in patients with head and neck cancer undergoing radiotherapy,20 articles were ultimately included,including 5 expert consensus articles,1clinical decision making article,7 systematic evaluations,2 guidelines,and 5 randomized controlled trials.Through the rating of the included literature and the extraction and integration of evidence,the final content includes eight aspects: training purpose,training object,training time,training plan,training plan,radiation therapy recommendations,quality control,and effect evaluation.2.Evidence Transfer stage: Through expert meetings and questionnaires,the clinical practicability and feasibility of the evidence were evaluated,and 7 pieces of evidence(training place restrictions and medical equipment problems)were eliminated,and finally20 pieces of evidence suitable for clinical application were screened.Finally,the evidencebased team revised and improved the included evidence to form the final draft of Evidencebased Nursing Practice Plan for Swallowing Function Training of Patients with Head and Neck Tumor Radiotherapy.3.Evidence Implementation stage: Changes in nurses,patients and systems before and after the application of evidence.(1)Nurse level: the passing rate of the nurse knowledge questionnaire test increased from 40% before the application of evidence to 100%(>60 points passed),and the score increased from 61.90 ± 1.760 before the application of evidence to 94.00 ± 3.091(P<0.05);The average score of nurses’ evidence-based nursing ability increased from 48.10±4.954 before evidence-based nursing practice to 86.30±3.860;After the application of evidence,the implementation rate of indicators 1,2,5 and 6 has increased by more than 85% from the previous 0,and the implementation rate of indicators 3,4,7 and 8 has increased by more than 80% from the previous 20%.(2)Patient level: The scores of dysphagia and oral intake quality of patients after the application of evidence were significantly higher than those before the application.(3)System level: the formation and introduction of evidence-based swallowing function training program for patients with head and neck cancer radiotherapy,and the establishment and improvement of nursing positions for swallowing function training management of patients with head and neck cancer radiotherapy.Conclusion:1.This study summarizes the best evidence of swallowing function training for patients with head and neck tumor radiotherapy from eight aspects,including training purpose,training object,training time,preparation before training,training plan,radiotherapy suggestions,quality control,and effect evaluation,according to evidence-based method,which has strong guiding significance.Clinical nursing staff should pay attention to the management of swallowing function training for patients with head and neck tumor radiotherapy,and formulate safe and effective measures in combination with individual factors of patients A highly executed training program.2.The swallowing function training program for radiotherapy patients with head and neck cancer has certain practicability and scientificity;3.Evidence-based practice scheme can improve the dysphagia of head and neck cancer patients in radiotherapy department.