Development and application of review indicators for best evidence application in the management of high-risk diabetic foot in community
10.3760/cma.j.cn115682-20231228-02864
- VernacularTitle:社区糖尿病高危足管理最佳证据应用的审查指标制定及应用
- Author:
Ting WEI
1
;
Jing WANG
;
Yan HU
;
Ying XU
Author Information
1. 同济大学医学院，上海 200092
- Keywords:
Diabetes;
High-risk diabetic foot;
Review indicators;
Evidence transformation;
Evidence-based nursing
- From:
Chinese Journal of Modern Nursing
2024;30(27):3664-3672
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To carry out evidence transformation for the management of high-risk diabetic foot in communities, construct review indicators to evaluate the status quo of community application, analyze the promoting and obstacle factors in evidence transformation and formulate reform strategies and optimization measures.Methods:Based on the Canadian Knowledge to Action Framework as the theoretical framework, the review indicators and review methods were developed on the basis of identifying clinical nursing problems, summarizing evidence and introducing community scenarios. Based on the results of baseline review, obstacle factors were analyzed and countermeasures were developed.Results:A total of 31 best evidences were included in this study, and 25 review indicators were developed. The implementation rates of the 2, 4 to 7, 16, 20, 21 and 23 review indicators were 8%, 6%, 8%, 8%, 8%, 16%, 17%, 4% and 4%, respectively, and the implementation rates of the remaining indicators were 0. Through focus interview analysis, the main obstacle factors included that the management mode of diabetic high-risk foot in the community was still exploring, the construction of multidisciplinary nursing outpatient platform needed strong leadership and resource support, the post setting of multidisciplinary nursing team needed to be improved, the management of diabetic high-risk foot lacked reasonable medical procedures, the outpatient department lacked diversified publicity and education materials for diabetic high-risk foot management and community nurses lacked evidence-based preparation. The promotion factors included the high level of attention paid by the management of the hospital and nursing department, the significance of the management of high-risk diabetic foot paid by specialist nurses and patient expectations of good outcomes as motivation for specialist nurses to work. The reform strategy included building an outpatient nursing platform, clarifying the responsibilities of outpatient nursing posts, optimizing the outpatient treatment process, configuring hardware facilities (various screening and examination instruments and propaganda and education sports room), completing the supporting materials for high-risk foot health education (including courseware, practice manual, videos, posters and cards), and carrying out the management of diabetic high-risk foot in the community. After in-hospital and out-of-hospital training, the implementation rate of indicators 1 to 17, 20 to 23 was 100.00%, the implementation rate of indicator 18 was 61.11%, the implementation rate of indicator 19 was 79.63%, the implementation rate of indicator 24 was 66.67% and the implementation rate of indicator 25 was 82.41%.Conclusions:There is still a great gap between the foot management of high-risk diabetic foot and community practice. A full and comprehensive analysis of the obstacles and promoting factors in community practice and the implementation of corresponding reform strategies can promote the effective application of evidence in community situations.
