化疗失眠患者评估和护理的最佳证据应用

目的评估目前与化疗患者失眠的评估和护理相关的循证证据,将与化疗患者失眠的评估和护理的相关最佳证据应用到护理实践中,通过质量审查促进临床护理质量的改进。方法2016年6-9月,在我院化疗科完成了2轮质量审查。查询到了澳大利亚乔安娜·布里格斯研究中心(Joanna Briggs Institute,JBI)在线临床治疗及护理证据网络(COnNECT+)数据库及美国国立综合癌症网络(National Comprehensive Cancer Network,NCCN)中有关化疗患者失眠的最佳证据推荐,根据证据制定了5条审查标准,进行了证据应用前的基线审查,分析了证据应用存在的障碍、可获得的资源及解决办法,制定了相应的循证实践方案,将现有的最佳证据整合到护理实践中,再实施了干预后的审查。结果在基线审查中,5条审查标准的依从性为0~28.57%,将最佳证据引入到护理实践后,第2轮审查中,5条审查标准的依从性达到了69.56%~100%;护士和患者的知识得到了提升;患者的失眠率下降。结论本次最佳证据应用改进了化疗患者失眠的评估和护理的护理实践,提高了护理质量。     

提高妇科手术后留置导尿管相关管理水平的循证实践

目的评估目前与留置导尿管相关管理的循证实践,将留置导尿管相关管理的最佳证据应用到护理实践中,通过质量审查促进临床护理质量的改进。方法 2015年7-10月在一个妇科病房完成留置导尿管管理质量审查。用澳大利亚乔安娜·布里格斯研究中心(Joanna briggs institute,JBI)根据最佳证据制订的4条审查标准,进行临床留置导尿管相关管理的基线审查,制定相应的循证实践方案。并运用JBI临床证据实践系统,将现有的最佳证据整合到护理实践中,再实施干预后的审查。结果将最佳证据引入护理实践后,四条审查标准的依从性均达到100%,妇科术后留置导尿患者的知识水平显著提升。结论本次循证护理实践项目改进了导尿管管理的护理实践,但仍需结合临床实际,不断完善,以促进护理质量的提升。     

脑卒中患者下肢深静脉血栓预防管理的循证护理实践

目的将评估和预防脑卒中患者下肢发生深静脉血栓的循证最佳证据运用到临床实践中,提高护士对患者卒中后下肢深静脉发生血栓风险评估的依从性和干预管理的能力。方法通过澳大利亚阿德莱德的乔安娜·布里格斯研究中心系统的临床最佳证据应用系统工具,制订出7条审查标准,对神经内科20名护士和30例入院脑卒中患者进行第1轮审查,循证最佳证据实践后进行第2轮审查。结果 7条审查标准执行依从性从基线审查的56.67%上升到第2轮审查70.00%～100.00%;下肢深静脉血栓风险筛查从零上升至100.00%。结论通过质量审查提高了护士对脑卒中患者下肢发生深静脉血栓风险评估能力和预防管理能力,建立了风险评估模型和预防流程,降低了脑卒中患者下肢发生深静脉血栓的发病率。     

全喉切除术患者术前护理评估及健康教育的最佳证据应用

目的将全喉切除术患者术前评估及健康教育的最佳证据应用于临床实践,提高护士对相关证据应用的依从性,改善护理质量。方法采用JBI临床证据应用系统(PACES),基于现有的最佳证据,制订了5条审查标准,将证据融入护理实践,在一个耳鼻喉科病房开展基线审查-证据应用-第2轮质量审查。结果在第2轮质量审查时,1条审查标准的执行率达到94%,其余4条审查标准的执行率均达到100%,较基线提高31%~100%;患者相关疾病知识得分从12.5分提升至14.1分。结论基于证据的质量审查项目改善了护理实践行为,但是证据应用项目的成功实施必须结合临床情境和我国国情。     

炎症性肠病患者鼻胃管置管最佳证据实践

目的将与鼻胃管置管不良反应及置管成功率相关的最佳证据应用到炎症性肠病患者护理实践中,以促进临床护理质量的改进。方法根据最佳证据制订了6条审查标准,将证据融入护理常规与操作流程,在炎症性肠病特色病区开展了2轮质量审查与流程再造。结果在基线审查中,6条审查标准的依从性为0～62%;将最佳证据引入到护理实践后第两轮审查中,所有审查标准依从性均达到100%,置管护士的专业理论与操作技能得分均90分以上,基线和第2轮审查比较,置管疼痛等不良反应与置管的一次性成功率差异有统计学意义(P0.05)。结论基于循证的质量审查项目能提高炎症性肠病患者肠内营养和鼻胃管置管的临床管理,提高患者在置管过程中的配合程度和良好体验及一次性置管的成功率,并大幅度降低置管过程中的不良反应。     

腹腔镜术后恶心呕吐预防和管理的循证护理实践

目的:实施术后恶心呕吐预防和管理的循证实践并观察其效果。方法:应用循证护理的方法形成最佳证据,以基于证据的持续质量改进模式为理论框架,按照证据获取、现状审查、证据应用和效果评价,于2021年3月—5月将证据应用于术后恶心呕吐病人的管理中,比较循证实践应用前后病人术后恶心呕吐的发生率、恶心呕吐程度的改变等指标的变化。结果:循证实践应用了22条证据,证据应用组术后恶心呕吐的发生率和术后恶心呕吐的程度均明显低于基线审查组,差异有统计学意义(P<0.05)。结论:通过循证护理对术后恶心呕吐进行管理,可有效减少术后恶心呕吐的发生,降低术后恶心呕吐反应的程度,同时规范了术后恶心呕吐管理的方法和护理措施,提高了护士循证实践的能力。     

颅脑损伤患者目标温度管理的循证实践

目的 将颅脑损伤患者目标温度管理最佳证据应用于临床实践并评价其效果。方法 遵循乔安娜布里格斯研究所循证护理中心应用模式，基于最佳证据制订16条审查指标，以基于证据的持续质量改进模式为理论框架，于2021年6月—2022年4月，按照基线审查、实践变革和证据应用后变革效果的再审查将循证实践应用于神经外科ICU颅脑损伤患者，比较循证实践前后护理人员审查指标的执行率、目标温度管理相关知识水平、循证实践能力、患者并发症发生率及组织文化水平等。结果 循证实践后，各项审查指标第1、2轮审查执行率较基线均有提升，其中审查指标2～3、7～11、13执行率提升显著，差异有统计学意义(P<0.05)；基线审查、第1轮审查、第2轮审查3组患者的3级寒颤发生率显著降低(χ²=7.680,P=0.021)；基线审查、第1轮审查、第2轮审查护士关于颅脑损伤患者目标温度管理的知识现状调查问卷、循证实践影响因素问卷得分均提高(F=3.827,P=0.025;F=4.997,P=0.009)，循证实践后护士循证护理实践障碍量表得分较基线降低(F=4.174,P=0.018)，组织文化水平较基线...     

脑卒中住院病人口腔护理的循证实践

[目的]制订和应用脑卒中住院病人口腔护理的最佳循证实践方案,规范护理人员口腔护理实践行为,提高口腔护理效果。[方法]结合最佳证据和情景分析,形成脑卒中住院病人口腔护理的最佳循证实践方案和脑卒中住院病人口腔护理标准护理流程,并将证据应用于神经内科病房脑卒中住院病人。审查小组制定了5条审查指标,对35名护士及30例脑卒中住院病人进行基线审查,经过对护理人员进行培训和开展临床实践3个月后进行第2轮审查。[结果]两轮审查显示,35名护士接受系统的口腔护理方案培训,行为依从率从11.43%～57.14%升至100.00%,质量审查前后病人口腔卫生评分比较差异有统计学意义(P0.05)。[结论]基于循证的质量审查项目可以改善护士应用最佳证据的执行行为,有效提高脑卒中住院病人的口腔护理效果。     

预防住院患儿跌倒的循证实践

目的：将预防住院患儿跌倒的最佳证据应用于临床，提高护士在预防住院患儿跌倒的护理实践活动中对于最佳证据的依从性，促进住院患儿的安全。方法采用JBI临床证据实践应用系统（JBI‐PACES ）的标准程序，基于现有最佳证据，制订了5条审查标准，将证据融入护理常规，在1个儿科病房开展质量审查，包括证据应用前的基线审查、实践变革和证据应用后变革效果的再审查。结果证据应用后，除第5条标准的依从率保持100％外，其余4条标准的依从率提高了22％～100％。家长的平均知识得分由13分上升至18分，护士的平均知识得分由37分上升至48分。结论基于循证的质量审查项目，改善了预防住院患儿跌倒的临床护理实践，但仍需要进行持续质量审查，以不断提高护理质量。     

3～12岁儿童术后疼痛评估的循证实践

目的：将3～12岁儿童术后疼痛评估的最佳证据应用于临床实践，提高护士对儿童术后疼痛的认知，促进开展正确有效的评估。方法遵循JBI循证护理中心的临床证据实践应用系统（JBI‐PACES）的标准程序，包括证据应用前基线审查、实践变革和证据应用后变革效果的再审查。获取JBI在线临床治疗及护理证据网络（COn‐N EC T＋）数据库中3～12岁儿童术后疼痛评估相关证据，并制订相应审查标准7条。采用现场观察法、访谈、查阅护理病历收集数据。证据应用前后各有30例手术患儿以及22名护士纳入。分析每条证据应用存在的障碍、可获得的资源及解决办法，因地制宜地制订实践方案。以护士每条标准行为依从性率评价证据应用前后的有效性。结果实施3～12岁儿童疼痛评估护理循证实践方案后，在JBI护理质量审查的7条标准中，7条标准的完成率均得到极大提高（0～97％，20％～93％，41％～97％，7％～100％，20％～93％，0～100％，0～97％）。干预后3～12岁儿童术后疼痛从容易被忽视，改进为中重度疼痛能够得到及早评估和管理。结论将JBI儿童术后疼痛评估循证标准应用于3～12岁患儿术后疼痛评估，能提高护士疼痛评估和管理的知识技能，从而提高儿童手术疼痛管理质量，但仍需落实持续质量改进。     

以护士主导的项目管理在肿瘤化疗无呕吐病房构建中的效果评价

目的探讨以护士主导的项目管理在肿瘤化疗无呕吐病房构建中的效果评价。方法成立肿瘤化疗无呕吐病房项目管理小组,以美国项目管理协会PMBOK项目实施的各阶段对“构建肿瘤化疗无呕吐病房”进行项目管理。结果通过实施项目管理后,病房化疗所致恶心呕吐（CINV）筛查率由9529%提升至100%,恶心发生率由1828%下降至946%,呕吐发生率由1489%下降至493%,差异均有统计学意义（P＜0.05）。患者对CINV管理满意度较实施前比较有所提升（P＜0.05）。结论通过项目管理,可有效降低CINV发生率,提高患者CINV管理满意度,从而提升临床护理工作质量。     

Efficacy and cost: avoiding undertreatment of chemotherapy-induced nausea and vomiting

Although nausea and vomiting occur in patients with cancer for various reasons, chemotherapy-induced nausea and vomiting (CINV) remains one of the most distressing symptoms associated with cancer therapy. Despite advances in the management of that side effect, patients with cancer receiving chemotherapy continue to report CINV. Oncology nurses should be aware of advances in the management of CINV. Healthcare provider perceptions of CINV may not accurately represent actual occurrence of the symptom, and CINV may affect patients' quality of life or even treatment adherence for selected patients. Although evidence-based guidelines are available, not all healthcare providers, including oncology nurses, follow recommendations for prevention of CINV. Inadequately treated CINV can lead to increased resource costs, as well as patient suffering. This article will review the evidence for the cost of inadequately treated CINV, as well as current clinical guidelines for management of this symptom. Oncology nurses are critical in the assessment and management of CINV, as well as in making recommendations for practice improvement.     

Clinical Updates in Nausea and Vomiting

ObjectiveTo review recent updated antiemetic guidelines from national cancer organizations and its impact on chemotherapy-induced nausea and vomiting (CINV) in the prevention and delayed phase of therapy. This article will also describe assessment and nursing strategies for individualized care and timely side effect management.Data SourcesData sources include peer-reviewed articles sourced in electronic databases.ConclusionCINV is a persistent problem for a large percentage of patients undergoing chemotherapy treatment despite advances in antiemetic therapy and increased use of targeted therapies. CINV management should be based on patient-focused assessment and adherence to national antiemetic guidelines. Ongoing assessment and follow-up are critical to ensure optimum management of side effects to optimized quality of life.Implications for Nursing PracticeAwareness of national antiemetic guidelines is important in caring for patients undergoing chemotherapy. CINV can have a significant impact on patients, causing physical effects, treatment delays, and diminished quality of life. Oncology nurses play a key role in assessment of patient-related risk factors, education of patients and caregivers regarding pain medications, side effects, and oral adherence and continued follow-up for early recognition and intervention for uncontrolled CINV.     

肿瘤化疗所致恶心呕吐现状调查

目的调查化疗所致恶心呕吐（chemotherapy—inducednauseaandvomiting,CINV）的患者心理预期和发生情况,并评估CINV对患者生活质量的影响,为提高临床医生对CINV的认识和重视提供依据。方法采用问卷调查的方式,调查华中科技大学同济医学院附属同济医院使用中度致吐风险化疗（MEC）或高度致吐风险化疗（HEC）的患者,并对其进行连续两周期相同化疗方案的随访。患者分别于化疗开始前、化疗第2天和化疗第6天,记录化疗期间急性、延迟性恶心呕吐发生情况、自主止吐用药和CINV对生活功能的影响,调查结果采用描述性分析和多元线性回归分析。结果本研究共调查344例患者,最终303例患者完成问卷调查。结果显示：单日化疗MEC组急性、延迟性和总的完全缓解率分别为86．1％、76．6％和71．5％,HEC组为84．1％、71．0％和66．7％。多日化疗患者分别为93．8％、64．9％和64．9％;第2周期化疗前患者关于恶心呕吐预期值和焦虑值与患者前一周期化疗延迟性恶心发生的严重程度密切相关;约30％的患者因CINV对生活功能造成负面影响。结论在行中度和高度致吐风险化疗的患者中,CINV治疗现状仍存在较大问题,尤其是在延迟期反应和恶心症状的控制方面。在临床实践中需进一步加强对CINV的关注,并提供更加有效的治疗措施。     

A prospective observational study of chemotherapy-related nausea and vomiting in routine practice in a UK cancer centre

Objective The aim of the study was to assess levels of chemotherapy-induced nausea and vomiting (CINV) in routine practice. Materials and methods The study was an observational prospective evaluation using patient self-reports. One hundred and two patients with cancer in a single cancer centre in UK receiving their first chemotherapy treatment participated in the study and were followed up over four cycles, providing a total of 272 assessments of nausea and vomiting. Data was collected with the use of the MASCC Antiemesis Tool (MAT), which is an eight-item short clinical scale assessing acute and delayed nausea and vomiting after chemotherapy. Results Results indicated that acute vomiting was experienced by 15.7% of the patients in cycle 1 and delayed vomiting by 14.7%, while acute nausea was present in 37.3% of the patients and delayed nausea in 47.1%, increasing over the subsequent cycles. Moderately emetogenic and highly emetogenic chemotherapy had the highest incidence of CINV, whereas patients receiving highly emetogenic chemotherapy showed significant levels of delayed nausea. Acute symptoms were more easily controlled than delayed symptoms. Discussion The data suggest that, while vomiting is well controlled, nausea remains a significant problem in practice, and optimal management of CINV is yet to be achieved. Understanding more clearly the biological basis of nausea will assist in managing this complex symptom more effectively in practice.     

Evidence‐based practice for pain management for cancer patients in an acute care setting

The purpose of this study is to implement an evidence utilization project using an audit and feedback approach to improve cancer pain management. A three‐phased audit and feedback approach was used. A 46‐bed oncology nursing unit in the university's cancer centre was selected as a research site. Nursing records extracted from 137 patients (65 for the baseline assessment and 72 for the follow‐up audit) were used to examine nurse compliance with four audit criteria derived from best practice guidelines related to the assessment and management of pain. We observed a significant improvement in compliance from baseline to follow‐up for the following criteria: documenting the side effects of opioids (2–83%), use of a formalized pain assessment tool (22–75%), and providing education for pain assessment and management to patients and caregivers (0–47%). The audit and feedback method was applicable to the implementation of clinical practice guidelines for cancer pain management. Leadership from both administrative personnel and staff nurses working together contributes to the spread of an evidence‐based practice culture in clinical settings. As it was conducted in a single oncology nursing unit and was implemented over a short period of time, the results should be carefully interpreted.     

Update on the management of chemotherapy-induced nausea and vomiting.

Chemotherapy is associated with a variety of side effects, and many of these can be dose-limiting. One of the most dreaded side effects for patients receiving chemotherapy is nausea and vomiting, however. Although in the last 2 decades there have been several advances in the development of new therapies for prevention of chemotherapy-induced nausea and vomiting (CINV), recent pharmacologic advances have significantly improved control of this feared side effect. Antiemetic guidelines help clinicians manage CINV and are updated frequently. Ongoing studies further define appropriate management of patients with CINV; of particular interest is delayed nausea and vomiting. With the addition of the long-acting serotonin antagonist, palonosetron, and the unique neurokinin-1 antagonist, aprepitant, control of CINV has improved considerably for those patients receiving chemotherapy. This article discusses CINV and recent pharmacologic advances in controlling this side effect. Guidelines for the management of CINV are reviewed.     

Validation and psychometric assessment of a short clinical scale to measure chemotherapy-induced nausea and vomiting: the MASCC antiemesis tool

There is a lack of clinical tools to facilitate communication between clinicians and patients about chemotherapy-induced nausea and vomiting (CINV). The Multinational Association of Supportive Care in Cancer (MASCC) has developed such a tool, which is an eight-item scale for the assessment of acute and delayed nausea and vomiting, and is completed once per cycle of chemotherapy. The aim of the current study was to assess its psychometric properties, specifically reliability and validity, cultural transferability and equivalence, and congruence with proxy assessments, as well as to determine if accuracy of recall of CINV events using the MASCC Antiemesis Tool (MAT) differed over time from chemotherapy. A prospective study was carried out with adult cancer patients and their informal carers from two hospitals, one each in the United Kingdom (UK) and United States of America (U.S.). Patients completed the Rhodes Index for nausea, vomiting and retching (INVR) daily for the first five days after chemotherapy and were then asked to complete the MAT at one week, two weeks, or three weeks after chemotherapy. Carers completed an adapted MAT concurrently with patients. The sample consisted of 87 patients and 22 informal carers. The internal consistency reliability of the scale was high, with Cronbach alphas of 0.77 (patient sample) and 0.82 (carer sample). Responses were similar between the UK and U.S. samples in terms of nausea and vomiting, and both samples found the scale easy to use. Contrasted-groups validity (using age as a grouping variable) and concurrent validity (MAT compared with INVR) suggested that the scale is sensitive to detect the different dimensions of CINV and performed well against a daily assessment of nausea/vomiting (total score correlation r=0.86, P<0.001). Recall of events was high even three weeks after chemotherapy (correlations with INVR of 0.44-0.99, all P<0.01). Factor analysis clearly identified three factors, namely vomiting, acute nausea, and delayed nausea. Proxy assessments by carers were congruent with the patients' responses, especially in relation to vomiting. The MAT is a reliable, valid, clear, and easy-to-use clinical tool that could facilitate discussion between clinicians and patients about their nausea and vomiting experience, thereby potentially aiding treatment decisions. Regular assessment of nausea and vomiting after chemotherapy has the potential to significantly improve CINV management.