生命末期成人住院患者护理评估的最佳证据总结

doi:10.3761/j.issn.0254-1769.2023.13.006

摘要/Abstract

摘要：

目的检索、评价并汇总生命末期成人住院患者护理评估的最佳证据，为护理实践提供循证支持。方法系统检索BMJ Best Practice、UpToDate、国际指南网、英国国家卫生与临床优化研究所网站、苏格兰院际指南网、医脉通指南网、加拿大安大略注册护士协会网站、美国国家综合癌症网、欧洲肿瘤内科学会网站、美国临床肿瘤学会网站、澳大利亚乔安娜布里格斯研究所循证卫生保健中心数据库、Cochrane Library、PubMed、Embase、CINAHL、Web of Science、中国生物医学文献数据库、中国知网、万方数据服务平台和维普数据库，获取与生命末期成人住院患者护理评估相关的临床决策、指南、专家共识、证据总结、系统评价、Meta分析，检索时限为建库至2022年7月。由2名研究者独立进行文献质量评价、证据审校与提取，并经循证研究小组讨论后整合证据。结果共纳入13篇文献，其中临床决策3篇、指南6篇、专家共识2篇、系统评价2篇。从评估的重要性、评估实施人员、适用人群、评估时机、评估内容、评估工具、评估注意事项7个方面汇总22条证据。结论该研究总结了生命末期成人住院患者护理评估的最佳证据，建议护理人员在应用和转化证据时，充分考虑临床实际情况，探索具有本土特色的生命末期成人住院患者护理评估方案。

关键词: 生命末期, 安宁疗护, 住院, 护理评估, 证据总结, 循证护理学

Abstract:

Objective To search，evaluate and summarize the best evidence of comprehensive nursing assessment of adults hospitalised at the end of life，and to provide a reference for clinical nurses to carry out evidence-based practice. Methods We searched BMJ Best Practice，UpToDate，Guidelines International Network，National Institute for Clinical Excellence，Scottish Intercollegiate Guidelines Network，Yimaitong，Registered Nurses’ Association of Ontario，National Comprehensive Cancer Network，European Society for Medical Oncology，American Society of Clinical Oncology，Joanna Briggs Institute，Cochrane Library，PubMed，Embase，CINAHL，Web of Science，CBM，CNKI，Wanfang and CQVIP Database to collect all evidence about the comprehensive nursing assessment of adults hospitalised at the end of life. The search time limit is from the establishment of the databases to July，2022. There were 2 researchers who assessed the quality of the literature，reviewed and extracted the evidence，and integrated the evidence after discussion by the evidence-based research group. Results Totally 13 articles were involved，including 3 clinical decision supports，6 guidelines，2 expert consensuses and 2 systematic reviews. Finally，22 pieces of best evidence have been obtained from 7 aspects，including the importance of assessment，assessment implementation personnel，applicable population，assessment timing，assessment contents，assessment tools，assessment tips. Conclusion This study summarizes the best evidence of comprehensive nursing assessment of adults hospitalised at the end of life. It is recommended that nurses should fully consider the clinical situation when applying and transforming the evidence，and explore and carry out the program and practice of comprehensive nursing assessment for adults hospitalised at the end of life with Chinese characteristics.

Key words: End-of-Life, Palliative Care, Hospitalization, Nursing Assessment, Evidence Summary, Evidence-Based Nursing

郭俊晨, 龚有文, 戴云云, 成琴琴, 谌永毅. 生命末期成人住院患者护理评估的最佳证据总结[J]. 中华护理杂志, 2023, 58(13): 1571-1578.

GUO Junchen, GONG Youwen, DAI Yunyun, CHENG Qinqin, CHEN Yongyi. Summary of best evidence for comprehensive nursing assessment of adults hospitalised at the end of life[J]. Chinese Journal of Nursing, 2023, 58(13): 1571-1578.

图/表 5

图1 PubMed的文献检索策略

Figure 1 Literature search strategy of PubMed

图2 文献筛选流程图

Figure 2 Flow chart of literature screening

表1 纳入文献的基本特征（n=13）

Table 1 Sources and general characteristics of the included literature（n=13）

表2 纳入指南的质量评价结果（n=6）

Table 2 Quality assessment of included guidelines（n=6）

表3 生命末期成人住院患者护理评估的最佳证据汇总

Table 3 Evidence summary for the comprehensive nursing assessment in end-of-life adult inpatients

参考文献 30

[1]	World Health Organization. Strengthening of palliative care as a component of integrated treatment throughout the life course[J]. J Pain Palliat Care Pharmacother, 2014, 28(2):130-134. DOI PMID
[2]	Finkelstein EA, Bhadelia A, Goh C, et al. Cross country comparison of expert assessments of the quality of death and dying 2021[J]. J Pain Symptom Manage, 2022, 63(4):e419-e429. DOI URL
[3]	陆宇晗. 我国安宁疗护的现状及发展方向[J]. 中华护理杂志, 2017, 52(6):659-664.
	Lu YH. The status quo and development direction of hospice care in China[J]. Chin J Nurs, 2017, 52(6):659-664.
[4]	Goni-Fuste B, Crespo I, Monforte-Royo C, et al. What defines the comprehensive assessment of needs in palliative care? An integrative systematic review[J]. Palliat Med, 2021, 35(4):651-669. DOI URL
[5]	Stoneberg JN, von Gunten CF. Assessment of palliative care needs[J]. Anesthesiol Clin, 2006, 24(1):1-17. PMID
[6]	Richardson A, Palin J, Henry C, et al. Holistic common assessment of supportive and palliative care needs for adults requiring end of life care[EB/OL]. (2010-03-17)[2022-09-08]. https://webarchive.nationalarchives.gov.uk/20160805140434/http://www.nhsiq.nhs.uk/resource-search/publications/eolc-hca-guide.aspx.
[7]	National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology:palliative care(version 1.2022)[EB/OL]. (2022-03-25)[2022-09-02]. https://guide.medlive.cn/guideline/25864.
[8]	朱政, 胡雁, 周英凤, 等. 推动证据向临床转化(三)研究的选题和问题构建[J]. 护士进修杂志, 2020, 35(9):796-799.
	Zhu Z, Hu Y, Zhou YF, et al. Promoting the transformation of evidence to clinical practice:research topic selection and problem construction[J]. J Nurses Train, 2020, 35(9):796-799.
[9]	唐如冰, 李繁荣, 韦珏伶, 等. 终末期肿瘤患者呼吸困难管理的证据总结[J]. 中华护理杂志, 2022, 57(14):1690-1695. DOI URL
	Tang RB, Li FR, Wei JL, et al. Summary of best evidence for the management of dyspnea in patients with terminal cancer[J]. Chin J Nurs, 2022, 57(14):1690-1695. DOI URL
[10]	周芬, 郝玉芳, 丛雪, 等. 指南研究与评价工具AGREE Ⅱ及各领域分值的补充解释及思考[J]. 护理学报, 2018, 25(18):56-58.
	Zhou F, Hao YF, Cong X, et al. Supplementary explanation and reflection on the research and evaluation tool AGREE Ⅱ and the scores of each field[J]. J Nurs China, 2018, 25(18):56-58.
[11]	The Joanna Briggs Institute. Checklist for text and opinion[EB/OL]. (2017-07-15)[2022-08-25]. https://jbi.global/sites/default/files/2021-10/Checklist_for_Text_and_Opinion.docx.
[12]	熊俊, 陈日新. 系统评价/Meta分析方法学质量的评价工具AMSTAR[J]. 中国循证医学杂志, 2011, 11(9):1084-1089.
	Xiong J, Chen RX. An introduction to a measurement tool to assess the methodological quality of systematic reviews/meta-analysis:AMSTAR[J]. Chin J Evid Based Med, 2011, 11(9):1084-1089.
[13]	Jeanie Y, Oliver M. Palliative care:comprehensive palliative care assessment[EB/OL]. (2022-02-04)[2022-08-20]. https://bestpractice.bmj.com/topics/en-gb/1020/details.
[14]	National Coalition for Hospice and Palliative Care. Clinical practice guidelines for quality palliative care,4th edition[EB/OL]. (2018-10-31)[2022-08-28]. https://www.nationalcoalitionhpc.org/wp-content/uploads/2020/07/NCHPC-NCPGGuidelines_4thED_web_FINAL.pdf.
[15]	Rgistered Nurses Association of Ontario. End-of-life care during the last days and hours[EB/OL]. (2011-09-01)[2022-09-08]. https://rnao.ca/bpg/guidelines/endoflife-care-during-last-days-and-hours.
[16]	National Institute for Clinical Excellence. End of life care for adults:service delivery[EB/OL]. (2019-10-16)[2022-08-29]. https://www.nice.org.uk/guidance/n9142.
[17]	Osman H, Shrestha S, Temin S, et al. Palliative care in the global setting:ASCO resource-stratified practice guideline[EB/OL]. (2018-05-08)[2022-09-01]. https://www.asco.org/practice-patients/guidelines/patient-and-survivor-care#/31016.
[18]	王春青, 胡雁. JBI证据预分级及证据推荐级别系统(2014版)[J]. 护士进修杂志, 2015, 30(11):964-967.
	Wang CQ, Hu Y. JBI evidence pre-classification and evidence rank system(2014 edition)[J]. J Nurses Train, 2015, 30(11):964-967.
[19]	Tomasz RO, April C. Overview of comprehensive patient assessment in palliative care[EB/OL]. (2021-11-29)[2022-08-27]. https://www.uptodate.cn/contents/overview-of-comprehensive-patient-assessment-in-palliative-care?search=Overview%20of%20comprehensive%20patient%20assessment%20in%20palliative%20care&source=search_result&selectedTitle=1-150&usage_type=default&display_rank=1.
[20]	Harman SM, Bailey FA, Walling AM. Palliative care:the last hours and days of life[EB/OL]. (2021-10-11)[2022-08-27]. https://www.uptodate.com/contents/palliative-care-the-last-hours-and-days-of-life?search=Palliative%20care:%20The%20last%20hours%20and%20days%20of%20life&source=search_result&selectedTitle=1-150&usage_type=default&display_rank=1.
[21]	中国临床肿瘤学会肿瘤支持与康复治疗专家委员会, 中国抗癌协会肿瘤放射治疗专业委员会, 重庆市医药生物技术协会癌症康复与姑息治疗专业委员会. 肺癌姑息治疗中国专家共识[J]. 中华医学杂志, 2022, 102(27):2084-2095.
	Committee of Tumor Support and Rehabilitation Therapy,Chinese Society of Clinal, Oncology,Tumor Radiation Therapy Committee of Chinese Anti-Cancer Association, Committee for Cancer Rehabilitation and Palliative Care of Chongqing Medicinal Biotechnology Association. Chinese expert consensus on palliative care of lung cancer[J]. Natl Med J China, 2022, 102(27):2084-2095.
[22]	Weissman DE, Meier DE. Identifying patients in need of a palliative care assessment in the hospital setting:a consensus report from the Center to Advance Palliative Care[J]. J Pal-liat Med, 2011, 14(1):17-23.
[23]	Hermans K, De Almeida Mello J, Spruytte N, et al. A comparative analysis of comprehensive geriatric assessments for nursing home residents receiving palliative care:a systematic review[J]. J Am Med Dir Assoc, 2014, 15(7):467-476. DOI URL
[24]	谌永毅, 刘翔宇. 安宁疗护专科护理[M]. 北京: 人民卫生出版社, 2020:5.
	Chen YY, Liu XY. Hospice specialist nursing[M]. Beijing: People’s Medical Publishing House, 2020:5.
[25]	Canadian Hospice Palliative Care Association. A model to guide hospice palliative care:based on national principles and norms of practice[EB/OL]. (2013-09-01)[2022-09-09]. https://www.chpca.net/media/319547/norms-of-practice-eng-web.pdf.
[26]	Yang J, Wahner-Roedler DL, Zhou X, et al. Acupuncture for palliative cancer pain management:systematic review[J]. BMJ Support Palliat Care, 2021, 11(3):264-270. DOI URL
[27]	邓仁丽, 陈柳柳, 史宝欣, 等. 中国文化背景下预立医疗照护计划的研究进展[J]. 中华护理杂志, 2015, 50(9):1117-1121.
	Deng RL, Chen LL, Shi BX, et al. Research progress of pre-established medical care plan under the cultural background of China[J]. Chin J Nurs, 2015, 50(9):1117-1121.
[28]	Emanuel LL, Alpert HR, Emanuel EE. Concise screening questions for clinical assessments of terminal care:the needs near the end-of-life care screening tool[J]. J Palliat Med, 2001, 4(4):465-474. DOI PMID
[29]	Schildmann EK, Groeneveld EI, Denzel J, et al. Discovering the hidden benefits of cognitive interviewing in two languages:the first phase of a validation study of the Integrated Palliative Care Outcome Scale[J]. Palliat Med, 2016, 30(6):599-610. DOI PMID
[30]	王建晶, 刘义兰, 朱文静, 等. 护士人文护理培训现状及需求的多中心调查研究[J]. 中华护理杂志, 2022, 57(10):1231-1237. DOI URL
	Wang JJ, Liu YL, Zhu WJ, et al. A multicenter survey on the status and demand of humanistic nursing training for nurses[J]. Chin J Nurs, 2022, 57(10):1231-1237. DOI URL