产妇正常分娩第二三产程护理的循证实践

doi:10.3761/j.issn.0254-1769.2020.12.003

摘要/Abstract

摘要：

目的探讨基于最佳证据的产妇正常分娩第二、三产程的护理方案,并评价其应用效果。方法应用循证的方法系统检索产妇正常分娩第二、三产程护理方案的国内外指南,评价并汇总最佳证据,制订审查指标,进行基线审查,基于审查结果分析促进和障碍因素。比较证据应用前后产妇的分娩结局,助产士对产妇正常分娩第二、三产程护理措施的认知水平及审查指标的执行情况。结果最佳证据应用后,产妇会阴完整率从7.9%提升到13.4%;助产士对产妇正常分娩第二、三产程护理措施的认知得分从培训前的25~85（54.9±14.3）分提升至50~100（77.1±13.8）分;除指标14、15外,证据应用前执行率<50%指标的执行率均上升到70%以上。结论本研究基于最佳证据,结合科室临床情境、患者意愿,并通过分析促进和障碍因素,制订产妇正常分娩第二、三产程的护理方案,证据应用后,产妇会阴完整率、助产士相关护理措施认知水平得到提高,助产士工作行为得到规范。

关键词: 分娩, 第二产程, 第三产程, 循证护理, 产科护理

Abstract:

Objective To explore the nursing care plan based on the best evidence for the second and third parturition of normal delivery,and to evaluate its application effects. Methods Evidence-based methods are used to systematically retrieve domestic and foreign guidelines for the second and third parturition nursing measures for normal delivery of women,to evaluate and summarize the best evidence,to formulate review indicators,to conduct baseline reviews,and analyze the contributing and obstacle factors based on the review results. A variety of methods were used to train midwives and obstetric nurses,and to compare the delivery outcomes of mothers before and after the application of the evidence,the degree of knowledge and implementation of the evidence by nursing staff. Results After the application of the best evidence,the rates of maternal perineal intact increased from 7.9% to 13.4%;the midwives’ scores of knowledge related to the second and third stages of labor increased from 25~85（54.9±14.3）before training to 50~100（77.1±13.8）;except indicatiors 14 and 15,the implementation rate of less than 50% of indicators before the application of evidence have all risen to more than 70%. Conclusion This study is based on the best evidence,combined with the clinical situation of the department,the patient’s willingness. The factors of contributing and obstacle risks were analyzed to formulate the nursing plans of the second and third stage of labor for the normal delivery of the mothers. After the implementation of the evidence,the level of perineal intactness of mothers is improved;the level of knowledge of midwives is improved and their working behavior is regulated.

Key words: Parturition, Second Stage of Labor, Third Stage of Labor, Evidence-Based Nursing, Obste-trical Nursing

冯嘉蕾,岳洁雅,陈飞,袁艳丽,刘军,包艾荣,陈梅,邓俊,李晶,丁炎明. 产妇正常分娩第二三产程护理的循证实践[J]. 中华护理杂志, 2020, 55(12): 1777-1783.

FENG Jialei,YUE Jieya,CHEN Fei,YUAN Yanli,LIU Jun,BAO Airong,CHEN Mei,DENG Jun,LI Jing,DING Yanming. Evidence-based practice of midwifery care in the second and third stage of labor in normal delivery[J]. Chinese Journal of Nursing, 2020, 55(12): 1777-1783.

图/表 3

表1 产妇正常分娩第二、三产程循证护理方案的最佳证据总结

Table 1 Best evidence summary for midwifery care in the second and third stage of delivery

表2 产妇正常分娩第二、三产程循证护理方案的审查指标

Table 2 Review indicators of evidence-based practice of midwifery care

表3 证据应用前后助产士对审查指标执行率的比较

Table 3 The implementation rate of indicators before and after the application of evidence

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