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

摘要：

目的 全面评估肾移植患者免疫抑制剂服药依从性管理证据在临床的应用现状，构建审查指标，分析障碍及促进因素，制订变革策略。方法 以澳大利亚乔安娜布里格斯研究所循证卫生保健模式为理论框架，总结肾移植患者免疫抑制剂服药依从性管理最佳证据38条。制订审查指标并明确审查方法，在2022年11月1日—2023年1月31日对系统、医护人员、患者及家属进行基线审查，采用将证据引入实践策略分析临床实践过程中存在的障碍和促进因素，并制订相应的变革策略。结果 共制订23条审查指标，15条审查指标准确执行率<60%，其中，4条审查指标准确执行率为0。循证护理实践中的主要障碍因素包括科室现行肾移植患者免疫抑制剂服药依从性管理制度及流程与最佳证据存在差异、医护人员重视度和知信行水平不高、未规范开展依从性评估、院外管理缺少信息化支持；主要促进因素包括组织领导力强、医护人员变革氛围良好、团队成员具备信息化产品开发能力、肾移植患者及家属对医护人员信任度高。依此制订相应的变革策略，包括完善制度和流程、持续质量监控、强化规范培训及考核、电子健康干预服药依从性，邀请患者及家属参与服药依从性管理。结论 肾移植患者免疫抑制剂服药依从性管理的证据与临床实践存在较大差距，应科学、全面评估临床情境中的障碍因素与促进因素，采取针对性的变革策略，促进证据向临床实践转化，提升护理质量。

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