Zhang Lanfang, Wu Yanni, Du Mengya, He Lian, Xie Guozhu, Wang Hongmei, Zhou Chunlan, Chen Peijuan
Department of Radiotherapy, Nanfang Hospital, Southern Medical University, Guangzhou, People's Republic of China.
Nursing and Health Science Department, University of Massachusetts Boston, Boston, USA.
JBI Database System Rev Implement Rep. 2019 Nov;17(11):2390-2400. doi: 10.11124/JBISRIR-2017-004001.
This project aimed to implement an evidence-based practice to assess and manage lung cancer-associated cough, thereby relieving patients' physical pain and psychological challenges and improving their quality of life.
Cough is one of the most common symptoms experienced by patients with lung cancer. If a cough is not proactively managed, patients may develop decreased compliance with treatments and experience a reduced quality of life. Cough assessment and management are essential components of nursing practice that should include evidence-based interventions.
Seven evidence-based audit criteria were developed from current evidence. The JBI Practical Application of Clinical Evidence System (PACES) was used to perform a baseline audit on 30 patients and 20 nurses in the Department of Radiotherapy of Nanfang Hospital. The Getting Research into Practice (GRiP) component of PACES was used to identify barriers, strategies, resources and outcomes. Following implementation of strategies to improve compliance, a post-audit was conducted using the same sample size and audit criteria.
The seven evidence-based audit criteria were as follows: 1) Clinicians have received training on the assessment and management of lung cancer-associated cough; 2) In patients with lung cancer-associated cough, a comprehensive assessment was conducted to identify any co-existing causes linked to cough; 3) Any reversible causes of cough were treated according to evidence-based guidelines; 4) A validated scale was used to assess the frequency and severity of cough and distress experienced by the patients; 5) Patients (and their caregivers) have received education regarding management of cough; 6) Patients (and their caregivers) have received training on cough suppression exercises; 7) For symptomatic therapy, a stepwise approach was followed according to evidence-based guidelines. The baseline results showed that compliance rates were 0% for criteria 1, 4 and 5; 70% for criterion 6; 80% for criterion 7; 90% for criterion 3 and 93% for criterion 2. The implementation of strategies to increase compliance with best practice, including establishing training and education programs for nursing staff and patients, utilizing some validated scales to assess the frequency and severity of cough and the distress caused to the patients, and establishing a quality control team to supervise implementation of the assessment and management of cough, achieved ≥ 93% compliance rate for all seven audit criteria.
An evidence-based and nurses-oriented best practice for cough assessment and management was successfully established among patients with lung cancer-associated cough.
本项目旨在实施基于证据的实践，以评估和管理肺癌相关咳嗽，从而减轻患者的身体疼痛和心理挑战，提高其生活质量。
咳嗽是肺癌患者最常见的症状之一。如果咳嗽得不到积极管理，患者可能会出现治疗依从性下降，生活质量降低。咳嗽评估和管理是护理实践的重要组成部分，应包括基于证据的干预措施。
根据现有证据制定了七条基于证据的审核标准。使用循证卫生保健国际协作中心临床证据系统的实际应用（JBI PACES）对南方医院放疗科的30名患者和20名护士进行基线审核。使用PACES的将研究成果转化为实践（GRiP）部分来确定障碍、策略、资源和结果。在实施提高依从性的策略后，使用相同的样本量和审核标准进行审核后评估。
七条基于证据的审核标准如下：1）临床医生接受过肺癌相关咳嗽评估和管理的培训；2）对肺癌相关咳嗽患者进行全面评估，以确定与咳嗽相关的任何并存原因；3）根据循证指南治疗咳嗽的任何可逆原因；4）使用经过验证的量表评估患者咳嗽的频率和严重程度以及所经历的痛苦；5）患者（及其护理人员）接受过咳嗽管理方面的教育；6）患者（及其护理人员）接受过咳嗽抑制练习的培训；7）对于症状治疗，根据循证指南采用逐步方法。基线结果显示，标准1、4和5的依从率为0%；标准6为70%；标准7为80%；标准3为90%；标准2为93%。实施提高最佳实践依从性的策略，包括为护理人员和患者建立培训和教育项目，使用一些经过验证的量表评估咳嗽的频率和严重程度以及对患者造成的痛苦，并建立一个质量控制团队来监督咳嗽评估和管理的实施，所有七条审核标准的依从率均达到≥93%。
在肺癌相关咳嗽患者中成功建立了一种以护士为导向的基于证据的咳嗽评估和管理最佳实践。
