Effect of continuous nursing on rehabilitation of older patients with joint replacement after discharge

BACKGROUND Joint replacement is a common treatment for older patients with high incidences of hip joint diseases.However,postoperative recovery is slow and complications are common,which reduces surgical effectiveness.Therefore,patients require long-term,high-quality,and effective nursing interventions to promote rehabilitation.Continuity of care has been used successfully in other diseases;however,little research has been conducted on older patients who have undergone hip replacement.AIM To explore the clinical effect of continuous nursing on rehabilitation after discharge of older individuals who have undergone joint replacement.METHODS A retrospective analysis was performed on the clinical data of 113 elderly patients.Patients receiving routine nursing were included in the convention group(n=60),and those receiving continuous nursing,according to various methods,were included in the continuation group(n=53).Harris score,short form 36(SF-36)score,complication rate,and readmission rate were compared between the convention and continuation groups.RESULTS After discharge,Harris and SF-36 scores of the continuation group were higher than those of the convention group.The Harris and SF-36 scores of the two groups showed an increasing trend with time,and there was an interaction effect between group and time(Harris score:F_(intergroup effect)=376.500,F_(time effect)=20.090,Finteraction effect=4.824;SF-36 score:F_(intergroup effect)=236.200,Ftime effect=16.710,Finteraction effect=5.584;all P<0.05).Furthermore,the total complication and readmission rates in the continuation group were lower(P<0.05).CONCLUSION Continuous nursing could significantly improve hip function and quality of life in older patients after joint replacement and reduce the incidence of complications and readmission rates.

Research Progress of Continuous Nursing for Patients with Chronic Wounds After Discharge

The research status of continuous nursing of patients with chronic wounds is reviewed.Since the research on continuous nursing of chronic wound patients in China is still in the initial stage,if necessary,learn from foreign experience,improve relevant systems,develop corresponding evaluation tools,actively implement telemedicine,and carry out hospital-community linkage models,etc.to provide high-quality nursing services for patients with chronic wounds.

Corroborative Activities and Recognition Between Community Comprehensive Care Unit’s Nurses and Care Managers in Supporting Discharge of Elderly from Hospital - A Secondary Publication

Objective: The purpose of this study was to clarify the collaborative activities and mutual recognition between community comprehensive care unit nurses (Ns) and care managers (CM) in supporting the discharge of the elderly from the hospital. Methods: A total of 300 nurses working in community comprehensive care wards and 360 care managers working in B City in A Prefecture were surveyed using an anonymous self-administered questionnaire. Results: The highest percentage of responses regarding necessary collaborative activities with multiple professions in supporting hospital discharge were the same for Ns and CMs. The items regarding practice with the highest percentages were “relationship as a team” for Ns, and “user-centered awareness” for CM. While these professionals were willing to share information about their patients’ lives after discharge, the percentage of those explaining their expertise was low. It is thought that collaborative activities focusing on these aspects would lead to more appropriate discharge support.

Validation of the index for the core competence of nurses leading discharge planning for older patients in China

Objective:With the continuous advancement of aging in China,the number of older inpatients has increased sharply.Older patients have a high demand for planning their discharge services.Nurses serve as the leader of discharge planning for patients;there is a lack of reliable evaluation tool to evaluate the core competitiveness of nurses who implement discharge planning for older patients in China.The purpose of this study was to validate the index for the core competence of nurses who lead discharge planning for older patients developed by a project team through the Delphi method in the early stage.Methods:A cross-sectional questionnaire survey with 3-stage stratified sampling was used to select 1075 nurses from 17 public general hospitals in Ningxia,China.Results:The index consists of 4 first-level indicators,13 second-level indicators,and 57 third-level indicators.The results show that 57 third-level indicators had good discrimination.With exploratory factor analysis(EFA),4 common factors that explained 72.79%of the total variance were extracted.The Cronbach's a was 0.98,and the retest reliability within a 14-d interval was 0.86.The confirmatory factor analysis(CFA)results show that the fit of the index structure was good.The criterion validity was 0.73.Conclusions:The index presented excellent psychometric proper ties and can be used to measure the core competence of nurses in implementing discharge planning for older patients in China.

When Home Hospice Patients Discharge to Nursing Home: A Mixed Method

Background: Hospice care is to provide necessary medical care and support for patients and the families at the end of life (EOL). Hospice care patients typically withdraw from aggressive treatment. Even though home hospice has been shown to improve the quality of care, home hospice patients still revoke the services for various reasons. A little is known about where home hospice patients are being transferred. This study aims to address this gap and explore common reasons for home hospice discharge and placements, where patients being transferred other than home. Methods: Data were retrieved from the 2007 National Home and Hospice Care Survey (NHHCS). NHHCS is one in a series of nationally representative sample surveys of U.S. home health and hospice agencies. Results: Within identified home hospice patients, approximately 82.1% were deceased at discharge, and 846 (18.2%) were discharged for other reasons, including patients being stabilized or improved (30.2%), aggressive treatment (31.8%), moved (e.g., geographically, 13.5%) and others. Patients lived with a spouse were less likely to utilize external resources, like volunteers, thereby more likely to discharge patients to long-term facilities. Discussion: The current study suggest that it is difficult for the family to give all remaining care for their loved ones despite the support and resources for those home hospice patients. The characteristics of those who transferred to nursing facilities from home hospice will be discussed throughout.

Pharmacist Integration into Transitions of Care at a Community Hospital： Skilled Nursing Facility Discharges

In 2012-2013, CMH （Community Memorial Hospital） had a 10.5% 30-day readmission rate from SNFs （skilled nursing facilities）. The focus of the Connections of Care Coalition was to review the medication reconciliation process and to involve pharmacists in the transition of patients to SNFs. The objective of the project was to work as an interdisciplinary team to improve the communication during transitions of care from our hospital to local SNFs by identifying key issues and initiating pharmacy practice change. This quality improvement project had a pre-post study design. Patients older than 18 years of age discharged to SNFs and/or readmitted from SNFs within 30 days were included. Baseline data was collected, specific pharmacist interventions were identified, educated on and implemented, and post-implementation data was collected. The number of interventions made and documented by pharmacists for patients being discharged from CMH to local SNFs did not significantly change during this quality improvement study. Clinically significant interventions were made on high risk medications, such as warfarin. Finally, a newly redesigned SNF workflow was implemented to include pharmacy, nursing, social work/case management to improve patient care and safety for discharges to SNFs.

A Spider in a Broken Web:Nurses’Views on Discharge Planning for Older Patients after Hip Fracture Surgery Who Live in their Own Homes in Rural Areas

Introduction: The in-hospital rehabilitation of patients who have undergone surgery for hip fracture requires a team-based effort, in which nurses play an all-embracing role throughout the patients’ hospital stays. Although discharge planning has been widely studied, little is known about discharge planning from hospitals to homes in rural settings. Aim: To describe nurses’ views on discharge planning for older patients after hip fracture surgery who live in their own homes in rural areas. Methods: A qualitative method was used. Four focus group interviews were conducted with 18 nurses who work at an orthopaedic clinic. The interview texts were analysed with qualitative content analysis. Findings: Nurses expressed that patients needed support from healthcare personnel as well as relatives in order to prepare for life at home. They also expressed that patients were not supported in all aspects of discharge planning because they faced difficulties in having their voices heard. Nurses described that many of those aspects were beyond their own control, which had left them with little to non-ability to influence discharge planning. Findings additionally indicate that discharge planning seems not affected by occurring in rural settings. Conclusions: Although discharge planning is intended to meet the unique wishes and needs of each patient given the realities of existing resources, nurses’ responsibilities in discharge planning are unclear. This study shows an organisation in which healthcare personnel continue to make decisions for patients. Significance for nurses to perform a discharge planning that support patients’ participation seems to be a communication based on shared understanding.

Nursing care of a patient with acute mastitis after dystocia

Objective:To discuss the prevention of acute mastitis during lactation and the nursing after its formation.Methods:The diet is light and easy to digest,keep the mood at ease,massage and drain the milk.After the occurrence of acute mastitis during lactation,prompt symptomatic treatment and care.Results:As a result after careful treatment and care acute mastitis during lactation healed.Conclusion:Effective prevention and care are the key to the treatment of acute mastitis during lactation.

Evaluation of Pharmacist-Managed Medication Reconciliation Process after Hospital Discharge at an Internal Medicine Clinic

This paper is to analyze the impact of ambulatory care pharmacists on reduction of 30-day readmission rates of HDF （hospital discharge follow-up） patients and to assess a link between readmission rates and medication appointment compliance as well as medication discrepancies. This was a retrospective, single-center study that included all adult patients scheduled for HDF appointments at the UIM （university internal medicine） clinic of the MUSC （Medical University of South Carolina） from May 1, 2013 through December 31, 2013. A total of 470 patients were included with 190 patients attended their scheduled HDF appointments with their PCPs （primary care providers） and the ambulatory care pharmacists, and 280 patients attended their scheduled HDF appointments only with their PCPs. The 30-day readmission rate was 22% in patients who attended HDF appointments with both of the healthcare providers versus 41% in patients who attended HDF appointments only with their PCPs （P 〈 0.05）. Medication errors and discrepancies are common during transitions of care. However, ambulatory care pharmacists play a crucial role in significantly reducing 30-day readmission rates after hospital discharge by providing thorough and complete medication reconciliation services.

Nursing discharge teaching of hospitalized postpartum women in China:A cross-sectional study

Background:Postpartum women encounter a diverse array of physiological challenges following childbirth,and they may also contend with issues such as a lack of self-care knowledge childcare knowledge,and childcare experience.This study aimed to explore the quality of discharge teaching for hospitalized postpartum women.Methods:A total of 292 parturients who gave birth in a tertiary hospital were selected using the convenience sampling method and surveyed using a general data questionnaire and discharge teaching quality scale.Results:The total score for the quality of discharge teaching was 111.95±28.64.In bivariate analysis,significant differences were identified between postpartum women with differences in postpartum complications,ambulation time,wound pain,infant health status,and infant feeding methods(p<0.05).Wound pain and infant feeding methods were significant factors in a multiple linear regression model(p<0.05).Conclusions:Nursing staff should focus on psychological nursing care and give more personalized teaching to postpartum women with severe wound pain and who bottle feed their newborns.

前列腺癌根治术患者出院准备服务方案的构建与应用

目的基于循证护理理念构建前列腺癌根治术患者出院准备服务方案,并探讨其临床应用效果。方法将66例前列腺癌根治术患者按照入院时间分为对照组35例,观察组31例。对照组采用常规护理方法和随访方案;观察组基于文献检索及专家函询,构建前列腺癌根治术患者出院准备服务方案,并对患者实施该方案。结果出院时观察组出院准备度、出院指导质量评分显著高于对照组(均P<0.05);出院后1个月、3个月观察组焦虑及生活质量评分显著低于对照组(均P<0.05)。结论出院准备服务方案的实施可以提高前列腺癌根治术患者的出院准备度、出院指导质量,缓解患者焦虑情绪,提高生活质量。

骨搬运患者出院准备度评估量表的编制及信效度检验

目的编制骨搬运患者出院准备度评估量表,并检验其信效度。方法参考Meleis转变理论,在文献回顾、半结构式访谈的基础上初步形成条目池,通过德尔菲专家函询法对条目进行修订。2023年9月在广州市三级甲等医院选取20例骨搬运术后预出院患者进行预调查,检验量表的可读性。2023年9—11月选取广州市三级甲等医院的527例搬运术后预出院患者作为调查对象,对量表进行项目分析和信效度检验。结果骨搬运患者出院准备度评估量表包括5个维度、30个条目。量表水平内容效度指数为0.951,条目水平的内容效度指数为0.790~1.000;探索性因子分析共提取5个公因子,累计方差贡献率为66.963%;验证性因子分析结果显示,模型拟合程度良好。量表各维度的平均方差抽取量分别为0.563、0.615、0.592、0.614、0.572,组合信度为0.885、0.827、0.941、0.905、0.842。量表总的Cronbachα系数为0.941。结论骨搬运患者出院准备度评估量表信效度良好,可作为评估骨搬运患者出院准备度的工具。

肠结核病人出院准备度现状及影响因素

目的:调查肠结核病人出院准备度的现况,并探讨其影响因素。方法:采用便利抽样法选取2022年4月—2023年4月在南京市第二医院结核科住院的130例肠结核病人作为研究对象。采用一般资料调查表、出院准备度量表和出院指导质量量表对病人进行问卷调查。结果:肠结核病人出院准备度总分为(90.24±15.84)分,条目均分为(7.52±1.32)分,处于中等水平。多重线性回归分析结果表明,出院指导质量、文化程度、家庭人均月收入、年龄、医疗费用支付方式是影响肠结核病人出院准备度的主要因素(P<0.05)。结论:肠结核病人的出院准备度为中等水平,应对年龄较大、文化水平较低、家庭人均月收入较低、没有医保和出院指导质量较低的病人加强出院指导,建立肠结核病人的出院准备度标准化干预方案,强化医护人员的健康教育意识与能力的培训,采取多样化的宣教形式等措施以改善其出院准备度现况。

体外膜肺氧合治疗病人出院后生活体验的质性研究

目的:提高体外膜肺氧合(ECMO)治疗病人出院后生活质量,为延续护理提供参考。方法:采用现象学研究法,选取2017年1月—2018年6月在赣州市某心脏中心接受ECMO治疗后出院的13例病人进行半结构式访谈,采用Colaizzi法对资料进行处理。结果:提炼出ECMO治疗病人出院后生活体验的4大主题:躯体功能的变化、心理状态的变化、积极调试以适应生活、强烈的康复需求。结论:ECMO治疗病人出院后存在多方面的问题,医护人员在病人出院前应制定周密、全面的延续护理计划,提高病人的生活质量。

中青年冠心病PCI术后患者出院准备度现状及影响因素

目的调查中青年冠心病患者经皮冠状动脉介入治疗(PCI)术后患者出院准备度的现状及影响因素。方法选取郑州大学第一附属医院心内科于2023年5—10月收治的210例接受PCI术治疗的中青年冠心病患者进行问卷调查,问卷内容由6个调查表构成:一般资料调查表、疾病资料调查表、出院准备度量表、出院指导质量量表、自我效能量表、社会支持评定量表。结果中青年冠心病PCI术后患者出院准备度总得分为(92.07±11.85)分。出院准备度总分与出院指导质量总分呈正相关(r=0.901,P<0.05);出院准备度总分与自我效能总分呈正相关(r=0.632,P<0.05);出院准备度总分与社会支持评定总分呈正相关(r=0.686,P<0.05)。多重线性回归分析显示,影响中青年冠心病PCI术后患者出院准备度的影响因素有年龄、受教育程度、婚姻状况、家庭人均收入、疾病发病情况、出院指导质量、自我效能、社会支持,能解释回归方程82.5%的变异。结论中青年冠心病PCI术后患者出院准备度处于中等水平。中青年冠心病PCI术后患者出院准备度受年龄、受教育程度、家庭人均收入、疾病发病情况、出院指导质量、自我效能、社会支持影响,患者出院准备度影响患者康复及健康结局,医护人员制定有针对性的干预措施,可提高患者治疗效果和生活质量。

基于再设计出院模式的多维度延续性护理在糖尿病视网膜病变患者中的应用效果

目的:观察基于再设计出院(RED)模式的多维度延续性护理在糖尿病视网膜病变(DR)患者中的应用效果。方法:选取2021年1月至2022年7月该院收治的98例DR患者进行前瞻性研究,按照随机数字表法将其分为对照组和观察组各49例。对照组实施常规护理,观察组实施基于RED模式的多维度延续性护理,比较两组护理依从性、护理前后自我管理能力[成年人健康自我管理能力测评量表(AHSMSRS)]评分及视功能相关生命质量[视功能相关生存质量量表(VFQ-25)]评分。结果:护理1、3个月后,两组护理依从性评分均高于护理前,且观察组高于对照组,差异有统计学意义(P<0.05);护理后,两组AHSMSRS评分均高于护理前,且观察组高于对照组,差异有统计学意义(P<0.05);两组VFQ-25评分均高于护理前,且观察组高于对照组,差异有统计学意义(P<0.05)。结论:基于RED模式的多维度延续性护理应用于DR患者,可提高患者护理依从性和自我管理能力,改善视功能水平,效果优于常规护理。

基于过渡理论的回肠代膀胱术后病人支持方案的应用

目的:探讨基于过渡理论的回肠代膀胱术后病人支持方案的应用效果。方法:采用便利抽样法选取60例上海某三级综合医院回肠代膀胱造口术后病人为研究对象,采用非同期对照研究,对照组和试验组各30例。对照组采用常规护理,试验组采用基于过渡理论的回肠代膀胱术后病人支持方案,比较两组病人的出院准备度及出院3个月后尿路造口自护能力、造口适应、并发症发生情况和满意度。结果:试验组出院后3个月尿路造口自护能力评分、造口适应评分、满意度均高于对照组;出院时出院准备评分高于对照组;出院后3个月尿路造口并发症发生率低于对照组,差异均有统计学意义(P<0.05)。结论:基于过渡理论的回肠代膀胱术后病人支持方案可以提高病人的尿路造口自护能力、出院准备度、造口适应能力、满意度,减少尿路造口并发症发生率,改善临床预后。

外科责任护士出院计划能力的潜在剖面分析及影响因素研究

目的探讨外科责任护士出院计划能力现状,分析其类别及人群特征。方法便利选取3所三级甲等医院的516名外科责任护士作为调查对象,采用一般资料调查表、责任护士出院计划能力量表、自我效能量表及职业认同感量表进行调查,对其出院计划能力进行潜在剖面分析,并通过单因素分析和logistic回归分析识别各类别的影响因素。结果外科责任护士出院计划能力分为3个类别:低能力组(24.23%)、中等能力组(49.22%)和高能力-达成共识组(26.55%)。logistic回归分析结果显示,外科责任护士年龄、工作年限、学历、是否参加过出院计划培训、自我效能感及职业认同感是出院计划能力潜在剖面类别的影响因素(均P<0.05)。结论外科责任护士出院计划能力存在异质性。护理管理者可根据不同类别的影响因素对外科责任护士进行个体化干预,以提高其整体出院计划能力。

脑卒中患者医院-家庭过渡期护理的研究进展

对过渡期护理的概念、脑卒中患者医院-家庭过渡期护理发展现状、我国脑卒中患者过渡期护理存在问题及顺利过渡的改善策略等进行综述,旨在为构建适合我国脑卒中患者的过渡期护理模式、护理方案提供依据,为更好地维护并促进脑卒中患者的康复和健康提供借鉴。

基于出院需求评估结果制订的护理出院计划对老年髋部骨折术后患者出院准备度、出院指导质量及早期康复效果的影响

目的探讨基于出院需求评估结果制订的护理出院计划对老年髋部骨折术后患者出院准备度、出院指导质量及早期康复效果的影响。方法将214例老年髋部骨折术后患者分为观察组106例和对照组108例。给予对照组患者骨科常规护理干预,观察组在对照组的基础上,实施基于出院需求评估结果制订的护理出院计划。采用老年髋部骨折术后出院需求评估表、老年髋部骨折术后出院准备度评估表和中文版出院指导质量量表(QDTS)分别评估两组患者出院需求、出院准备度和出院指导质量。比较两组患者的老年髋部骨折术后出院需求评估表得分、老年髋部骨折术后出院准备度评估表得分、QDTS得分,以及患者出院后1个月和3个月的并发症、跌倒、再骨折及死亡情况。结果入院3 d,两组患者的老年髋部骨折术后出院需求评估表各维度得分及总得分比较,差异无统计学意义(P>0.05)。出院当日,观察组的老年髋部骨折术后出院准备度评估表各维度得分及总得分、QDTS各维度得分及总得分高于对照组(P<0.05)。观察组出院后1个月的并发症发生率和出院后3个月的跌倒发生率低于对照组(P<0.05);两组患者出院后1个月和3个月的再骨折和死亡情况比较,差异无统计学意义(P>0.05)。结论基于出院需求评估结果制订的护理出院计划有助于提高老年髋部骨折术后患者的出院准备度及出院指导质量,降低患者术后早期并发症、跌倒的发生风险,可在一定程度上提升老年髋部骨折术后患者的早期康复效果。