肾移植患者住院期间体力活动的循证护理实践

目的 将肾移植患者体力活动最佳证据应用于临床实践，评价其实施效果，以期促进肾移植患者早期康复。方法 应用循证护理学方法，系统检索2009年1月—2021年3月国内外有关肾移植患者体力活动的指南、系统评价、证据总结、专家共识等。2021年5月—12月，以知识转化模式为指导，结合临床情景与利益相关者主观意愿，对最佳证据进行筛选，制订循证实践方案，并于2022年4月—6月在安徽省某三级甲等医院器官移植中心实施，比较方案应用前后护士对审查指标的执行率，以及肾移植患者握力、2 min步行距离、30 s坐立次数、首次离床日、首次排气日、自理能力、自我效能感、锻炼意向、平均住院日等体力活动水平与早期恢复相关结局指标。结果 循证实践后护士对审查指标的执行率从33.33%～73.33%上升至34.48%～100%，差异有统计学意义（P<0.05）。肾移植患者术后首次离床日由7(7,8) d缩短至5(5,6) d，首次排气日由3(3,4) d缩短至2(2,3) d，自理能力得分由92(90,95)分提高至100(95,100)分，自我效能感得分由（25.07±5.06）分提高至（29.69±6.43...

Evidence based nursing practice of physical activity of kidney transplant recipients during hospitalization

Objective To apply the best evidence of physical activity in kidney transplant recipients（KTRs） to clinical practice and evaluate the implementation effect，so as to promote the early recovery of KTRs. Methods Using the method of evidence-based nursing，the guidelines，systematic reviews and expert consensuses about the physical activity of KTRs in China and abroad from January 2009 to March 2021 were retrieved systematically. From May 2021 to December 2021，under the guidance of the Knowledge to Action Framework，and in combination with clinical scenarios and subjective wishes of stakeholders，the best evidence was cut and adjusted，and an evidence-based practice plan was formulated and implemented in an organ transplantation center of a tertiary hospital in Anhui Province from April 2022 to June 2022. The nurse execution rates before and after the application of the plan，the grip strength of renal transplant recipients，the 2-minute walk distance，the 30-second sitting frequency，the first-bed departure date，the first exhaust date，self-care ability，self-efficacy，exercise intention，the average hospitalization day，and other physical activity levels and early recovery-related outcome indicators were compared. Results After evidence-based practice，the implementation rate of nurse review index increased from 33.33%~73.33% to 34.48%~100%，and the difference was statistically significant（P<0.05）. The date of first leaving bed was shortened to 5（5，6）days from 7（7，8） days；the date of first exhaust was shortened to 2（2，3） days from 3（3，4） days；the score of self-care ability was increased from 92（90，95） to 100（95，100）；the score of self-efficacy was increased from（25.07±5.06） to（29.69±6.43）；the score of exercise intention increased from 16（12，16） to 16（14，19），and the differences were statistically significant（P<0.05）. Conclusion Evidence-based nursing practice of physical activity in KTRs during hospitalization can improve the implementation rate of nurse review indexes，shorten the bed rest time after the operation，improve the outcome indexes such as self-care ability and self-efficacy of patients，and promote the early prognosis of patients.