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.

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.

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。

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。

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。

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。

髋关节置换术患者出院准备服务的最佳证据总结

目的 检索、筛选并汇总髋关节置换术患者出院准备服务的最佳证据。方法 依据“6S”模型,计算机检索相关指南网站、专业学会网站和国内外数据库中有关髋关节置换术患者出院准备服务的临床决策、临床指南、专家共识、证据总结、系统评价及随机对照试验,检索时限为建库至2023年3月15日。结果 共纳入23篇文献,其中临床指南8篇、系统评价3篇、专家共识12篇,共形成19条证据,包括筛选与评估(4条)、制定出院计划(3条)、院内服务(6条)、出院前准备(3条)和出院后随访评价(3条)5个方面。结论 本研究总结了髋关节置换术患者出院准备服务的最佳证据,在临床实践中建议根据患者需求、临床情境等因素选择适宜本土转化的证据,进而为髋关节置换术患者提供个性化出院准备服务,提升护理服务质量,促进患者身心康复。

经导管心脏瓣膜手术患者出院准备服务的最佳证据总结

目的 检索、筛选、评价并整合国内外经导管心脏瓣膜手术患者出院准备服务的相关证据,为规范经导管心脏瓣膜手术患者的出院准备服务临床护理实践提供循证依据。方法系统检索国内外数据库中有关经导管心脏瓣膜手术患者出院准备服务的临床决策、推荐实践、证据总结、临床实践指南、系统评价、专家共识和随机对照研究等。检索时限为建库至2023年4月,由2名研究者对文献进行方法学质量评价,并根据主题对证据进行提取和汇总。结果 共纳入14篇文献,其中临床决策1篇、指南1篇、最佳实践3篇、系统评价3篇、专家共识3篇、证据总结2篇和随机对照研究1篇。从入院时、住院期间、出院前、出院后和出院后效果评价5个方面汇总31条最佳证据。结论 该研究总结了经导管心脏瓣膜手术患者出院准备服务的最佳证据,在后续证据转化过程中应结合国内临床具体情境,有针对性地选择证据,以提升患者的出院准备度,提高患者满意度。

Meleis转变理论联合出院计划联动模式在慢性心力衰竭患者护理中的应用效果分析

目的探讨慢性心力衰竭(chronic heart failure,CHF)患者采用Meleis转变理论联合出院计划联动模式护理的效果。方法方便选取2023年6—12月滨州市中心医院收治的86例CHF患者为研究对象,依据不同护理方法分成对照组(n=43)和干预组(n=43),对照组给予常规护理干预,干预组给予Meleis转变理论联合出院计划联动模式干预,比较两组患者自我护理能力[欧洲心衰自我护理行为评价量表(European Heart Failure Self-care Behavior Scale,EHFSCB-9)]、生活质量[明尼苏达心衰生活质量评定量表(Minnesotaliving with Heart Failure Questionnaire,MLHFQ)]、遵医依从性、护理满意度。结果护理后两组患者EHFSCB-9评分均下降,且干预组低于对照组,差异有统计学意义(P均<0.05)。护理后两组患者MLHFQ评分均下降,且干预组低于对照组,差异有统计学意义(P均<0.05)。干预组遵医依从性为95.35%(41/43)高于对照组的79.07%(34/43),差异有统计学意义(χ^(2)=5.108,P<0.05)。干预组护理满意度为97.67%(42/43)高于对照组的81.40%(35/43),差异有统计学意义(χ^(2)=4.468,P<0.05)。结论Meleis转变理论联合出院计划联动模式应用于CHF患者护理中,能够改善患者自我护理能力及生活质量,提高遵医依从性及护理满意度。

糖尿病患者出院准备服务的证据总结

目的:提取并汇总国内外糖尿病患者出院准备服务的相关证据,为我国糖尿病患者出院准备服务的实践提供循证依据。方法:系统检索国内外指南网站、专业学会网站、中英文数据库中关于糖尿病患者出院准备服务的文献,检索时限为从建库至2023年3月27日。对文献进行质量评价,对符合质量标准的文献进行证据提取。结果:纳入12篇文献,共总结28条证据,包括出院准备服务的意义、流程优化、干预对象、干预原则、院内服务、出院前衔接、出院后随访7个方面。结论:医护人员应重视院内对患者开展健康指导的关键作用,加强多环节沟通,结合临床实际情境将证据转化为切实可行的个体化糖尿病患者出院准备服务方案。

肺癌手术病人出院准备服务的最佳证据总结

目的:系统检索、评价、总结肺癌手术病人出院准备服务的最佳证据,为临床实践提供依据。方法:系统检索UpToDate、BMJ Best Practice、JBI、NICE、NGC、the Cochrane Library、PubMed、医脉通、中国知网、中国生物医学文献服务系统、万方数据库、维普数据库等国内外网站及数据库中关于肺癌手术病人出院准备服务相关指南、证据总结、最佳实践、临床决策、系统评价、标准、专家共识,检索时限为建库至2023年11月30日。依据文献质量评价工具评价文献,对证据进行提取、汇总和分级。结果:共纳入18篇文献,其中临床决策3篇、指南4篇、证据总结2篇、系统评价4篇、专家共识3篇、标准2篇,最终形成入院筛查评估、制定出院计划、出院准备、出院后续追踪、效果评价5个主题共28条推荐意见的肺癌手术病人出院准备服务最佳证据。结论:临床医护人员在应用总结的证据时,需结合本国国情、科室特点及病人实际情况,制定本土化、个性化的肺癌手术病人出院准备服务方案,以提高病人出院准备度,有效减少病人术后并发症及再入院率。