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透析期间饮食管理最佳证据临床应用的障碍因素分析——基于CFIR理论▲
Obstacles to clinical use of the best evidence for dietary management during dialysis: an analysis based on CFIR theory

内科 202419卷03期 页码:252-256

作者机构:1 广西中医药大学附属瑞康医院,南宁市 530011;2 广西中医药大学护理学院,南宁市 530015

基金信息:广西医疗卫生适宜技术开发与推广应用项目(S2022057);广西壮族自治区卫生健康委员会自筹经费科研课题(Z-A20220913)

DOI:10.16121/j.cnki.cn45⁃1347/r.2024.03.06

  • 中文简介
  • 英文简介
  • 参考文献

目的 探究透析期间饮食管理最佳证据临床应用的障碍因素。方法 以实施性研究整合框架(CFIR)为理论指导,制定访谈提纲并进行半结构式访谈,抽取护士作为研究对象,应用Colaizzi七步法分析资料。结果 共形成5个主题,分别是创新、外部因素、内部因素、个体和实施过程。创新方面包括2个亚主题:部分证据未充分考虑临床情景,适用性不高;缺乏相关知识的培训,护士知识更新不及时。外部因素方面包括1个亚主题:社会支持是促进变革重要的外部力量。内部因素方面包括3个亚主题:虽然变革会增加护士工作量,但利大于弊;流程规范化,健康教育材料是必需;注意保持良好护患关系,促进变革顺利开展。个体方面包括2个亚主题:护理人员变革决心强,中层领导在变革中起关键作用。实施过程方面包括2个亚主题:患者的宣教工作是主要的困难,部分证据未充分考虑患者意愿。结论 应制定规范的透析期间饮食管理流程、完善系统培训机制、丰富健康教育材料、充分考虑证据的临床情景和患者意愿,以推动在临床上应用透析期间饮食管理最佳证据。 

Objective To explore the obstacles to clinical use of the best evidence for dietary management during dialysis. Methods Under the theoretical guidance of the consolidated framework for implementation research (CFIR), an interview outline was drawn, according to which semi-structured interviews were conducted. Nurses were selected as research subjects, and Colaizzi's seven-step method was used to analyze the data. Results A total of 5 themes were generated, namely innovation, external factors, internal factors, individuals, and implementation process. In terms of innovation, there were 2 sub-themes: some evidence did not fully consider the clinical context, so it was not highly applicable; there was a lack of training in relevant knowledge, and nurses' knowledge was not updated timely. In terms of external factors, there was 1 sub-theme: social support was an important external force for changes. In terms of internal factors, there were 3 sub-themes: although the changes would increase the workload of nurses, the benefits outweighed the disadvantages; the process should be standardized, and health education materials were necessary; attention should be paid to maintaining a good relationship between nurses and patients to promote the smooth development of changes. In terms of the individual aspect, there were 2 sub-themes: nurses were highly determined to change, and middle managers played a key role in changes. In terms of the implementation process, there were 2 sub-themes: the main difficulty was the education of patients, and some evidence did not fully take patients' wishes into account. Conclusion It is necessary to develop a standardized dietary management process during dialysis, improve the systematic training mechanism, enrich health education materials, and fully consider the clinical context of the evidence and patients' wishes, so as to promote the clinical use of the best evidence for dietary management during dialysis.

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