儿童造血干细胞移植后皮肤移植物抗宿主病评估与预防的审查指标制定与障碍因素分析
杨利灵, 詹莎, 薛晓燕, 陈凯, 刘青, 王丽, 王怡怡, 吴萌, 陆群峰

Development of indicators and analysis of barriers for assessment and prevention of cutaneous graft-versus-host disease after haematopoietic stem cell transplantation in children
YANG Liling, ZHAN Sha, XUE Xiaoyan, CHEN Kai, LIU Qing, WANG Li, WANG Yiyi, WU Meng, LU Qunfeng
表1 儿童造血干细胞移植后皮肤GVHD评估与预防的审查指标及审查方法
Tab 1 Indicators and review methods for assessment and prevention of cutaneous GVHD after haematopoietic stem cell transplantation in children
DimensionIndicatorPopulationReview methodReview adherence rate/%
Skin evaluation1. The nurse thoroughly examines the child's entire body for skin conditions prior to transplantation

Nurses

(n=19)

Participatory observation100.00
2. The nurse thoroughly assesses the skin condition of the child's entire body on a daily basis during the transplantation period

Nurses

(n=19)

Access to care record sheets0
3. The nurse assesses the grade of the child's skin GVHD using the Glucksberg criteria within 7 d of transplantation

Nurses

(n=19)

Access to care record sheets0
4. The nurse is able to correctly select and use a skin GVHD assessment tool

Nurses

(n=19)

Questionnaire method52.63
5. The nurse uses a diary to record changes in the child's skin condition

Nurses

(n=19)

Access to care record sheets0
6. The nurse is able to use the body surface area method to indicate the area of the child's skin that has been damaged

Nurses

(n=19)

Access to care record sheets; questionnaire method21.05
7. The nurse marks the assessment sheet for the child indicating the use of photosensitive medication

Nurses

(n=19)

Access to care record sheets0
Skin protection8. The caregiver trims cuts the child's nails short during the transplantation period

Caregivers

(n=22)

Participatory observation; interview method81.80
9. Caregivers use lukewarm water for cleansing the child's skin, followed by towel drying or patting dry, and then apply moisturizer

Caregivers

(n=22)

Interview method100.00
10. Caregivers apply moisturiser to the child every 4‒6 h and after the application of steroid creams

Caregivers

(n=22)

Participatory observation; interview method4.54
11. Caregivers store moisturisers in a cool place

Caregivers

(n=22)

Participatory observation100.00
12. Caregivers should avoid exposing children to direct sunlight, particularly between 10:00 and 16:00

Caregivers

(n=22)

Interview method100.00
13. The care givers is able to correctly protect the child from the sun

Caregivers

(n=22)

Interview method100.00
Management of adverse skin reactions14. The nurse is able to correctly advise the physician to perform a skin culture for non-integrated skin

Nurses

(n=19)

Questionnaire method0
15. The nurse is able to correctly manage non-integral skin breaks

Nurses

(n=19)

Questionnaire method100.00
16. The nurse is able to select appropriate skin care products for the care of the child's slow-healing wounds

Nurses

(n=19)

Questionnaire method10.50
Guidance on the use of medication17. The nurse should inform the caregivers and the child of the side effects of tacrolimus ointment

Nurses

(n=19)

Participatory observation; interview method0
18. The nurse should assess the skin condition of a child who has been using steroid creams for a long period of time

Nurses

(n=19)

Participatory observation; interview method89.47
Follow-up and screening19. On discharge, nurses should instruct caregivers and children to carry out their own comprehensive skin checks once a month

Nurses

(n=19)

Participatory observation; interview method0
20. At discharge, the nurse should instruct the caregivers and the child on the correct frequency of skin follow-up visits

Nurses

(n=19)

Questionnaire method; participatory observation0
21. At the time of discharge, nurses should instruct female children to have regular gynaecological outpatient follow-up visits

Nurses

(n=19)

Questionnaire method; interview method0
22. At discharge, nurses should instruct male children to have regular follow-up visits to the urology clinic

Nurses

(n=19)

Questionnaire method; interview method0