知识与财富的链接
目的构建适用于社区医疗卫生站的脑卒中吞咽困难识别与管理循证实践方案,推动医院医疗护理向社区下沉。方法在已有三甲医院方案的基础上,采用文献研究法,检索国内外吞咽困难相关证据,结合利益相关者会议更新证据,进而更新和调适循证实践方案。结果对脑卒中吞咽困难识别与管理循证实践方案进行社区医院跨机构调适后,吞咽障碍筛查工具由标准吞咽功能评定量表改为洼田饮水试验(护士用)和吞咽障碍指数(患者用),营养风险管理工具由NRS2002改为营养不良通用筛查工具,并增加中医护理技术和远程卒中管理。根据修订结果,重新修订工作流程,更新健康教育材料等。结论脑卒中吞咽困难识别与管理社区循证实践方案的构建,为在社区医院开展循证实践提供了框架。
Objective To construct an evidence-based nursing protocol for poststroke dysphagia assessment and management in community, and to promote hospital-community linkage.Methods Based on the protocol formed for tertiary hospital in previous stu-dies, we retrieved relevant evidence of dysphagia assessment and management, and then conducted stakeholder discussion to update the evidence and adapt the protocol.Results After adaptation, the protocol for community included: Water Swallowing Test for nurse use and Dysphagia Handicap Index for patient use replaced the Standard Swallowing Assessment for dysphagia screening; the Malnutrition Universal Screening Tool was substituted for the Nutritional Risk Screening-2002 for nutrition risk management; traditional Chinese medicine techniques and telerehabilitation were added in the protocol.According to the new protocol, we revised the work process and updated patient health education manual, etc.Conclusion The protocol provides framework to implement evidence-based nursing practice for poststroke dysphagia management in community.
