中国全科医学 ›› 2024, Vol. 27 ›› Issue (14): 1729-1734.DOI: 10.12114/j.issn.1007-9572.2023.0190

• 论著 • 上一篇    下一篇

创伤性伤口患者居家带伤洗浴方案的构建与初步验证研究

赵婷1, 蒋琪霞2,*(), 徐慧黎1, 陆娴1, 巢红芳1   

  1. 1.213000 江苏省常州市,南京医科大学附属常州市第二人民医院创面修复护理中心
    2.210002 江苏省南京市,东部战区总医院烧伤整形科
  • 收稿日期:2023-03-15 修回日期:2023-05-25 出版日期:2024-05-15 发布日期:2024-03-22
  • 通讯作者: 蒋琪霞

  • 作者贡献:

    赵婷负责进行文章的构思与设计,进行统计学处理,对结果进行分析与解释,撰写论文并进行修订;蒋琪霞负责文章的质量控制及审校,对文章整体负责,监督管理;徐慧黎、陆娴负责进行研究的实施与数据收集;巢红芳负责进行数据整理。

  • 基金资助:
    军队卫勤创新课题(20WQ027)

Construction and Preliminary Validation of Bathing with Wounds at Home Scheme for Patients with Traumatic Wounds

ZHAO Ting1, JIANG Qixia2,*(), XU Huili1, LU Xian1, CHAO Hongfang1   

  1. 1. Trauma Repair Care Center, Changzhou No. 2 People's Hospital, Affiliated Hospital of Nanjing Medical University, Changzhou 213000, China
    2. Department of Burns and Plastic Surgery, General Hospital of Eastern Theater Command, PLA, Nanjing 210002, China
  • Received:2023-03-15 Revised:2023-05-25 Published:2024-05-15 Online:2024-03-22
  • Contact: JIANG Qixia

摘要: 背景 创伤是一种发生率高、耗费大的全球性健康问题,预防和控制感染是创伤性伤口处理的一大挑战,而创伤后长时间不进行皮肤清洗在影响舒适度的同时也增加伤口感染的发生率。尽管很多患者创伤后有洗浴的意愿,然而何时洗浴、如何洗浴尚不明确,因此,构建适宜的带伤洗浴方案对保持皮肤和伤口清洁十分必要。 目的 构建适合我国创伤性伤口患者使用的居家带伤洗浴方案,为保持创伤患者的皮肤清洁、改善伤口愈合结局提供可行的护理方案。 方法 检索国内外数据库获取原始文献,通过循证分析、归纳、小组讨论,形成创伤性伤口患者居家带伤洗浴方案的条目初稿。纳入15名副高职称以上的伤口护理专家,采用德尔菲专家函询法修改和完善带伤洗浴方案,每轮函询间隔1周,采用专家积极系数和权威系数评价函询结果的可靠性,采用变异系数评价函询结果的一致性,当变异系数<0.25时表示专家意见趋于一致,停止函询,形成修改稿。纳入门诊创伤性伤口患者30例进行预试验,采用Likert 5级评分验证带伤洗浴方案的便利性、安全性和患者依从性,讨论修改后形成最终方案。 结果 纳入23篇相关文献,循证分析、讨论后形成了"洗浴前准备""洗浴操作""洗浴后处理"3个一级条目、7个二级条目、9个三级条目和4个四级条目的创伤性伤口患者居家带伤洗浴方案初稿。15位专家进行2轮函询后意见趋于一致,两轮问卷回收率分别为93.75%和100.00%,权威系数分别为0.947和0.957。第一轮各条目重要性和可操作性变异系数分别为0~0.25、0~0.23,第二轮各条目重要性和可操作性变异系数分别为0.09~0.18、0.07~0.14,共删除条目2个,修改条目5个,新增条目2个,形成了修改稿。预试验验证结果:30例创伤性伤口患者依从洗浴方案每周洗浴(2.70±0.47)次,每次洗浴时间10~15 min,便利性评分(4.67±0.48)分,依从性评分(4.70±0.47)分,未发生与洗浴有关的不良事件及洗浴有关的伤口感染。预试验证明洗浴方案安全可靠、简单便利,患者依从性好,最终形成包括3个一级条目、8个二级条目、9个三级条目和3个四级条目的创伤性伤口患者居家带伤洗浴方案终稿。 结论 本研究构建创伤性伤口患者居家带伤洗浴方案过程中,专家积极系数和权威系数高,获得了函询专家的一致认可。预试验中30例创伤性伤口患者的依从性高,带伤洗浴方案安全、便利,可用于我国创伤性伤口患者居家带伤洗浴。

关键词: 创伤与伤口, 洗浴, 伤口护理, 皮肤护理, 循证, 专家函询法

Abstract:

Background

Trauma is a highly prevalent and costly global health problem. Prevention and control of infection is a major challenge in the management of traumatic wounds, while prolonged absence of skin washing after trauma will increase the incidence of wound infection, as well as the discomfort. Although many patients are willing to take a bath after trauma, the timing and method of bathing remains unclear. Therefore, it is necessary to build an appropriate scheme of bathing with wounds to keep the skin and wounds clean.

Objective

To construct a bathing with wounds at home scheme suitable for patients with traumatic wounds in China, and to provide a feasible care scheme for keeping the skin of trauma patients clean and improving the outcome of wound healing.

Methods

Database at home and abroad were searched to obtain original literature, the first draft of the items of bathing with wounds at home scheme for patients with traumatic wounds was formulated through evidence-based analysis, generalization, group discussion. Fifteen wound care experts with associate or higher titles were included, and Delphi consultation was used to modify and improve the bathing with wounds scheme, with an interval of one week for each round of correspondences, the reliability of the consultation results was evaluated by the expert positive and authority coefficients. The consistency of the consultation results was evaluated by the coefficient of variation, a revised draft was formulated with terminated consultation when the coefficient of variation less than 0.25, which means that the expert opinions tend to be consistent. Thirty patients with traumatic wounds were enrolled in the pre-test, Likert 5-point scale was used to verify the convenience, safety and patient compliance of the bathing with wounds scheme, and the final scheme was developed after discussion and modification.

Results

After the inclusion of 23 related papers, the first draft of bathing with wounds scheme was developed through evidence-based analysis and discussion, involving three first-level items (including preparation befor bathing, bathing operation and treatment after bathing), seven second-level items, nine third-level items and four fourth-level items. The opinions of the 15 experts converged after 2 rounds of correspondence, with recall rates of 93.75% and 100.00%, with authority coefficients of 0.947 and 0.957, respectively. The variation coefficients of importance and maneuverability of each item in the first round were 0-0.25 and 0-0.23, and those in the second round were 0.09-0.18 and 0.07-0.14, respectively, a total of 2 items were deleted, 5 items were modified and 2 items were added, resulting in a revised draft. The 30 enrolled patients with traumatic wounds took baths (2.70±0.47) times per week according to the bathing scheme, with the average bath time of 10-15min, convenience and compliance scores of (4.67±0.48) and (4.70±0.47), and no bathing-related adverse events and wound infection occurred.The pre-test proved that the bathing plan was safe、reliable、simple and have good patient compliance. The final draft of the bathing with wounds scheme for traumatic wound patients included three first-level items, eight second-level items, nine third-level items and three fourth-level items.

Conclusion

In the construction process of the bathing with wounds scheme for traumatic wound patients, the positive and authority coefficients of experts are high, which has been unanimously approved by corresponding experts. The compliance of 30 patients with traumatic wounds in the pre-test was high, suggesting that the bathing with wounds scheme is safe and convenient, which can be applied to bathing with wounds at home for patients with traumatic wounds in China.

Key words: Trauma and wound, Bath, Wound care, Skin care, Evidence-based practice, Expert correspondence method

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