Construction Of Nursing Plan Of Tracheotomy In Burn Patients With Inhalation Injury

Objective:To construct a scientific and normative nursing plan of tracheotomy in burn patients with inhalation injury,in order to provide references for clinical practice and standard formulation.Methods:(1)The semi-structured interview was adopted to select 10 nurses and 5 patients from Department of Burns as interview subjects from September to October 2018 to investigate the status of tracheotomy care.The research team worked out a large number of literature studies and combined with clinical practice to formulate the interview outline;the interview record was transcribed by two researchers;the interview material was analyzed by using Colaizzi 7-step analysis method.(2)Combined with the semi-structured interview,the nursing plan of tracheotomy in patients with inhalation injury was preliminarily constructed by using the method of evidence-based nursing.We searched evidences from multiple databases,guideline networks,and websites of professional associations.The type of research retrieved included clinical decision,guideline,evidence summary,systematic review,and expert consensus.The retrieval time limit is from the establishment of the database to April 30,2019.Research quality evaluation,evidence extraction,evidence level and recommendation grade determination were conducted independently by two researchers.When there were differences,the research group reached a consensus after discussion.The quality evaluation of clinical practice guidelines was completed by AGREE II(Appraisal of Guidelines for Research and Evaluation ?).The quality evaluation of clinical decisions and evidence summaries should track the original studies of the extracted items.According to the research design of the original study,13 different types of evaluation tools which were developed by The Joanna Briggs Institute(JBI)in 2016,were selected.Systematic reviews,expert consensuses and other types of researches were also evaluated by the corresponding JBI quality evaluation tool.In this study,GRADE(Grades of Recommendations Assessment,Development and Evaluation)was adopted as the determination standard of evidence level and recommendation grade for the evidences extracted from guidelines and systematic reviews.And for the evidences extracted from expert consensuses,clinical decisions,evidence summaries and other types of studies,JBI evidence pre-ranking and recommendation grading system(2014 edition)was applied.(3)The Delphi method was used to invite 15 medical and nursing experts to conduct two rounds of consultation,in order to verify and improve the preliminary plan.Results:(1)Four themes were identified through the semi-structured interview:the status of burn tracheotomy care,the important steps of burn tracheotomy care,the lack of systematic and standardized training of burn tracheotomy care,and the lack of update and optimization of burn tracheotomy care.Among them,the status of burn tracheotomy care mainly included lack of unified operating standards,patients'feelings,existing problems and suggestions.The important steps of burn tracheotomy care included sputum suction and aseptic operation.(2)This study included 22 literatures,including 1 clinical decision,3 guidelines,7 JBI evidence summaries,7 systematic reviews,and 4 expert consensuses.Evidences extracted from clinical decision and evidence summaries were respectively from 2 systematic reviews,5 expert opinions,1 literature review,2 case series studies,2 case reports,2 cohort studies,2 cross-sectional studies,and 1 randomized controlled trial.Finally,12 categories and 76 items of best evidence were summarized,and the nursing plan of tracheotomy in patients with inhalation injury was preliminarily constructed.(3)All of the experts are vice senior title or above,with a wealth of inhalation injury treatment and nursing experience.The two-round response rates were 100%,and the Suggested rates were 46.67%and 26.67%.The expert authority coefficient of the first round was 0.93,the second round was 0.92.After two rounds of consultation,the Kendall coordination coefficient of the first-level indicators was 0.286,the second-level indicators was 0.279,all P value<0.05.The index weight was determined by the Precedence chart and importance rating.In the first round of consultation,two first-level indicators were merged,one first-level indicator was revised and one first-level indicator was added.12 secondary indicators were deleted,8 secondary indicators were modified and 13 secondary indicators were added.In the second round of consultation,2 secondary indicators were deleted and 3 secondary indicators were modified.Ultimately,12 categories and 75 items of the nursing plan of tracheotomy in burn patients with inhalation injury was completed.Conclusion:We used the semi-structured interview,the method of evidence-based nursing,and Delphi method to construct a scientific and normative nursing plan of tracheotomy in burn patients with inhalation injury.The nursing plan consists of 12 categories and 75 items,which include timing,method and complication of surgery,airway evaluation,airway suction,humidification and nebulization,cuff management,selection and fixation of trachea cannula,tracheotomy stoma care,prevention of VAP(Ventilator-Associated Pneumonia),communication,dysphagia,extubation and multidisciplinary care.