护士应用预防关节置换术后深静脉血栓形成最佳证据的障碍因素研究

doi:10.3761/j.issn.0254-1769.2022.08.010

摘要/Abstract

摘要：

目的探讨关节置换术后预防深静脉血栓护理最佳证据在临床应用的障碍因素,为临床拟订对策提供依据。方法 2020年7月—8月,基于理论域框架（theoretical domains framework,TDF）制订访谈提纲,便利选取北京市某三级甲等医院骨科二病房的16名护士进行焦点小组访谈。按照TDF的相关领域对转录后的文本进行分析。结果目前临床工作中,科室已借助信息系统开展深静脉血栓风险评估,但护士对评估量表掌握程度欠佳,且评估所涉及的相关内容需要调取病历信息,对评估工作的开展造成了一定阻碍;护士具备开展健康宣教和基本预防的意识,但由于缺乏辅助工具开展工作困难且难以引起患者重视,进而丧失了行动意愿,并对健康宣教和基本预防效果产生怀疑;护士掌握健康教育相关内容,能正确执行物理预防和药物预防,且科室已开展预防效果评价,但由于缺乏相关流程,护士间行为存在差异。结合TDF,将上述障碍因素分别归属为知识、环境因素、动力和目标、结果的期望和行为规范5个领域。结论影响关节置换术后预防深静脉血栓形成护理最佳证据在临床应用的障碍因素具有多样性,需要科室在明确障碍因素的基础上,开展循证护理实践的变革,推进关节置换术后预防深静脉血栓形成护理最佳证据的临床应用。

关键词: 关节成形术,置换, 人工关节, 深静脉血栓形成, 理论域框架, 质性研究, 护理

Abstract:

Objective To explore the barriers in the clinical use of evidence-based deep vein thrombosis prevention after joint replacement,and to provide bases for clinical measures. Methods The interview outline was developed based on the Theoretical Domains Framework（TDF） from July to August 2020. Totally 16 nurses working in the department of orthopedic at a tertiary A hospital in Beijing were selected for semi-structured interviews by convenient sampling,and the content analysis was conducted based on the results. The content of the transcribed text is analyzed,and specific topics and codes are classified according to the relevant fields of TDF. Results In clinical practice,the department has used the HIS system to assess DVT risks,but the nurses do not have a good grasp of the assessment scale,and the case information need to be retrieved,which has caused certain obstacles to the development of the assessment work. Nurses have the awareness to carry out health education and nursing prevention,but due to the lack of auxiliary tools,it is difficult to attract patients’ attention,and thus they lose the will to act,and hold doubts about the prevention effects. Nurses master health education related content and can implement physical and drug prevention,and the department has carried out prevention effect evaluation. However,due to the lack of relevant procedures,there are differences in behaviors among nurses. Combined with TDF,the above obstacles are classified into 5 domains：knowledge,environmental factor,motivation and target,result expectation,and code of conduct. Conclusion There is a variety of obstacles that affect the prevention of deep vein thrombosis after joint replacement in clinical application. It is necessary for the department to carry out the reform of evidence-based nursing practice on the basis of obstacles and promote the clinical application of the best evidence for the prevention of deep vein thrombosis after joint replacement.

Key words: Arthroplasty,Replacement, Joint Prosthesis, Deep Vein Thrombosis, Theoretical Domains Framework, Qualitative Study, Nursing Care

徐园, 吴欣娟, 杨旭, 王钰, 庞冬, 王晓杰, 刘佳, 尚高鹏, 姜英, 朱丽筠, 马玉芬. 护士应用预防关节置换术后深静脉血栓形成最佳证据的障碍因素研究[J]. 中华护理杂志, 2022, 57(8): 958-963.

XU Yuan, WU Xinjuan, YANG Xu, WANG Yu, PANG Dong, WANG Xiaojie, LIU Jia, SHANG Gaopeng, JIANG Ying, ZHU Liyun, MA Yufen. Obstacle factors of the best evidence application for the prevention of deep vein thrombosis after joint replacement[J]. Chinese Journal of Nursing, 2022, 57(8): 958-963.

图/表 2

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