作者：肖倩1 ，温绣蔺1 ，罗利群2 ，苏留菊2 ，汪静容3

单位：

1.710061陕西省西安市，西安交通大学第一附属医院护理部　2.712046陕西省咸阳市，陕西中医药大学护 理学院　3.710032 陕西省西安市，空军军医大学第二附属医院手术室

Units：

1.Department of Nursing, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, China 2.College of Nursing, Shaanxi University of Chinese Medicine, Xi'an 712046, China 3.the Second Affiliated Hospital of Air Force Military Medical University, Xi'an 710032, China

关键词：

卒中；偏瘫；良肢位管理；循证实践；护理质量审核

Keywords：

Stroke; Hemiplegia; Good limb management; Evidence-based practice; Nursing audit

CLC：

R 743

DOI：

10.12114/j.issn.1008-5971.2024.00.092

Funds：

国家卫生健康委医院医疗质量（循证）管理研究项目（YLZLXZ23G009）

摘要：

　目的　制订脑卒中偏瘫患者良肢位管理循证护理审查指标，并分析循证护理过程中的障碍因素。方法 以Johns Hopkins循证护理实践模式为理论指导，确定循证护理问题，组建循证护理团队，检索脑卒中偏瘫患者良肢 位管理证据，汇总脑卒中偏瘫患者良肢位管理的最佳证据，确立循证护理审查指标并进行基线审查，调查西安交通大 学第一附属医院康复科39名护士良肢位摆放知信行水平，分析脑卒中偏瘫患者良肢位管理循证护理中的障碍因素和促 进因素，并拟定行动策略。结果　本研究从9篇文献中汇总出24条脑卒中偏瘫患者良肢位管理的最佳证据，包括良肢 位摆放的重要性、团队成员、摆放前评估、摆放时机、摆放规范、并发症防治及质量控制与评价7个方面；最终确定 28条脑卒中偏瘫患者良肢位管理的循证护理审查指标，其中依从率为0的审查指标4条、依从率＞0且＜60%的审查指标 15条、依从率为60%～85%的审查条目3条、依从率＞85%且＜100%的审查指标2条、依从率为100%的审查指标4条。 39名康复科护士知识维度得分为（43.2±9.3）分、态度维度得分为（36.9±6.0）分、技能维度得分为（39.8±8.0） 分，临床护士良肢位摆放知信行量表总分为（120.0±17.6）分。根据基线审查结果，以28条审查指标为对照，从系 统、实践者、患者3个层面逐条探讨，全面分析脑卒中偏瘫患者良肢位管理循证护理中的障碍因素和促进因素，并制 订相应的行动策略。结论　本研究确定的28条脑卒中偏瘫患者良肢位管理的循证护理审查指标具有规范性、适用性， 可为循证护理奠定基础，但护理审查指标的整体依从率偏低。脑卒中偏瘫患者良肢位管理循证护理的主要障碍因素为 科室缺乏规范化良肢位管理流程和教育资料、护理人员缺乏良肢位管理相关知识、患者及家属对良肢位管理认知不够 及依从性较差等。

Abstract：

【Abstract】　Objective To formulate evidence-based nursing review indicators for good limb position management of stroke patients with hemiplegia, and analyze the obstacles in the process of evidence-based nursing. Methods Under the guidance of Johns Hopkins evidence-based nursing practice model, the evidence-based nursing problems were determined, the evidence-based nursing team was established, the evidence of good limb position management for stroke patients with hemiplegia was retrieved, the best evidence of good limb position management for stroke patients with hemiplegia was summarized, the evidence-based nursing review indicators were established and baseline review was conducted, the level of knowledge, attitude and practice of good limb position of 39 nurses in Rehabilitation Department in the First Affiliated Hospital of Xi'an Jiaotong University was investigated, and the obstacles and stimulus in evidence-based nursing of good limb position management for stroke patients with hemiplegia were analyzed and action strategies were formulated. Results A total of 24 pieces of best evidence of good limb position management for stroke patients with hemiplegia were summarized from 9 articles, covering 7 aspects, including the importance of good limb position, team composition, pre-placement evaluation, placement timing, placement standards, prevention and treatment of complications, and quality control and evaluation. Finally, 28 evidence-based nursing review indicators of good limb position management for stroke patients with hemiplegia were determined, including 4 indicators with a compliance rate of 0, 15 indicators with a compliance rate of > 0 and < 60%, 2 indicators with a compliance rate of 60%- 85%, 3 indicators with a compliance rate of > 85% and < 100%, and 4 indicators with a compliance rate of 100%. Among the 39 nurses in Rehabilitation Department, the score of knowledge dimension was (43.2±9.3) points, the score of attitude dimension was (36.9±6.0) points, the score of skill dimension was (39.8±8.0) points, and the total score of the Knowledge，Belief and Behavior Questionnaire for Putting Normal Limb Position in Clinical Nurses was (120.0±17.6) points. Based on the baseline review results, the study used the 28 review indicators as controls and comprehensively analyzed the obstacles and stimulus in evidence-based nursing of good limb position management for stroke patients with hemiplegia, and formulated corresponding action strategies. Conclusion The 28 evidence-based nursing review indicators of good limb position management for stroke patients with hemiplegia developed in this study are standardized and applicable, they can provide a foundation for evidence-based nursing. However, the overall compliance of these indicators is relatively low. The main obstacles in evidence-based nursing of good limb position management for stroke patients with hemiplegia are the lack of standardized good limb position management process and educational materials in the department, lack of knowledge of good limb position management in nursing staff, lack of awareness of good limb position management and poor compliance in patients and their families.

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