老年髋部骨折术后患者过渡期居家护理指导方案的构建和应用

Development and application of a transitional home nursing program for the elderly patients after surgery of hip fractures

目的构建老年髋部骨折患者过渡期居家护理指导方案并探讨其应用效果。方法基于文献回顾和德尔菲法构建老年髋部骨折患者过渡期居家护理指导方案并应用。选择2022年3月至2023年1月本院收治的104例老年髋部骨折患者作为研究对象,其中2022年3月至2022年8月收治的52例患者设为对照组,2022年9月至2023年1月收治的52例患者设为试验组。对照组采取常规过渡期护理,试验组则实施过渡期居家护理指导方案。比较两组患者出院时、出院后3个月康复效果、生活质量和功能锻炼和服药依从性。结果2轮专家函询后问卷回收率100.00%、91.67%,Kendall协调系数W分别为0.800、0.832(均P<0.05)。方案包括指导内容(饮食和营养指导、康复锻炼、居家环境建设、健康教育、心理护理和并发症预防)与指导形式(线上和随访)两大方面。试验组患者实施方案出院后3个月康复效果、生活质量、功能锻炼及用药依从性高于对照组,两组比较,差异具有统计学意义(均P<0.001)。结论构建的老年髋部骨折患者过渡期居家护理指导方案科学性及实用性较好,可为患者医院-家庭过渡期护理提供依据和参考。

Objective To develop a transitional home nursing program and evaluate its effectiveness in guidance on the elderly patients after surgery of hip fractures.Methods A literature review on transitional home nursing was conducted and then Delphi method was employed to generate a transitional home nursing program and had it applied to the elderly patients after hip fracture surgery.After that,a total of 104 elderly patients with hip fractures admitted to Yancheng First People’s Hospital from March 2022 to January 2023 were enrolled as study subjects.According to the order of admission,52 patients admitted between March and August 2022 were assigned to a control group,while the rest of 52 patients admitted between September 2022 and January 2023 were assigned to an trial group.Patients in the control group received routine transitional nursing,and those in the trial group received instructions based on the developed transitional home nursing program.Patient recovery and the quality of life of the two groups were compared at the time of discharge and at 3 months after discharge.The patients'compliance at 3 months after discharge was analysed.Results After 2 rounds of consultations with 12 experts,the questionnaire retrieval rates reached 100.00%and 91.67%,with Kendall’s W coefficients of 0.800 and 0.832,respectively(both P<0.05).The home nursing program consisted of methods for the online instructions and postoperative follow-up.The contents of instructions covered diet and nutrition guidance,rehabilitation exercise,home environment,health education,psychological care and prevention of complication.The scores of rehabilitation,functional exercises,medication compliance and quality of life in the trial group were all significantly higher than those in the control group(all P<0.001).Conclusions The transitional home nursing program developed for elderly patients after hip fracture surgery in this study is scientific and practical.It can provide a basis for the hospital-home transitional nursing.