加速康复外科关节置换患者出院准备体验的现象学研究

Readiness experience for discharge in joint replacement patients based on enhanced recovery after surgery:a phenomenological study

目的了解髋、膝关节置换术患者住院期间参与加速康复外科(ERAS)模式的体验与感受,为完善ERAS围手术期和延续性护理方案提供参考依据。方法采用目的抽样法,对广东省某三甲医院关节外科2019年8—11月收治的15例髋、膝关节置换术后患者进行半结构式访谈,并采用Colaizzi关于现象学的7步分析法对收集的访谈资料进行分析、归纳及提炼主题。结果关节置换患者住院期间参与ERAS模式的体验与感受可归纳为4个主题:信息的不确定感;对治疗效果的担心;提前出院的不安全感;渴望回归与信心不足的矛盾。结论参与ERAS的髋、膝关节置换术后患者住院时间较短,无法完全消化医护人员提供的信息,患者担心出院后无力应对;临床医护人员应充分评估患者出院准备,提供个性化指导,完善院外延续护理服务,提高患者早期出院的体验感。

Objective To explore the experience and feelings of hip and knee replacement patients participating in the enhanced recovery after surgery(ERAS)model during hospitalization,so as to provide a reference for the improvement of ERAS perioperative and continuous nursing plans.Methods From August to November 2019,purpose sampling was used to select 15 patients undergoing hip and knee replacement who were admitted to the Department of Joint Surgery of a ClassⅢGrade A hospital in Guangdong Province for the semi-structured interview.Colaizzi's 7-step analysis method on phenomenology was used to analyze,summarize and refine the themes of the collected interview data.Results The experience and feelings of joint replacement patients participating in the ERAS model during hospitalization can be summarized into 4 themes,namely uncertainty of information,being worried about the treatment effect,insecurity of early discharge,the contradiction between the desire to return and lack of confidence.Conclusions Patients participating in ERAS had a short hospital stay after hip and knee replacement,and could not fully digest the information provided by the medical and nursing staff.Patients were also worried that they would not be able to cope after being discharged from the hospital.Clinical medical and nursing staff should fully evaluate the patient's readiness for discharge,provide personalized guidance,perfect out-of-hospital continuous nursing services and improve the patient's experience of early discharge.