Gastrostomi Bakımında Kanıta Dayalı Hemşirelik Bakım Paketinin Geliştirilmesi ve Hemşirelerin Uyumunun Değerlendirilmesi

Abstract

This study was conducted as a mixed method design study to developing an evidence-based nursing care bundle in gastrostomy care and evaluating the compliance of nurses. The study was carried out with 10 nurses and total 75 implementations on six patients Hacettepe University Adult Hospital Neurosurgery Intensive Care Unit between December 2021 and June 2022. Data were collected with the "Nurse Introductory Information Form", "Gastrostomy Care Questionnaire", "Evidence-Based Nursing Attitude Questionnaire", "Gastrostomy Care Bundle Form", "Gastrostomy Care Bundle Compliance Evaluation Control Form" and "Semi-structured Interview Form for the Use of Gastrostomy Care Bundle". Wilcoxon test and Friedman test were used to evaluate the quantitative data. At least 95% compliance was required in the evaluation of compliance with the Gastrostomy Care Bundle. Qualitative data were analyzed with qualitative content analysis. Gastrostomy Care Bundle was developed in line with the recommendations of the Institute for Healthcare Improvement. The developed care bundle consists 3 parameters including "peristomal area care", "tube feeding" and "medication administration through feeding tube” and 14 elements. After the development of the care bundle, nurses were trained on the gastrostomy care bundle and data collection forms were applied before and after the training. The Gastrostomy Care Bundle was used by nurses six months. At the end of the sixth months, a qualitative interview was conducted with the nurses regarding the use of the gastrostomy care bundle, and the "Gastrostomy Care Questionnaire" and the " Evidence-Based Nursing Attitude Questionnaire " were applied again. In the study, the compliance rate of the nurses with the "peristomal area care" parameter of the bundle was 100%, and the compliance rate with the "tube feeding" and " medication administration through feeding tube" parameters were 98.66%. A statistically significant difference was found in nurses' gastrostomy care knowledge scores at pretest, posttest and 6th month (p<0.05). A statistically significant difference was found in the pre-training and 6th month scores of the Evidence-Based Nursing Attitude Questionnaire (p<0.05). In the qualitative phase of the study, 2 themes as "Reflection of Using Gastrostomy Care Bundle on Nursing Care" and "Adopting the Gastrostomy Care Bundle" and 6 sub-themes emerged. The nurses stated that using the gastrostomy care bundle provided professionalism, made their practices visible, increased understanding within the team, was instructive, and that after the use of the care bundle, the thought that the care bundle would increase the workload changed in the opposite direction. As a result of the study, the rate of compliance with all parameters of the Gastrostomy Care Bundle was above 95% and nurses were evaluated as compliant with all parameters of the care bundle. In order to standardize gastrostomy care and improve the quality of care, it is recommended that the evidence-based nursing care bundle be used in the care of all patients with gastrostomy.