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In this article, the author pointed out the challenges for evidence-based practice in hospitals, and supplied advice for promoting.
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Objective:To construct a plan for relieving fatigue in breast cancer patients undergoing chemotherapy.Methods:We combined literature and clinical experience to construct a fatigue relief plan for breast cancer chemotherapy patients from August to October 2020. A total of 21 domestic two-glandular surgeons, nursing experts, and surgical nursing teachers were invited to conduct 2 rounds of Delphi expert letter inquiries, and analyzed the positive coefficient of experts and the degree of expert authority to evaluate the reliability of experts, and evaluated the coordination degree of expert opinions through the coefficient of variation and Kendall's harmony coefficient.Results:The effective response rate of the two rounds of questionnaires was 100%, the enthusiasm coefficient of experts was very high. The authority coefficients of the 2 rounds of consulting experts were 0.89 and 0.90 respectively (all>0.7), expert authority coefficient was very high. The Kendall harmony coefficients of the first-level and second-level indicators in the first round were 0.160 and 0.086, statistically significant (all P<0.05). In the second round, the Kendall′s harmony coefficients of dimension, first-level and second-level indicators were 0.190, 0.211, 0.378, statistically significant (all P<0.05). The coefficient of variation of each item in the second round was 0.04-0.12, and the full score rate was 28.57%-95.24%. All met the index screening standards established by the scheme. Finally, 3 dimensions, 3 first-level indicators and 16 third-level indicators were determined. Conclusions:The fatigue relief plan for breast cancer chemotherapy patients has necessity, practicality and scientificity.It has guiding significance for standardizing the fatigue relief of patients undergoing chemotherapy after radical mastectomy.
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Objective To develop the Pressure Ulcer trigger tool, and to test the reliability and validity of the tool. Methods The tool was developed based on the conceptual schema of pressure ulcer, literature analysis and nursing practices, the Pressure Ulcer trigger tool was developed totally 274 records from 193 children were used to test the reliability and validity of the Pressure Ulcer trigger tool. Results The Pressure Ulcer trigger tool consisted of 3 items. The Cronbach's α coefficient for the total scale was 0.826, and Cronbach's α coefficient of each factor ranged from 0.743 to 0.819. The intra-class correlation coefficient was 0.941. The content validity index was 0.945, the correlation coefficients among each item ranged from 0.434 to 0.524, and the coefficient between each item score and total score ranged from 0.703 to 0.870. Concurrent validity was indicated by high sensitivity (100%) and specificity (96.40%). Parallel validity test Kappa value was 0.819. Conclusion The Pressure Ulcer trigger tool showed excellent preliminary psychometric performance when used to assess risk of pressure ulcer in pediatric patients, while further researches are merited.
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Objective To develop a nurse-driven analgesia and sedation management plan and determine whether the protocol leads positive results.Methods This was a before and after protocol implementation study in 2 pediatric intensive care units of 2 tertiary care hospitals.A total of 77 medical pediatric patients requiring mechanical ventilation with pediatric intensive care unit (PICU) length of stay for at least 24 h were included.Prior to implementation of the protocol,analgesia and sedation was managed by the attending physician's order.Afterwards,post implementation,nurses managed analgesia and sedation following the protocol,including maximum human care,complying the same sedation objective,ordination of the speed according to Comfort Scale and Withdrawal Assessment Tool.Results Before the implementation of protocol,the amount of murphy equivalent was (18.51 ± 13.34) mg/kg,the amount and time of Midazolam were (26.29 ± 13.58) mg/kg and (137.31 ± 104.78) h respectively,mechanical ventilation time was (174.00±90.17)h and time of PICU stay was (12.28 ± 8.86) d;after the implementation of protocol the indexes were (11.46 ± 15.97) mg/kg,(12.01 ± 10.06) mg/kg,(99.44 ±47.29) h,(111.15 ± 58.82) h,(10.88 ± 7.68) d,and there were significant differences (t=0.743-2.595,P＜0.05).The incidence of withdrawal after the implementation of protocol (19.44％,7/36) was significantly lower than that before the implementation of protocol (4.88％,2/41),and there was significant difference (x2=3.940,P＜ 0.05).The coincidence of sedation assessment of after the implementation of protocol was 93.33％ (126/135),that of before the implementation of protocol was 83.67％ (82/98),and there was significant difference (x2=5.532,P＜0.05).Conclusions The plan takes "early analgesia,minimizing sedation,maximizing human concern" as the guiding ideology,and strives to achieve the goal of sedation individualization,clarification of medical and nursing responsibilities,continuity of medical communication,standardization of drug selection and regulation,routinization of withdrawal procedures,routinization of evaluation records,and the management of analgesia and sedation is included in the department.In the key projects of nursing quality management,we should institutionalize the implementation process management.The implementation of the program improves the comfort level of children,thus reducing the stress state of children,reducing the incidence of withdrawal symptoms and unplanned extubation,and ultimately reducing drug consumption and mechanical ventilation time.