妊娠期糖尿病产妇分娩的新生儿血糖管理审查指标的制订及障碍因素分析

目的全面评估妊娠期糖尿病产妇分娩的新生儿血糖管理的临床现状,制订循证护理审查指标,分析障碍及促进因素。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,进行文献检索、评价并汇总证据,制订审查指标及审查方法;根据基线审查结果进行障碍因素分析,制订对策。结果本研究共纳入10条最佳证据,制订14条审查指标,其中仅2条指标依从率为100%,对审查结果逐条分析后得出主要障碍因素为系统层面流程制度缺乏、护士低血糖相关培训不足、产妇及家属对新生儿低血糖认知不够等,主要促进因素为领导力强、多团队协作等。实施相应对策后,14条审查指标依从率均>90%,其中10条为100%。结论科学、全面评估实践中的障碍与促进因素,并给予相应的对策,可以有效促进证据在临床中的应用。

Establishment and obstacle analysis of evidence-based nursing indexes of blood glucose management in neonates delivered by mothers with gestational diabetes

Objective To comprehensively evaluate the clinical status of blood glucose management in neonates delivered by mothers with gestational diabetes in obstetrics，and to develop review indicators of evidence based nursing，analyze obstacles and contributing factors. Methods With JBI health care model as the evidence based theoretical framework，clinical problems were identified；literature retrieval，evaluation and evidence were collected；review indicators and review methods were developed. According to the results of baseline review,the obstacle factors were analyzed,and methods and countermeasures were developed. Result Totally 10 pieces of best evidence were included and 14 clinical review indicators were formulated,of which there are only 2 indicators with the compliance rate of 100%. After detailed analysis of the results,it is concluded that the main obstacles are the lack of process management,insufficient training of nurses on hypoglycemia and the lack of awareness of mothers and family members. The main contributing factors are strong leadership and team work. According to implementation of the corresponding countermeasures,compliance rates of 14 indicators were all above 90%,of which 10 were 100%. Conclusion The obstacles and contributing factors in practice were scientifically and comprehensively evaluated,and corresponding countermeasures were properly proposed,which can effectively promote the application of evidence in clinical practice.