预防住院患者经鼻管喂养非计划拔管的循证护理实践

目的 探讨基于最佳证据的预防住院患者经鼻管喂养非计划拔管的干预方法并评价其效果。方法 采用JBI临床证据实践模式检索中国知网、万方、JBI（Joanna Briggs Institute）Library、Cochrane Library、PubMed、英国国家临床优化研究所指南库（National Institutefor Health and Care Excellence, NICE）以及美国国立指南文库（National Guideline Clearinghouse, NGC）获取患者经鼻管喂养非计划拔管策略的最佳证据,利用JBI 2014版证据分级系统进行证据质量评价,并将证据转化为临床审查标准。结果 循证实践后,非计划拔管率低于证据应用前（P<0.05）;管道固定合格率明显提高（P<0.05）;非计划拔管培训护士考核成绩由证据应用前（84.23±17.01）提高到证据应用后（95.02±7.32）,差异有统计学意义（P<0.05）;7条审查指标,护士的执行率由基线审查时的0~28%提高到证据应用后78.56%~100%,差异有统计学意义（P<0.05）。结论 基于循证的预防经鼻管喂养非计划拔管循证实践可以有效规范胃管的管理,提高护理人员胃管相关知识,降低非计划拔管率。

Evidence-based Nursing Practice of Unplanned Extubation of Inpatients with Nasal Tube Feeding

Objective To explore the best evidence-based interventions for nasal tube feeding and unplanned extubation in inpatients and to evaluate the efficacy. Methods With the JBI clinical Evidence Practice model, the Cochrane Library Pubmed for Health and Care Excellence (NICE) and the National Guideline Clearinghouse (NGC)were searched to obtain the best evidence on unplanned extubation.The quality of evidence was evaluated by using the JBI2014 version of evidence grading system and then the evidence was converted into clinical review standards. Results After the application of evidence,the rate of unplanned extubation was lower than before(P<0.05).The qualified rate of tube fixing was obviously improved(P<0.05). The examination score of nurses in unplanned extubation training was improved from 84.23±17.01 to 95.02±7.32, and the difference was statistically significant(P<0.05). The 7 review indicators showed that the execution rate of nurses increased from 0~28% at the baseline review to 78.56%~100% after the application of evidence, showing statistical significance (P<0.05). Conclusion Evidence-based unplanned extubation through nasal tube feeding can effectively standardize the management and nursing practice of gastric tube, improve nursing staff's knowledge of gastric tube, and reduce the rate of unplanned extubation.