Objective:To retrieve and analyze the relevant guidelines for the second and third stages of normal delivery, and summarize the evidence of high-quality guidelines so as to provide references for the formulation of clinical practice programs.Methods:We took Johns Hopkins evidence-based nursing practice model as theoretical guidance and set up an evidence-based team.We systematically searched major guideline publication websites, electronic resource databases, related academic groups and guideline networks at home and abroad, evaluated guidelines and summarized the best evidence, and the search time limit was up to June 1, 2019. The literature quality evaluation and evidence extraction were carried out independently by four researchers with evidence-based training.Results:This study included two guidelines, summarizing the 20 best evidences in 9 aspects of humanistic support, delivery companion, delivery position, fetal monitoring, delayed exertion, perineal protection, fundus compression, prevention of postpartum hemorrhage, and delayed umbilical cord clamping.Conclusions:Based on the existing evidence, it integrates the best evidence of nursing measures for the second and third stages of normal delivery. It is recommended that maternal and child institutions promote the transformation of the best evidence based on their actual conditions.

目的 探讨基于最佳证据的产妇正常分娩第二、三产程的护理方案,并评价其应用效果.方法 应用循证的方法系统检索产妇正常分娩第二、三产程护理方案的国内外指南,评价并汇总最佳证据,制订审查指标,进行基线审查,基于审查结果分析促进和障碍因素.比较证据应用前后产妇的分娩结局,助产士对产妇正常分娩第二、三产程护理措施的认知水平及审查指标的执行情况.结果 最佳证据应用后,产妇会阴完整率从7.9％提升到13.4％;助产士对产妇正常分娩第二、三产程护理措施的认知得分从培训前的25～85(54.9±14.3)分提升至50～100(77.1±13.8)分;除指标14、15外,证据应用前执行率＜50％指标的执行率均上升到70％以上.结论 本研究基于最佳证据,结合科室临床情境、患者意愿,并通过分析促进和障碍因素,制订产妇正常分娩第二、三产程的护理方案,证据应用后,产妇会阴完整率、助产士相关护理措施认知水平得到提高,助产士工作行为得到规范.

Objective? To evaluate and summarize the best available evidence of kangaroo mother care for premature infants both in China and abroad, and to provide evidence-based support for clinical practice. Methods? Evidence on kangaroo mother care including evidence-based guidelines, best practices, systematic evaluation and so on were systematically retrieved from databases such as UpToDate, Cochrane Library, Ontario Registered Nurses Association of Canada, National Institute for Health and Care Optimization of the United Kingdom and National Guidelines Network of the United States from the establishment of the database to December 15th, 2018. Four researchers were divided into two groups and evaluated the quality of literature and extracted data. Results? Eight papers were included, including one guideline and seven systematic reviews. The best evidence included suitable population, support system, skin contact (timing, duration, operator), breast feeding support, etc. After evidence extraction, evidence aggregationin combination with localized adjustment in clinical situation, this study has formed eight best evidences. Conclusions? It is necessary to strengthen and support the education of relative knowledge about kangaroo mother care, improve the facilities and promote the development of clinical kangaroo mother care based on the evidence and consider the special humanistic attributes with clinical environment at the same time .

目的 分析在线医疗服务模式在护理实践中的应用效果.方法 以互联网医疗服务平台为对象,调查2016年12月至2017年11月北京大学第一医院妇产科的住院患者在健康知识阅读、满意度评价、出院随访3方面内容.结果 健康知识阅读率为95.93%(26267/27382),答疑率为90.24%(296/328);出院满意度得分(90.24 ± 6.42)分;随访率为91.18%(4032/4422),成功率为57.99%(2338/4032).结论 互联网医疗健康教育模式的应用使临床护理工作更加高效、科学、简捷.