Cardiology Department, The First Affiliated Hospital of Kunming Medical University, No. 295, Xichang Road, Kunming, 650032, China.
Cardiology Department, People's Hospital of Yuxi City, Yuxi, China.
BMC Health Serv Res. 2024 Sep 19;24(1):1101. doi: 10.1186/s12913-024-11561-4.
Preoperative visit-care for transcatheter aortic valve replacement (TAVR) plays a crucial role in improving the quality of care and patient safety. However, preoperative care for TAVR patients is still in its early stages in China, with the care often being experience-based. The application of relevant evidence in nursing practice is necessary. Little is known regarding the facilitators and barriers to apply and compliance to the evidences about preoperative visit-care for TAVR in nursing.
The Nurse's Compliance Checklist was used to investigate the evidence-based compliance of nurses (n = 21) who worked in the TAVR team in the evidence-based implementation setting. Meanwhile, an Evidence-Based Practice Beliefs Scale, and Influencing Factors Checklist were used to investigate all nurses (n = 66) who work in the same setting. Stakeholders (Middle and senior-level nursing administrators, frontline clinical nurses, and patients) interview was carried out to further disclose the barriers and facilitators in the process of evidence-based practice.
The results of this study showed that only 1 evidence implemented fully (100%) by nurses, 3 evidences with 0% implementation rate, and implementation rate of the other evidences were 9.5∼71.4%. The overall score of nurses' evidence-based nursing belief level was (3.52 ± 0.82). Three domains of barriers were identified: the Context Domain included lack of nursing procedures, inadequate health education materials, insufficient training; the Practitioner Domain included insufficient attention, lack of relevant knowledge, high work pressure and uncertainty of expected results, and Patient Domain included lack of relational knowledge. Facilitating factors included leadership support, nurse' high evidence-based nursing belief, high executive ability and enthusiasm for learning.
The study indicated that the nurses' compliance of evidence-based practice in preoperative visit-care for TAVR was in lower level. There were some factors influencing the application of the evidences. The study revealed potential modifiable barriers to the successful implementation of evidence-based preoperative visit-care, including a lack of preoperative visit- care routine, related knowledge and training. Leadership support and nurse training should be considered to improve nurses' compliance with evidence-based practice.
经导管主动脉瓣置换术（TAVR）的术前访视护理对提高护理质量和患者安全至关重要。然而，中国的 TAVR 患者术前护理仍处于起步阶段，护理往往基于经验。有必要将相关证据应用于护理实践。关于 TAVR 术前访视护理应用和遵守相关证据的促进因素和障碍因素知之甚少。
在证据实施环境中，使用护士依从性检查表调查 21 名 TAVR 团队护士（n=21）的基于证据的依从性。同时，使用基于证据的实践信念量表和影响因素检查表调查同一环境中的 66 名护士（n=66）。对利益相关者（中级和高级护理管理人员、一线临床护士和患者）进行访谈，以进一步揭示循证实践过程中的障碍和促进因素。
本研究结果表明，护士完全执行（100%）的证据仅有 1 项，执行率为 0%的证据有 3 项，其他证据的执行率为 9.5∼71.4%。护士基于证据的护理信念水平的总分（3.52±0.82）。确定了三个障碍领域：情境领域包括缺乏护理程序、健康教育材料不足、培训不足；从业者领域包括关注度不足、缺乏相关知识、工作压力大以及对预期结果的不确定性；患者领域包括缺乏关系知识。促进因素包括领导支持、护士对循证护理的高度信念、较高的执行能力和学习热情。
研究表明，TAVR 术前访视护理中护士基于证据的实践依从性处于较低水平。有一些因素影响证据的应用。研究揭示了成功实施基于证据的术前访视护理的潜在可改变障碍，包括缺乏术前访视护理常规、相关知识和培训。应考虑领导支持和护士培训，以提高护士对循证实践的依从性。
