糖尿病足评估的循证护理实践研究

doi:10.3761/j.issn.1672-9234.2024.08.017

摘要/Abstract

摘要：

目的根据糖尿病足评估的最佳证据，开展循证实践，并评价其应用效果。方法以知识-行动框架模式为指导，在前期糖尿病足评估的证据总结基础上，对证据在临床的适用性进行评价，筛选适宜在临床实施的证据，制订审查指标；进行基线审查，并分析障碍因素，制订干预措施。比较证据应用前后护士对糖尿病足评估的知识掌握程度、审查指标执行情况及伤口面积变化。结果最佳证据应用后，36个审查指标中24个执行率高于实施前（P<0.05），有3个审查指标执行情况为相关工具实现从无到有的改变，护士对糖尿病足评估知识的掌握程度有所提升，但患者伤口4周和12周的面积在实施前后差异没有统计学意义（P>0.05）。结论基于糖尿病足评估最佳证据的循证实践，可提高护士糖尿病足评估的知识水平及证据的执行率，能够规范糖尿病足评估的护理实践。

关键词: 糖尿病足, 循证实践, 评估, 伤口护理, 证据应用

Abstract:

Objective To develop evidence-based practice based on the best evidence of diabetic foot assessment and evaluate its effectiveness. Methods Guided by the Knowledge-action model，on the basis of the evidence summary of diabetic foot assessment，the clinical applicability of the evidence was evaluated，the evidence items suitability for clinical implementation were screened，and the review indicators were developed. Baseline reviews were conducted，and obstacle factors were analyzed to develop interventions. Before and after the application of evidence，the nurses’ knowledge of diabetic foot assessment，the implementation of review indicators and the change of wound area were compared. Results After the application of the best evidence，the implementation rate of 24 of the 36 review items was higher than before the implementation（P<0.05），and three review items changed from non-existence to existence of relevant tools. Nurses’ knowledge of diabetic foot assessment was significantly improved（P<0.05），but the wound area at 4 weeks and 12 weeks did not change significantly（P>0.05）. Conclusion Evidence-based practice based on the best evidence of the diabetic foot assessment can improve the knowledge level of diabetic foot assessment and implementation rate of evidence，and can standardize the nursing practice of diabetic foot assessment.

Key words: Diabetic foot, Evidence-based practice, Assessment, Wound care, Evidence application

张佩英, 路潜, 庞冬, 关辉, 李会娟, 刘瑾, 丁炎明. 糖尿病足评估的循证护理实践研究[J]. 中华护理教育, 2024, 21(8): 1000-1005.

ZHANG Peiying, LU Qian, PANG Dong, GUAN Hui, LI Huijuan, LIU Jin, DING Yanming. Evidence-based nursing practice for diabetic foot assessment[J]. Chinese Journal of Nursing Education, 2024, 21(8): 1000-1005.

图/表 3

参考文献 15

[1]	van Netten JJ, Bus SA, Apelqvist J, et al. Definitions and criteria for diabetic foot disease[J]. Diabetes Metab Res Rev, 2020, 36(Suppl 1):e3268.
[2]	中华医学会糖尿病学分会,中华医学会感染病学分会,中华医学会组织修复与再生分会. 中国糖尿病足防治指南(2019版)(Ⅰ)[J]. 中华糖尿病杂志, 2019, 11(2):92-108.
[3]	《多学科合作下糖尿病足防治专家共识版》编写组. 多学科合作下糖尿病足防治专家共识(2020版)全版[J]. 中华烧伤杂志, 2020, 36(8):E01-E52.
[4]	邓博, 刘宁, 谭静. 糖尿病足溃疡护理管理的最佳证据总结[J]. 循证护理, 2021, 7(16):2186-2191.
	Deng B, Liu N, Tan J. Summary of the best evidences for nursing management of diabetic foot ulcers[J]. Chin Evid Based Nurs, 2021, 7(16):2186-2191.
[5]	Field B, Booth A, Ilott I, et al. Using the Knowledge to Action Framework in practice:a citation analysis and systematic review[J]. Implement Sci, 2014, 9:172.
[6]	Rycroft-Malone J, Bucknall T. Models and frameworks for im-plementing evidence-based practice:linking evidence to action[M]. Oxford:Wiley-Blackwell, 2010.
[7]	朱政, 胡雁, 邢唯杰, 等. 不同类型循证问题的构成[J]. 护士进修杂志, 2017, 32(21):1991-1994.
[8]	张佩英, 王薇, 李高强, 等. 糖尿病足评估的证据总结[J]. 中华现代护理杂志, 2019, 25(18):2286-2290.
	Zhang PY, Wang W, Li GQ, et al. A summary of evidence for diabetic foot assessment[J]. Chin J Mod Nurs, 2019, 25(18):2286-2290.
[9]	Registered Nurses’ Association of Ontario. Toolkit:implementa-tion of best practice guidelines[M]. 2nd ed. Toronto: Registered Nurses’ Association of Ontario, 2012.
[10]	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.
[11]	Monteiro-Soares M, Martins-Mendes D, Vaz-Carneiro A, et al. Classification systems for lower extremity amputation predi-ction in subjects with active diabetic foot ulcer:a systematic review and meta-analysis[J]. Diabetes Metab Res Rev, 2014, 30(7):610-622.
[12]	Registered Nurses’ Association of Ontario. Assessment and management of foot ulcers for people with diabetes,second edition[EB/OL].(2013-03). https://rnao.ca/bpg/guidelines/asse-ssment-and-management-foot-ulcers-people-diabetes-second-edition.
[13]	毛秋婷, 曾铁英. 循证护理实践水平与医院循证组织文化建设相关性研究[J]. 护理研究, 2017, 31(20):2520-2523.
[14]	郭员志, 张红梅, 赵培, 等. 乳腺癌术后淋巴水肿预防与护理的循证实践[J]. 中华护理杂志, 2023, 58(7):773-781. doi: 10.3761/j.issn.0254-1769.2023.07.001
	Guo YZ, Zhang HM, Zhao P, et al. Evidence-based practice of lymphedema prevention and nursing care after breast cancer surgery[J]. Chin J Nurs, 2023, 58(7):773-781. doi: 10.3761/j.issn.0254-1769.2023.07.001
[15]	成磊, 冯升, 胡雁, 等. 我国循证护理实践中证据应用概念模式的构建[J]. 护理学杂志, 2019, 34(3):72-77.
	Cheng L, Feng S, Hu Y, et al. Development of a conceptual model of evidence implementation in nursing practice in China[J]. J Nurs Sci, 2019, 34(3):72-77.