| ObjectiveBased on the evidence,the cluster feeding training program for stroke patients with swallowing d isorder was constructed and clinically verified to provide reference for the feeding management of post-stro ke patients with swallowing disorder.Methods1 Summary of the best evidence for feeding training protocols in stroke patients with dysphagia.Guided by evidence-based nursing theory,JBI evidence-based health care model was introduced to search c omputer decision system,practice guide website,professional association website and original database acc ording to "6S" evidence-based medicine resource distribution model.Develop a scientific and rigorous liter ature retrieval method,and revise and supplement relevant literature after reading it on the basis of pre-retrieval;The documents were screened ac cording to the inclusion and exclusion criteria and PIPOST model.Two researchers evaluated literature qua lity in a back-to-back manner,and extracted and summarized relevant evidence after reading each article to form the best evidence summary.2.Construction of cluster feeding training scheme.A cluster scheme construction team was established and an expert meeting was held in the hospital to determine the level and recommendation strength of evidence using JBI’s FAME structure and strength classification principle.The same parts of the theme content were combined and summarized,and the theme of evidence was summarized,and the preliminary draft of the cluster nursing plan was formed after discussion and modification by the expert group.20 experts from 11 hospitals in 6 regions were selected to conduct two rounds of Delphi expert letter consultation on the draft plan.SPSS 25.0 software was used to make a statistical analysis of the letter inquiry results,which mainly consisted of three parts: expert positive coefficient,expert authority degree and expert coordination degree.The importance of each item is represented by the mean of importance assignment(x),recognition rate(Cj),full score frequency(Kj)and coefficient of variation(CV).The inclusion criteria were importance assignment mean(x)> 3.5,recognition rate(Cj)≥50%,full score frequency(Kj)≥20%,coefficient of variation(CV)< 0.25.After discussing the results of the letter again,the group formed the training program of cluster feeding for stroke patients with dysphagia.3.Clinical validation of cluster feeding training regimen for stroke patients with dysphagia disorder.A total of 64 patients with dysphagia after stroke who were admitted to the rehabilitation medicine department of a third-level A hospital from October 2021 to August 2022 were selected as the study objects by convenience sampling method.According to the order of admission,the patients were divided into the experimental group and the control group,each with 32 cases.The control group underwent routine swallowing and feeding rehabilitation training,and the experimental group underwent cluster feeding training.Standard swallowing function scale(SSA)and Functional Oral Feeding Scale(FOIS)were used to evaluate the changes of swallowing function and oral feeding function before and after treatment.Swallowing safety positive rate(incidence of choking and abnormal voice)was used to evaluate the incidence of swallowing aspiration.The improvement of nutritional status was assessed by body mass index(BMI).The test data were sorted and statistically analyzed by EXCELE and SPASS25.0 software,and there was statistical difference at P < 0.05.Results1 According to the inclusion and exclusion criteria and the quality evaluation of literatures,17 literatures meeting the requirements were finally selected,including 5 guidelines,2 systematic reviews,6expert consensus,and 4 best evidence summaries.After the evidence was extracted and integrated,4evidence themes and 27 best pieces of evidence were formed: direct ingestion assessment,food texture improvement,postural compensation,post-ingestion monitoring.2.The first draft of the bunching scheme was formed after the group discussion on bunching scheme construction and two rounds of Delphi expert consultation were conducted.According to the expert selection criteria,a total of 20 experts from 11 Grade A hospitals in Henan Province,Zhejiang Province,Chengdu City,Guangzhou City,Wuhan City,Wuxi City and Nanjing were selected.In the two rounds of correspondence,the positive coefficient of experts was 90% and 75% respectively.The coefficient of judging basis is 0.95 and 0.96,the coefficient of familiarity is 0.92 and 0.96,the academic level is 0.84 and0.83,and the authority coefficient of the two rounds of experts is 0.90 and 0.92,respectively.Kendall’s harmony coefficient is 0.650 and 0.197 respectively.The cluster feeding training program for stroke patients with dysphagia included 9 cluster nursing measures in 7 evidence topics,including feeding assessment,food texture improvement,postural compensation,intermittent oral tube feeding,free drinking water training,oral hygiene management,and post-ingestion monitoring.3 Clinical intervention results:3.1 Before intervention,there was no statistical difference in age,gender,disease type and other general baseline data between the two groups(P > 0.05),and the baseline data between the two groups were comparable.3.2 Before treatment,there was no statistical difference in baseline values of standard swallowing function Scale(SSA)scores between control group and experimental group(P > 0.05);After treatment,the mean score of swallowing function in both groups was increased compared with that before treatment(P <0.05),and the score of swallowing function in test group was higher than that in control group,and the difference between groups was statistically significant(P < 0.05).3.3 Before treatment,there was no statistical difference in the baseline FOIS swallowing function score between the control group and the experimental group(P > 0.05),and after treatment,the FOIS score of the two groups was increased compared with that before treatment(P < 0.05),and the FOIS score of the experimental group was higher than that of the control group,and the difference between groups was statistically significant(P < 0.05).3.4 After the control group implemented routine swallowing training,the positive rate of coughing decreased from 75% before treatment to 50%,and the difference before and after treatment was statistically significant(P < 0.05).The incidence of abnormal pronunciation decreased from 46.9% to31.3%,and there was no significant difference before and after treatment(P > 0.05).After group feeding training,the positive rate of coughing decreased from 59.4% before treatment to 25%,and the difference was statistically significant(P < 0.05).The incidence of abnormal pronunciation decreased from 43.8% to9.4%,and the difference was statistically significant before and after treatment(P < 0.05).Before treatment,there was no significant difference in the positive rate of coughing and positive rate of swallowing safety between the control group and the experimental group(P > 0.05),but there was significant difference after treatment(P < 0.05).3.5 Before treatment,the body mass index scores of the control group and the experimental group were tested by t test,and there was no statistical difference in baseline value(P > 0.05);After treatment,the mean body mass index score of the two groups was increased compared with that before treatment(P<0.01),and the mean body mass index score of the experimental group was higher than that of the control group,and the difference between the groups was statistically significant(P<0.01).ConclusionsBased on the theory of evidence-based nursing,the training program of cluster feeding has scientific rigor after the letter of Delphi experts.The feasibility and effect of the scheme were verified by the similar experimental research method,which confirmed that the scheme could improve the swallowing function,feeding capacity and swallowing safety of patients,improve the nutritional status of patients,and provide a basis for clinical medical staff to carry out swallowing management. |
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