社区糖尿病高危足病人足部管理循证实践准备度障碍因素分析及变革策略研究

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Abstract Objective：To analyze the obstacle factors of evidence⁃based practice preparation for high risk management of diabetic foot in community centers， formulate reform strategies， and promote the transformation of evidence. Methods： A community high risk diabetic foot management team was setted up， and the Clinical Readiness of Evidence ⁃ Based Nursing Assessment（CREBNA） which was constructed by PARIHS framework was used to evaluate the readiness of evidence⁃based practice projects in the management of high risk diabetic foot in community. According to used the evaluation results，obstacle factors were analyzed by 4W1E factor analysis method，and the reform strategy was discussed. Results： The total score of CREBNA before implementation of the reform strategy was （127.24± 9. 81），and 9 items in the three dimensions of evidence，organizational environment and promoting factors were underprepared. The main obstacle factors were nurses needed time and ability to complete evidence dissemination and process re⁃engineering，leaders need to pay more attention to disciplinary trends and evidence ⁃ based programs， lack of leadership to promote evidence ⁃ based practice in nursing outpatient clinics， lack of various forms of training related to evidence ⁃ based practice projects， inadequate leadership empowerment of evidence⁃based program implementer，and the lack of relevant information support means for evidence⁃based projects. The main reform strategies were to set up a nursing management team for high⁃risk diabetic foot patients in the community，to set up a nursing clinic and establish an evidence ⁃ based transformation platform， make videos， manuals and cards of evidence ⁃ based project to promote evidence dissemination，hold evidence⁃based project promotion meetings regularly to obtain leadership support，establish an evidence⁃based salon activity group to enhance evidence⁃based capacity，open the nursing outpatient information platform to improve information means. The total score of CREBNA after the implementation of the reform strategy was high than that before the reform， and the difference was statistically significant P<0.05' . Conclusion：A comprehensive assessment of evidence⁃based readiness，analysis of obstacle factors and formulation of targeted intervention strategies before evidence⁃based practice are conducive to the smooth development of evidence⁃based programs.

Keywords high risk diabetic foot; readiness for evidence⁃based practice; obstacle factors; evidence⁃based nursing; evidence application摘要 目的：分析社区护理中心开展糖尿病高危足病人足部管理循证实践准备存在的障碍因素，制定变革策略，促进证据转化。（剩余8281字）