促进实践研究实证的成功例子

目的：促进实践研究实证需要多方面配合,获取医院管理层及一线护理人员的支持是其中重要一环。该研究拟定1项成年人人工气道内吸痰指引,应用在香港两间医院深切治疗部,探讨医院管理层对整个循证指引实践过程和护士实践指引依从性的影响。研究方法：研究分4个阶段：①拟定最佳护理实务指引,计划发放及实践指引的方法;②评估当前深切治疗部护士为病人进行人工气道内吸痰的情况;③发放及实践最佳护理实务指引;④评估在深切治疗部实践指引的整个过程及护士对指引的依从性。结果：实践指引前的审核结果显示,当前护理实务与循证护理建议存在着差异。实践指引后的审核结果显示,整体上护士的气管导管内吸痰技术良好,其中96%的依从性达75%或以上。实践指引前（73%）及后（89%）依从性的差异有统计学意义（t=-7.67,P〈0.005）。结论：研究确立了使用一套严紧及有系统的方法,更能有效地评估循证护理的成效。实践实证时除采用不同的实践指引方法和订立清晰的实践程序,临床管理人员的参与和支持对促进护士使用研究实证亦相当重要。

The success example of application research findings: the assessment of clinical guideline for tracheal suctioning

Objective： It was important to obtain support from hospital managers and clinical nurses in order to utilize research findings in practice . This study was to formulate a guideline for tracheal suctioning, apply it in intensive care units in two hospitals in Hong Kong and to explore the influence of hospital managers in the application of evidence based guidance and the compliance of nurses with the guideline. Methods： The four steps of this study were： ① to formulate the best practice guideline, and make a distributing and guiding plan; ② to assess the tracheal suctioning in intensive care unit; ③ to distribute the guideline and guide nurses; ④ to assess the compliance of nurses with guiding and the guideline. Results： There was difference between practice and guideline before the application of the guideline. After the application of the guideline, the tracheal suctioning skill of nurses was good, and 96% nurses compliance with the guideline at 75% suctioning . The compliance was 89% after application of the guideline, significantly higher than that before application（73%）（t=-7.67, P〈0.005）. Conclusion： This study established a strict and systematic method to evaluate the efficiency of evidence based nursing. Application research findings should adopt different guide method, establish limpid practice procedure and it was very importance to let the managers take part in the application process and obtain their support .