实施性研究整合框架下住院患者肠外营养安全护理的循证护理实践 [中文引用][英文引用]

目的 将基于实施性研究整合框架（consolidated framework for implementation research，CFIR）构建的住院患者肠外营养安全护理方案应用于临床，并评价其应用效果。方法 通过系统检索国内外数据库，汇总肠外营养安全护理最佳证据，形成方案草案；基于 CFIR 框架从干预特征、内部环境、外部环境、个体特征及实施过程 5 个领域识别方案的障碍与促进因素，制定针对性实施策略，构建住院患者肠外营养安全护理实施方案并实施。应用前后对照研究，采用便利抽样法，选取 2024 年 2月— 11 月宁夏某三级甲等医院重症医学科、胃肠外科及肝胆外科的 86 名护理人员和 78 例患者作为研究对象。其中 2024 年2 月— 6 月为方案实施前，2024 年 7 月— 11 月为方案实施后。比较方案实施前后，护理人员肠外营养知识水平、23 项循证审查指标的执行率，以及患者并发症（静脉炎、药物外渗）发生率和营养状况（身体质量指数、总蛋白、白蛋白）。结果 方案实施后，护理人员肠外营养知识得分高于对照组，23 项审查指标中 11 项的执行率高于实施前，静脉炎和药物外渗的总发生率低于实施前，前后比较，差异具有统计学意义（均 P<0.05）；实施前后营养状况指标（BMI、总蛋白、白蛋白）比较，差异无统计学意义（均P>0.05）。结论 基于 CFIR 框架构建的肠外营养安全护理方案，能有效提升护理人员的知识水平和临床实践的规范性，降低患者肠外营养相关机械性并发症的发生率。

Objective To implement a safety nursing program for inpatient parenteral nutrition（PN）developed on the basis of consolidated framework for implementation research（CFIR）and to evaluate its application effects. Methods The best evidence regarding safe PN nursing was systematically retrieved from domestic and international databases and summarised to form a draft protocol. Guided by CFIR，barriers and facilitators in protocol were identified across five domains: intervention characteristics，inner and outer settings，individual characteristics and implementation process. Targeted implementation strategies were formulated to develop a safety nursing implementation plan for inpatient PN. A pre-post study was conducted. A convenience sample of 86 nurses and 78 patients was recruited from the intensive care unit，Department of Gastrointestinal Surgery and Department of Hepatobiliary Surgery at a Tier-IIIA hospital in Ningxia from February to November 2024. The period from February to June 2024 was before the implementation of the plan, and the period from July to November 2024 was after. Outcome measures before and after implementation included nurses’PN knowledge，the implementation rates of 23 evidence-based audit criteria and patient outcomes including complication rates（phlebitis and drug extravasation）and nutritional status（body mass index，total protein and albumin）. Results After implementation，nurses’ PN knowledge score was significantly higher than that before implementation. Among the 23 audit criteria，the implementation rates of 11 items were significantly higher than those before implementation（all P<0.05）. The overall incidence of phlebitis and drug extravasation was significantly lower than that before implementation（P<0.05）. No statistically significant differences were observed in indicators of nutritional status（BMI，total protein and albumin）between before and after implementations（all P>0.05）. Conclusion The PN safety nursing program constructed based on CFIR framework can effectively improve nurses' knowledge and the standardisation of clinical practice and reduce the incidence of PN related mechanical complications in hospitalised patients.