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成人脑损伤认知功能障碍的护理管理:最佳证据实践策略总结。

Nursing management of cognitive dysfunction in adults with brain injury: Summary of best evidence-practiced strategies.

机构信息

Second Military Medical University, Shanghai, China.

Shanghai First Rehabilitation Hospital, Shanghai, China.

出版信息

J Clin Nurs. 2024 Jul;33(7):2496-2508. doi: 10.1111/jocn.17058. Epub 2024 Feb 17.

Abstract

OBJECTIVE

To summarize the best evidence-based strategies for the management of cognitive dysfunction in patients with brain injury and to provide a reference for clinical nursing practice.

DESIGN

Review.

METHODS

The review was presented using PRISMA guidelines. A systematic search of evidence on the management of cognitive dysfunction in patients with brain injury was conducted in computerized decision systems, guideline websites, professional association websites and comprehensive databases from the date of creation to 21 June 2023. The types of evidence included were clinical decision making, guidelines, evidence summaries, best practices, recommended practices, expert consensus, systematic reviews and meta-analyses. Two researchers trained in evidence-based methodological systems independently evaluated the quality of the literature and extracted, integrated and graded the evidence for inclusion.

RESULTS

A total of 20 articles were selected, including nine guidelines, three expert consensus articles, one clinical practice article and seven systematic reviews, and the overall quality of the literature was high. Thirty pieces of evidence were summarized in seven areas: assessment, multidisciplinary team, rehabilitation program, cognitive intervention, exercise intervention, music intervention and medication management.

CONCLUSIONS

This study summarizes the latest evidence on the management of cognitive dysfunction in the care of adults with brain injury and provides a reference for clinical nursing practice. The best evidence should be selected for localized and individualized application in clinical work, and the best evidence should be continuously updated to standardize nursing practice.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: Patients with cognitive impairment after brain injury often suffer from memory loss, attention deficit and disorientation and are unable to have a normal life and experience much enjoyment, which seriously affects their physical and mental health and creates a great burden of care for their families and society. Best evidence-based strategies for the nursing management of cognitive impairment in brain injury are essential for standardizing clinical nursing practice and providing timely, professional, systematic and comprehensive nursing interventions for patients.

REPORTING METHOD

This review is reported following the PRISMA 2020 statement guidelines, as applicable, to enhance transparency in reporting the evidence synthesis.

TRIAL AND PROTOCOL REGISTRATION

This study has been registered with the Fudan University Centre for Evidence-based Nursing, a JBI Centre of Excellence under registration number ES20232566, http://ebn.nursing.fudan.edu.cn/myRegisterList.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

摘要

目的

总结脑损伤患者认知功能障碍管理的最佳循证策略,为临床护理实践提供参考。

设计

综述。

方法

采用 PRISMA 指南呈现综述。系统检索了脑损伤患者认知功能障碍管理的循证医学证据,检索时间为创建日期至 2023 年 6 月 21 日,检索范围包括决策系统、指南网站、专业协会网站和综合数据库。纳入的证据类型包括临床决策、指南、证据总结、最佳实践、推荐实践、专家共识、系统评价和荟萃分析。两名经过循证方法学系统培训的研究人员独立评估文献质量,并提取、整合和分级纳入证据。

结果

共纳入 20 篇文献,包括 9 篇指南、3 篇专家共识文章、1 篇临床实践文章和 7 篇系统评价,文献整体质量较高。总结了 7 个领域的 30 条证据:评估、多学科团队、康复计划、认知干预、运动干预、音乐干预和药物管理。

结论

本研究总结了脑损伤成人认知障碍管理的最新循证证据,为临床护理实践提供了参考。应在临床工作中选择最佳证据进行本地化和个体化应用,并不断更新最佳证据,以规范护理实践。

对专业和/或患者护理的影响:脑损伤后认知障碍的患者常伴有记忆丧失、注意力缺陷和定向障碍,无法正常生活和享受生活,严重影响身心健康,给家庭和社会带来巨大的护理负担。脑损伤认知障碍护理的循证最佳策略对于规范临床护理实践,为患者提供及时、专业、系统、全面的护理干预至关重要。

报告方法

本综述按照 PRISMA 2020 声明指南进行报告,以提高证据综合报告的透明度。

试验和方案注册

本研究已在复旦大学循证护理中心(JBI 卓越中心,注册号 ES20232566)注册,网址为:http://ebn.nursing.fudan.edu.cn/myRegisterList。

患者或公众贡献

无患者或公众贡献。

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