基于循证的孕产妇盆底肌功能训练教育计划与实践效果

目的制定基于证据的孕产妇盆底肌功能训练教育计划,并评价实践效果。方法系统检索盆底肌功能训练相关证据,应用JBI的GRiP模式,分为证据应用前的基线审查(对产科病房的18名护士及30例孕产妇进行调查)、将证据引入实践、证据应用后再次审查(18名护士及30例孕产妇)3个阶段。结果建立了盆底肌功能训练教育流程。护士对盆底肌功能训练的知识和技能从基线审查时的2.67分提高到证据应用后的10.33分(P0.01);5条审查指标的执行率从基线审查时的11.1%、16.7%、0、16.7%、0,分别提高到证据应用后的100%、100%、100%、90.0%、63.3%(均P0.01)。孕产妇关于盆底肌功能训练的知识从2.03分提高到9.60分,训练意愿从60.0%提高到100%,训练准确率从10.0%提高到90.0%(均P0.01)。结论基于循证的孕产妇盆底肌功能训练教育计划可规范护士用证行为及提高护士的教育能力,改善孕产妇的知识、态度和行为。     

Evidence implementation: Development of an online methodology from the knowledge‐to‐action model of knowledge translation

This paper describes an online facilitation for operationalizing the knowledge‐to‐action (KTA) model. The KTA model incorporates implementation planning that is optimally suited to the information needs of clinicians. The can‐implement ^© is an evidence implementation process informed by the KTA model. An online counterpart, the can‐implement.pro ^©, was developed to enable greater dissemination and utilization of the can‐implement ^© process. The driver for this work was health professionals' need for facilitation that is iterative, informed by context and localized to the specific needs of users. The literature supporting this paper includes evaluation studies and theoretical concepts relevant to KTA model, evidence implementation and facilitation. Nursing and other health disciplines require a skill set and resources to successfully navigate the complexity of organizational requirements, inter‐professional leadership and day‐to‐day practical management to implement evidence into clinical practice. The can‐implement.pro ^© provides an accessible, inclusive system for evidence implementation projects. There is empirical support for evidence implementation informed by the KTA model, which in this phase of work has been developed for online uptake. Nurses and other clinicians seeking to implement evidence could benefit from the directed actions, planning advice and information embedded in the phases and steps of can‐implement.pro ^©.     

Fluid regimens for colostomy irrigation: a systematic review

Background Various techniques for managing faecal evacuation have been proposed; however, colostomy irrigation is favoured as it leads to better patient outcomes. Alternative fluid regimens for colostomy irrigation have been suggested to achieve effective evacuation. Aim The objective of this review was to summarise the best available evidence on the most effective fluid regimen for colostomy irrigation. Search strategy Trials were identified by electronic searches of CINAHL, PubMed, MEDLINE, Current Contents, the Cochrane Library and EMBASE. Unpublished articles and references lists from included studies were also searched. Selection criteria Randomised controlled trials and before-and-after studies investigating any fluid regimen for colostomy irrigation were eligible for inclusion. Outcomes measured included fluid inflow time, total wash-out time, haemodynamic changes during irrigation, cramps, leakage episodes, quality of life and level of satisfaction. Data collection and analysis Trial selection, quality appraisal and data extraction were carried out independently by two reviewers. Differences in opinion were resolved by discussion. Main results The systematic literature search strategy identified two cross-over trials that compared water with another fluid regimen. Owing to the differences in irrigating solutions used, the results were not pooled for analysis. Both the polyethylene glycol electrolyte solution and glyceryl trinitrate performed significantly better than water. Conclusion There is some evidence to support the effectiveness of fluid regimens other than water, such as polyethylene glycol electrolyte and glyceryl trinitrate, for colostomy irrigation. Further well-designed clinical trials are required to establish solid evidence on the effectiveness of other irrigating solutions that might enhance colonic irrigation.