Evidence-based Nursing Study On Prevention And Management Of Incontinence-associated Dermatitis In ICU Adult

Objective:This study consists of two parts.By referencing to evidence-based nursing methods,the first part aims to select and summarize best evidence for prevention and management incontinence-associated dermatitis among ICU patient.The second part applies the best evidence to clinical practice and evaluates its effects.Methods:1.We systematically searched the BMJ(best practice),Web of Science,American Guide Network(NGC),Cochrance Library,JBI,Ovid Biomedical Library,EBSCO host,CINAHL,Pub Med,CNKI、Wanfang、CBM on prevention and management of adult incontinence associated dermatitis,including guidelines(nearly 10 years),evidence summary,best practice information sheet,recommended practices,systematic reviews,expert consensus etc.Secondly,evaluated the quality of evidence and collected the IAD best evidence.2.Through expert discussions to make grade recommendations on the summarized evidence and develop review criteria.Using the framework of evidence-based continuous quality improvement application contracted by the Fudan University Evidence-based Nursing Center under the guidance of PDCA,from the process of evidence acquisition,baseline assessment,evidence introduction and effect evaluation,12 steps to promote the transformation of evidence to clinical.The clinical application of evidence was carried out in the comprehensive ICU of a third-class hospital in Chengde from December 2018 to July 2019,before and after the application of evidence 46 nurses and 90 incontinence patients were enrolled to observe the awareness rate of IAD related knowledge,the implementation rate of related nursing behaviors and the incidence of IAD before and after evidence application.Results:1.Summary of evidence:A total of 8 articles were included,including 7 evidence summaries,1 expert consensus,and a total of 19 pieces of evidence.The evidence involved included 4 aspects of: IAD assessment,IAD skin care,incontinence management,and staff training.2.Application of evidence:After the application of the evidence,the nursing staff’s knowledge of IAD prevention and management was significantly improved,and the overall score was increased from(46.08±15.94)points to(81.73±11.06)points(P<0.05).The incidence of IAD decreased from 22.2% to 5.6%(P<0.05).Before and after the application of evidence,except for the implementation rate of review item 1,which remains at 100%,the implementation rate of other review items has increased significantly(P<0.05).The implementation rate of review item 2 increased from 0% to 85.2%,review item 3 increased from 27.8% to 74.1%,review item 4 increased from 30.6% to 100%,review item 5 increased from 0% to 90%,and review item 6 increased from 16.7% to 70.4%,review item 7 increased from 0% to 87%,review item 8 increased from 0% to 83.3%,review item 9 increased from 0% to 79.6%,review item 10 increased from 38.9% to 92.6%.Conclusion:Applied the evidence-based nursing methods can reduce the incidence of IAD in patients with incontinence,improved the level of nursing staff’s knowledge on prevention and management of IAD,regulated the behavior of nursing staff,enables nurses to follow rules,and can effectively improve the quality of nursing.