| Objective:The aim is to build the continuous application scheme of the evidence-based practice program of the prevention and management enteral nutrition feeding intolerance based on the CFIR theoretical framework.Methods:Status review stage: Questionnaire method and observation method were adopted to understand the implementation status of 11 clinical review indicators,and then understand the application status of "evidence-based practice project for prevention and management of enteral nutrition intolerance after upper gastrointestinal surgery"(hereinafter referred to as "Project")in practice sites.Evidence updating stage: Systematically searched CNKI,Wanfang,Pub Med,JBI,Cochrane Library,Up To Date and other databases,as well as the websites of guidelines and professional associations,and updated relevant evidence on prevention and treatment of enteral feeding intolerance after upper digestive tract surgery;The search period was from October 2020(the previous evidence summary search deadline)to May 2022.The literature types included clinical practice guidelines,evidence summary,systematic review and expert consensus.Two researchers independently evaluated the quality of literature and the quality level of evidence obtained,and then supplemented and updated the relevant evidence of the research group in the previous stage,and determined the final recommended items through the applicability evaluation of stakeholders.Factor identification stage: Based on CFIR,qualitative research method was adopted to conduct semi-structured in-depth interviews with 12 stakeholders of evidence-based practice projects.Oriented content analysis was adopted to analyze the interview data,explore the multi-dimensional factors affecting the sustainability of the projects,and grade the obtained influencing factors to explore the nature and degree of influencing factors.Program construction stage: Based on the results of the implementation of the CFIR-ERIC strategy matching tool and the updated best evidence,the preliminary program was formulated,and the program was revised and improved through stakeholder meetings,so as to construct the sustainable application program of the evidence-based practice project of prevention and management of enteral nutrition intolerance.Results:(Ⅰ)Status Review stage:A total of 25 nurses were included in the review.Compared with one month after the implementation of the project,the level of knowledge,attitude and behavior of prevention and management of enteral nutrition intolerance decreased(P<0.05).There were statistical differences in the execution rate of indicators 1,2,3,7,8,9,10 and 11.In addition to the increase of the implementation rate of indicators 8 and 9 to 100%,the implementation rate of other indicators dropped from over 80% to below 50%,and indicators 2,3 and 7 were almost unimplemented.Compared with 42 patients included one month after the implementation of the project,the general data of 51 patients included in this round showed no statistical difference(P>0.05).In addition to the incidence of vomiting and reflux,the incidence of abdominal distension,abdominal pain,nausea and diarrhea were significantly increased(P<0.05).(II)Evidence updating stage:A total of 8 literatures were included,including 3 evidence summaries,1 clinical practice guideline,3 systematic reviews and 1 expert consensus.Through the integration and summary of evidence,17 articles were added and 5 articles were updated by comparing the previous best evidence.Through the evaluation and discussion of 8stakeholders,it was decided that 4 pieces of supplementary evidence should not be adopted,and finally formed the evidence for prevention and management of intestinal nutrition intolerance after upper gastrointestinal surgery(updated version).(III)Factor identification stage:Through semi-structured interviews with 12 stakeholders at the implementation site,various factors affecting the sustainability of evidence-based practice programs were identified.The results showed that 24 factors from five dimensions,namely,the characteristics of intervention programs,external factors,internal factors,individual characteristics and implementation process,played an important role in the sustainability process,among which 18 were hindering factors and 4 were promoting factors.2 neutral factors.The obstacle factors in the dimension of "characteristics of intervention programs" are complexity,sources of intervention programs,quality and strength of evidence,quality and combination of design,and timeliness of evidence-based programs.The obstacle factor of "external factor" dimension is external policy and incentive;The obstacle factors in the dimension of "internal factors" are goals and feedback,relative priority,learning atmosphere,organizational incentives and rewards,available resources,access to knowledge and information,culture,collaboration and communication,and organizational structural characteristics.The dimensions of "individual characteristics" included self-efficacy,knowledge and belief about intervention programs and other personal characteristics of nurses.The influence factors of the "process" dimension include the advocate as the facilitator and the officially appointed internal implementation leader,which are neutral factors.(IV)Project Construction Stage:The "Sustainable implementation Plan of evidence-based Practice for Prevention and Management of enteral nutrition Intolerance" finally constructed in this stage includes the establishment of an implementation team composed of 7 people,continuous training plan,quality control plan,revision of 2 nursing processes,2 nursing forms and 1 educational video to promote the implementation of the program.Conclusion:This study reviewed the implementation status of evidence-based practice project on prevention and management of enteral nutrition feeding intolerance.Compared with the implementation of the project for one month,the implementation rate of review indicators of nurses decreased significantly in 6 items after 15 months,the level of related knowledge and practice decreased significantly,and the feeding intolerance of patients increased significantly.The clinical translation of best evidence was hampered by poor program persistence.After the researchers summarized and stakeholders agreed to update,13 pieces of evidence were added to the best evidence collected by the research group in the early stage,and 5 pieces of evidence were updated to form the final recommended items of evidence for the prevention and management of enteral nutrition intolerance after upper gastrointestinal surgery(updated version),which provided knowledge support for the continuous implementation of evidence-based practice projects.Based on the CFIR framework,a total of 24 influencing factors from five dimensions of project sustainability were identified,among which 18 were hindering factors,4 were promoting factors and 2 were neutral factors.The implementation strategy matching tool of CFIR-ERIC was used to construct the "Sustainable Implementation Plan for the Prevention and Management Project of Enteral nutrition Intolerance" through in-depth discussions and decisions of stakeholders.The plan was formed in a rigorous process with comprehensive contents and received support from stakeholders. |
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