产程中经口摄入能量管理审查指标的制订及障碍因素分析

目的 开展产程中经口摄入能量管理的循证实践,构建审查指标,分析循证实践过程中的障碍因素及促进因素,制订变革策略。 方法 以乔安娜布里格斯研究所循证卫生保健模式为理论框架,确定临床护理问题,组建循证实践小组,系统检索、评价和汇总证据,制订审查指标并明确审查方法,2021年7月1日—8月20日进行基线审查,根据基线审查结果分析循证实践过程中存在的障碍、促进因素,并制订相应的策略。 结果 该研究共纳入18条最佳证据,制订13条审查指标,共9条指标准确执行率<60%,且其中5条准确执行率为0。助产士重视程度不够且相关知识了解不足,科室缺乏产程中限制经口摄入能量危险因素的评估工具、缺乏具体的饮食推荐方案及管理流程与宣教材料等是主要障碍因素,组织领导力强、有多学科团队支持、产妇及其家属参与积极性高等是主要促进因素,依此制订了相应的变革策略。 结论 该研究基于最佳证据和专业判断构建的审查指标科学、有效,具有适宜性和可行性,障碍因素及促进因素分析与变革策略的制订可为推进产程中经口摄入能量管理临床实践提供保障。

Development of review indicators and analysis of obstacles for oral intake management during labor

Objective To implement evidence-based practice of oral intake management during labor,develop review indicators,analyze obstacles and facilitators during implementation,and formulate reform strategies. Methods With the Joanna Briggs Institute evidence-based health care model as the guiding framework,an evidence-based practice team was formed after the clinical nursing problem was identified to search,evaluate and summarize the evidence,and to develop review indicators as well as review methods. Obstacles and facilitators were analyzed according to the baseline review results,and reform strategies were formulated. Results Totally 18 pieces of best evidence were included and 13 review indicators were formulated. There were 9 indicators with accurate execution rate of <60% and 5 of them were 0. The main obstacles were the lack of attention and relevant knowledge of midwives,the lack of assessment tools for risk factors of restricting oral intake during labor,specific dietary recommendations,management procedures as well as educational materials for different groups. The main facilitators were strong organizational leadership,multi-disciplinary team support,and high maternal and family participation and etc. Accordingly,corresponding reform strategies were formulated. Conclusion The review indicators constructed based on best evidence and combined with professional judgment were scientific,effective,appropriate and feasible. The analysis of obstacles and facilitators and the formulation of reform strategies can provide a guarantee for promoting the clinical practice of oral intake management during labor.