Chen Yun, Wan Jing, Zhu Zheng, Su Chunhong, Mei Zhengrong
Department of Obstetrics and Gynecology,Guangdong Provincial Key Laboratory of Major Obstetric Diseases, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
School of Nursing, Fudan University, Shanghai, China.
BMC Nurs. 2022 Apr 27;21(1):98. doi: 10.1186/s12912-022-00883-5.
Patients should be encouraged to mobilize with 24 h of caesarean section. However, the time of the first off-bed activity after surgery is usually 24 ~ 48 h in China. Due to the lack of knowledge of early off-bed activities, lack of attention to medical pain, and the absence of systematic evidence for the clinical transformation process. the aim of this study was showed that the application of evidence needs to be embedding in the real setting to construct the localization plan and achieve the effective result.
To establish evidence of the benefits of early postoperative off-bed activities on patients' well-being based on a literature review. An interrupted time series analysis was used to evaluate the effectiveness of the intervention. The first and third periods were both five months (from February 1st, 2019 to January 31st, 2020), with a two-month interrupted time (from July 1st, 2019 to August 31st, 2019).
Eight clinical practices were retrieved from the literature and incorporated into the intervention. A total of 465 patients were included: 226 patients before and 239 patients after implementing the intervention. The average onset time of postoperative off-bed activities was significantly earlier after the intervention than before the intervention (20.01 vs. 31.89 h after the operation, P < 0.001). The 24-h off-bed rate increased from 30.94% before to 91.21% after the intervention (P < 0.001). The average pain score of patients decreased from 5.23 points before to 3.82 points after the intervention (P = 0.032). The average postoperative hospital stay was shortened from 5.06 days before to 3.51 days after the intervention (P < 0.001). In addition, the incidence rates of postoperative ileus (POI) and infection decreased from 5.38% and 2.65% before to 1.67% and 0.84% after the intervention, respectively (P < 0.001).
We established an evidence-based nursing intervention. Evaluation of the effect of evidence-based practices should be considered in the clinical setting and include preoperative health education, effective analgesia management, and safety management.
应鼓励患者在剖宫产术后24小时内活动。然而，在中国，术后首次离床活动时间通常为24至48小时。由于缺乏早期离床活动的知识，对医疗疼痛缺乏关注，以及临床转化过程中缺乏系统证据，本研究旨在表明证据的应用需要融入实际环境，以构建本地化计划并取得有效结果。
基于文献综述建立术后早期离床活动对患者健康有益的证据。采用中断时间序列分析来评估干预措施的有效性。第一阶段和第三阶段均为五个月（从2019年2月1日至2020年1月31日），有两个月的中断时间（从2019年7月1日至2019年8月31日）。
从文献中检索到八项临床实践并纳入干预措施。共纳入465例患者：干预实施前226例，干预实施后239例。干预后术后离床活动的平均开始时间显著早于干预前（术后20.01小时对31.89小时，P<0.001）。24小时离床率从干预前的30.94%增至干预后的91.21%（P<0.001）。患者的平均疼痛评分从干预前的5.23分降至干预后的3.82分（P=0.032）。术后平均住院天数从干预前的5.06天缩短至干预后的3.51天（P<0.001）。此外，术后肠梗阻（POI）和感染的发生率分别从干预前的5.38%和2.65%降至干预后的1.67%和0.84%（P<0.001）。
我们建立了基于证据的护理干预措施。应在临床环境中考虑对基于证据的实践效果进行评估，包括术前健康教育、有效的镇痛管理和安全管理。
