| Objective:1.To summarize the best evidence of lactation maintenance of very low birth weight infants(VLBWI)mothers.2.To Construct the best evidence-based VLBWI maternal lactation maintenance intervention program.3.To evaluate the clinical effect of VLBWI maternal lactation maintenance intervention program.Method:1.Construct the best evidence-based lactation maintenance intervention program for VLBWI mothers(1)By using the method of literature researching,according to the pyramid "6S" model,we searched the clinical guidelines,systematic reviews,expert consensus / opinion and other top of the pyramid literature,and evaluated the quality of the literature to obtain high-quality evidence.(2)By using the method of expert meeting,experts from the pilot ward were invited to evaluate the evidence from the feasibility,suitability,clinical significance and effectiveness of evidence application,so as to determine the evidence suitable for clinical application and construct the review indicators.(3)By using the method of status quo investigation and taking the review indicators as the standard,the questionnaire of the implementation of review indicators was formulated to investigate the current situation of evidence application in pilot wards and identify the gap between clinical practice and evidence.(4)Using the focus group discussion method,i-PARIHS(Promoting Action on Research Implementation in Health Services Integrated framework)as the theoretical guidance framework,combined with the self-made outline,the obstacles and promoting factors of evidence application in clinical practice were analyzed.(5)The best evidence-based VLBWI maternal lactation maintenance intervention program was constructed by expert meeting method.2.Clinical application and effect evaluation of lactation maintenance intervention program for very low birth weight infants based on the best evidence The subjects who met the inclusion and exclusion criteria from January to June 2020 were selected as the control group,and those who met the inclusion and exclusion criteria from July to December 2020 were selected as the intervention group(1)Non synchronous control study was used to compare the implementation of the review indicators of departments and medical staff before and after the implementation of evidence-based practice,and to evaluate the impact of evidence-based practice on departments and medical staff.(2)Using self-control study and questionnaire of breastfeeding knowledge,the changes of breastfeeding related knowledge of nurses in pilot ward before and after evidence-based practice were compared.(3)Non synchronous control study was used to compare the changes of related outcome indicators of puerpera and their children(puerpera: review the implementation of indicators,the incidence of insufficient lactation,the score of breastfeeding attitude;Children:Breastfeeding situation,incidence of feeding intolerance,time to complete oral feeding,incidence of NEC,length of hospital stay),to evaluate the impact of evidence-based practice and intervention program on maternal and children.Result:1.The construction results of VLBWI maternal lactation maintenance intervention program based on the best evidence(1)A total of 10 articles were included in this study,including 3 guidelines,4 systematic reviews,1 expert consensus and 2 expert opinions.44 pieces of evidence in 9 aspects were summarized: 4 pieces of advocating breastfeeding,1 piece of informed consent,1 piece of identifying high-risk groups of lactation delay / disorder,1 piece of formulating feeding objectives,5 pieces of lactation monitoring,12 pieces of lactation support,5 pieces of lactation start-up,9 pieces of sucking requirements and 6 pieces of application of lactating agents.(2)According to the expert recommendations in the expert meeting method,delete the evidence that has been implemented in the ward and is not suitable for clinical introduction at present,and adjust and integrate the evidence to be included in clinical practice.This study finally included 24 pieces of evidence into clinical practice.According to the 24 pieces of evidence,a total of 20 review indicators were formulated,including 2 pieces at the department level,9 pieces at the medical staff level and 9 pieces at the maternal level.(3)According to 20 review indicators,the clinical application status of evidence was investigated.The results showed that there were 6 review indicators with zero implementation rate,10 review indicators with implementation rate < 60%,and only 4review indicators with implementation rate > 60%.It shows that the implementation of review indicators is poor,and there is a big gap between evidence and clinical practice.(4)After focus group discussion,this study analyzed 17 obstacles and 24 promoting factors of evidence application from the aspects of change,change recipient and organizational environment.(5)Based on the best evidence of VLBWI mother’s lactation maintenance,this study constructed a comprehensive intervention program to promote and maintain VLBWI mother’s lactation,including the establishment team,preliminary preparation(data preparation,personnel training),maternal intervention content,intervention program application,effect evaluation(department level,medical staff level,maternal and child level).2.The clinical application and effect evaluation results of the intervention program for lactation maintenance of VLBWI mothers based on the best evidence(1)The influence of evidence-based practice on medical staff in departments and pilot wards After the implementation of evidence-based practice,the implementation rate of review indicators of departments and medical staff in pilot wards was higher than that before the implementation of evidence-based practice,and the difference was statistically significant(P < 0.05).The scores of nurses’ knowledge of breast feeding in the pilot ward before carrying out evidence-based practice were 45(40,60),and 80(75,85)after carrying out evidence-based practice,the difference was statistically significant(P < 0.05).(2)the influence of intervention scheme on parturients and their children This study included 33 parturients and their children in the control group and the intervention group.The results showed that there was no significant difference in general data between the two groups(P > 0.05).Comparison of maternal outcome indicators between the two groups: the implementation rate of maternal review indicators in the intervention group was higher than that in the control group,the difference was statistically significant(P < 0.05);The incidence of lactation deficiency in the intervention group was 39.39%,while that in the control group was 63.64%,the difference was statistically significant(P < 0.05);The score of maternal breastfeeding attitude in the intervention group was 66.03±5.56,and that in the control group was 59.42±6.60,the difference was statistically significant(P < 0.05).Comparison of children related outcome indicators between the two groups: the first breastfeeding time of children in the intervention group was 2(1,4)days after birth,and that in the control group was 5(3,7.5)days,the difference was statistically significant(P < 0.05);The total amount of breast feeding in the intervention group was 7252(4136,11310)ml,while that in the control group was 3867(1673,8048.5)ml,the difference was statistically significant(P < 0.05);The rates of exclusive breastfeeding during hospitalization,0~7 days exclusive breastfeeding,8~14 days exclusive breastfeeding and 15~28 days exclusive breastfeeding in the intervention group were 18.18%、60.61%、93.94% and 72.73% respectively,while those in the control group were 0、6.06%、42.42% and 30.30% respectively,the difference was statistically significant(P < 0.05);The incidence of feeding intolerance was 24.24% in the intervention group and 48.48% in the control group,the difference was statistically significant(P < 0.05);The intervention group reached the time of complete oral feeding in21(15,26)days after birth,and 28(20,33)days in the control group,the difference was statistically significant(P < 0.05).There was no significant difference in exclusive breastfeeding rate from 29 days to discharge 、 NEC incidence and hospitalization time between intervention group and control group(P > 0.05).Conclusion:(1)In this study,a localized comprehensive intervention program for lactation maintenance of VLBWI mothers based on the best evidence was constructed,including five parts:establishment team,preparation,maternal intervention content,application of intervention program and effect evaluation(2)The intervention scheme of mother lactation maintenance based on the best evidence in VLBWI has certain suitability and feasibility: the application of the intervention scheme can improve the implementation rate of the best evidence by departments,medical staff and mothers,improve the breastfeeding knowledge level of nurses in pilot wards,promote breastfeeding,reduce the incidence of insufficient lactation of mothers,improve the breastfeeding attitude score of mothers and improve the clinical outcome of children. |
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