Evidence-based Management Of Fatigue After Maintenance Hemodialysi

Objectives:To systematically search and evaluate the clinical practice guidelines and evidence synthesis of post-dialysis fatigue management at home and abroad,and to screen the best evidence that falls within the scope of nursing responsibility for this topic;Understanding the gap between clinical practice and best evidence,identifying facilitating and hindering factors in evidence transformation,and integrating best evidence with clinical context and stakeholder attitudes and needs,draw up the action strategy of the corresponding recommendation opinion,construct the evidence-based practice plan of the management of fatigue after hemodialysis and carry it out,thus improve the knowledge,skill level and evidence-based consciousness of the nurses in the hemodialysis room,and the nursing operation can be unified and standardized,finally,improve the quality of nursing care of hemodialysis fatigue management in the pilot ward.Methods:Guided by the JBI evidence-based practice model and triggered by the best evidence and clinical status of post-dialysis fatigue management,this study established an evidence-based practice team and used the literature research method to retrieve relevant guidelines and evidence synthesis at home and abroad,the literature evaluation tool was used to make a strict evaluation,and the best evidence pool with high quality was recommended as the basis of evidence-based management of post-dialysis fatigue.Investigation and interview were used to evaluate the clinical applicability of the best evidence,and to determine the final recommended items,so as to establish the review criteria.Using the methods of non-participation observation,interview and Questionnaire Survey,the author conducted a baseline review of the clinical practice in the department,and analyzed the obstacles and promoting factors in the implementation of the guidelines in the pilot ward according to the results of the review,develop appropriate action strategies,and ultimately develop appropriate clinical practice programs,the program will be introduced to the ward,evaluation process and results.Results:①Through systematic search and screening,this study included evidence-based Guide 0,Evidence Synthesis 6,System Evaluation 1,Expert Consensus 1.The quality evaluation of different literatures showed that the overall quality of the included literatures was good.②A total of 28 pieces of evidence were finally included.After translation,correction and synthesis,the final 6 pieces of recommendations and 12 pieces of review criteria were obtained.③The results showed that the incidence of fatigue was 70%,most of them were moderate fatigue,6 recommendations in the pilot ward were not ideal,the clinical compliance rate was less than 60%,and the rate of reaching the standard of patient and nurse knowledge questionnaire was 28.57%.④ According to the results of baseline survey,the evidence-based practice plan of this study was constructed based on clinical actual situation,patient’s preference and values,including related nursing management process,knowledge manual,education manual and so on.⑤After the implementation of the plan,the patients:the level of fatigue management knowledge increased from(48.17 ± 14.58)points to(86.33±4.64)points,and the fatigue scale score decreased from(10.33 ± 2.71)points to(6.17 ± 2.39)points.Satisfaction Increased from(0.70 ± 0.05)to(0.86±0.05);Nurses:The level of fatigue management knowledge increased from(47.86 ± 8.09)points to(71.43 ± 4.76)points,and satisfaction increased from(0.46±0.06)to(0.90 ± 0.07);review criteria:the implementation rate of each item has increased from(0%—71.4%)to(66.67%—100%).Conclusion:① At present,the best evidence related to fatigue management after hemodialysis in foreign countries is generally of good quality,and the recommendations in the guidelines are basically the same,but many items have not been developed in clinical practice.Although there are still some gaps between the best evidence and the best evidence,after the implementation of relevant clinical practice,the implementation rate of the best evidence,the knowledge level and satisfaction of patients and nurses have been greatly improved,and the degree of fatigue of patients has also been more Great improvement.This clinical practice has high clinical significance.③ This clinical practice has promoted the construction of the organizational level of care management for fatigued patients in the pilot ward.At present,the pilot ward already has the conditions to carry out evidence-based practice.Nursing managers have a very positive and supportive attitude to the change of evidence-based practice.Stakeholders have a more positive attitude towards the change of evidence-based practice.This study shows that constructing an evidence-based practice based on the best evidence,clinical scenarios,and stakeholder value orientation is a feasible and scientific method and an indispensable step before clinical transformation of evidence.