“医养结合-四元联动”整合照护的全流程闭环护理模式在乙型肝炎肝硬化失代偿患者中的应用

Application of whole-closed-loop nursing model of“integration of medical and nursing care-quaternary linkage”in decompensated patients with hepatitis B liver cirrhosis

背景由于乙型肝炎肝硬化失代偿病程长、病情迁延难愈,加之医院床位紧张,大部分患者病情稳定后需在家庭、社区或养老机构接受医疗护理,故做好医院-社区-居家-机构一体化的照护模式对患者的康复至关重要.目的评估"医养结合-四元联动"整合照护的全流程闭环护理模式在乙型肝炎肝硬化失代偿患者中的应用效果.方法本研究为单中心、前瞻性、随机对照研究,研究对象为2019-07/2020-07在本院完成院内治疗后正常出院的100例乙型肝炎肝硬化失代偿患者,按照电脑随机数字表法分为两组.常规组(50例)接受常规延续性护理,护理组(50例)实施"医养结合-四元联动"整合照护的全流程闭环护理模式.统计两组用药依从性及并发症,并观察干预前、干预3个月后情绪状态、社会支持、疾病不确定感、生活质量及自我管理行为的变化.结果护理组用药总依从性(98.00%)比常规组(84.00%)高,并发症发生率(10.00%)比常规组(26.00%)低(P均<0.05);护理组干预后简明心境问卷(profileof mood States, POMS)量表中紧张-焦虑、抑郁-沮丧、迷惑-混乱、愤怒-敌意及疲乏-迟钝评分均比常规组低,精力-活力评分比常规组高(P均<0.05);护理组干预后社会支持评定量表(social support rating scale, SSRS)、世界卫生组织生存质量测定量表简表(world health organization quality of life scale brief, WHOQOL-BREF)及自我管理行为量表各维度评分比常规组高,疾病不确定感量表(mishel uncertainty in illness scale for adult,MUIS-A)评分比常规组低(P均<0.05).结论 "医养结合-四元联动"整合照护的全流程闭环护理模式用于乙型肝炎肝硬化失代偿患者中具有较高的可行性,有利于提升患者用药依从性及社会支持度,改善情绪状态、自我管理行为,减轻疾病不确定感,提高后续的生活质量,减少并发症.

BACKGROUND Due to the long course of decompensated hepatitis B liver cirrhosis and the shortage of hospital beds,most of such patients need to receive medical care at home or in the community or elderly care center after their condition is stable.Therefore,an integrated care model involving the hospital,community,family,and institution is essential to the recovery of patients.AIM To evaluate the effect of the whole-closed-loop nursing model of“integration of medical care and nursing care-quaternary linkage”in patients with decompensated hepatitis B liver cirrhosis.METHODS This study is a single-center,prospective,randomized controlled study.The subjects of the study were 100 decompensated patients with hepatitis B cirrhosis who were discharged from the hospital after completing the in-hospital treatment from July 2019 to July 2020.They were randomized into either a routine care group(50 cases)or a novel care group(50 cases).The routine group received routine continuation care,and the novel care group implemented the whole-closed-loop nursing model of“integration of medical care and nursing care-quaternary linkagents”.The medication compliance and complications of the two groups were recorded,and changes in emotional state,social support,disease uncertainty,quality of life,and self-management behavior were observed before and 3 mo after the intervention.RESULTS The overall medication compliance rate of the novel care group(98.00%)was significantly higher than that of the routine care group(84.00%),and the complication rate(10.00%)was significantly lower than that of the routine care group(26.00%)(P<0.05).The scores of stress-anxiety,depression-frustration,confusion-confusion,anger-hostility,and fatigue-sluggishness on the Profile of Mood States scale were lower,and the energy-vitality score was significantly higher in the novel care group than in the routine care group(P<0.05).SSRS and WHOQOL-BREF scores as well as the scores of each dimension of the self-management behavior scale were significantly higher in the novel care group than in the routine care group,and the MUIS-A score was significantly lower than that of the routine care group(P<0.05).CONCLUSION The whole-closed-loop nursing model of“integration of medical and nursing care-quaternary linkage”is highly feasible for decompensated patients with hepatitis B cirrhosis,and it is conducive to improving patient medication compliance,social support,mood state,and self-management behavior,reducing disease uncertainty,improving quality of life,and reducing complications.