关键词: 肾移植, 免疫抑制剂, 服药依从性, 审查指标, 障碍因素, 循证护理学

Abstract:

Objective To comprehensively evaluate the current clinical application status of evidence regarding immunosuppressive medication compliance management in kidney transplant patients，construct review indicators，analyze the obstacles and promoting factors，and further formulate reform strategies. Methods Using the Joanna Briggs Institute evidence-based health care model as the theoretical framework，clinical nursing issues were identified，and a systematic search，evaluation，and summarization of 38 items of evidence were conducted. An evidence-based practice group was established；review indicators were constructed；review methods were clarified. Baseline reviews of systems，healthcare professionals，patients，and their families were conducted from November 1，2022，to January 31，2023. According to the review results，the obstacles and promoting factors in the process of evidence-based practice were analyzed，and corresponding strategies were formulated. Results A total of 23 review indicators were constructed. Among them，the accurate execution rate of 15 indicators was less than 60%，and the accurate execution rate of 4 indicators was 0. The main obstacles include a lack of systems and processes in departments，poor knowledge，attitude，and practice of medical staff，a lack of standardized risk assessment，and a lack of information support for out-of-hospital management. The primary promoting factors are strong organizational leadership，multidisciplinary team support，and high participation enthusiasm of recipients and their families. Corresponding reform strategies are formulated accordingly，including process and system improvement，continuous quality monitoring，enhanced standardized training and assessment，electronic health intervention for medication compliance，and involving patients and their families in the medication compliance management process. Conclusion There is a significant gap between the evidence on immunosuppressive medication compliance management in kidney transplant patients and its clinical practice. It is essential to assess the obstacles and facilitators scientifically and comprehensively in clinical situations，employ targeted reform strategies，facilitate the translation of evidence into clinical practice，and enhance the quality of nursing care.

Key words: Kidney Transplant, Immunosuppressor, Medication Compliance, Review Indicators, Obstacle Factors, Evidence-Based Nursing