| Objective: The thesis tests the effectiveness of discharge guidance based on the theoretical framework of the Omaha System on patients with angina not receiving interventional treatment,constructs discharge guidance informatization module of patients with angina not receiving interventional treatment according to the Omaha System on the nursing informatization platform.The researcher also investigates and interviews the feelings of nurses participating in the application of informatization module and constantly improves the module.The informatization knowledge base of discharge guidance is formed combining quantitative and qualitative research results and playing a guiding role and reference value in discharge guidance nursing practice.Method: mixed-methodsPart one: A randomized controlled trial on the application effect of Omaha System-based discharge guidance in patients with angina not receiving interventional treatmentA randomized controlled trial is conducted on 150 inpatients with angina not receiving interventional treatment in a cardiovascular ward in a tertiary hospital from December2015 to September 2016.Those randomized to the control group(n=75)receive the conventional discharge guidance by the duty nurses from three days before discharge to the day of discharge.Those randomized to the intervention group(n=75)receive discharge guidance based on the theoretical framework of the Omaha System.The duty nurses clarify patient problems of the intervention group at discharge based on Problem Classification Scale of the Omaha System.Then they develop specific intervention strategies based on Intervention Classification Scale of the Omaha System and the clarified problems.After implementation of interventions,the duty nurses assess the problems based on the Omaha System every day and adjusted the intervention strategies.The data are collected using Problem Classification Scale,Intervention Classification Scale,Problem Rating Scale for Outcomes,self-designed Effectiveness Evaluation Scale and General Information Questionnaire.The outcomes are assessed to test the effectiveness of discharge guidance health promotion strategies based on the Omaha System compared with the conventional discharge guidance.The data are statistically analyzed by descriptive statistics,independent-sample t test and analysis of variance using SPSS version 17.0.Part two: Construction of discharge guidance informatization module for patients with angina not receiving interventional treatment and investigation of nurses' feelings about using based on the Technology Acceptance ModelThe researcher designs discharge guidance informatization module for patients with angina not receiving interventional treatment according to the theoretical framework of the Omaha System on the regional collaborative nursing informatization platform that the hospital has constructed.35 nurses from a cardiovascular ward in a tertiary hospital are selected from the convenient sampling as participants in May 2018.Nurses' feelings about using discharge guidance informatization module is investigated based on the Technology Acceptance Model using the cross-sectional survey method in the quantitative research.The contents of the survey include perceived usefulness,interface perceived ease of use,operation perceived ease of use,presentation perceived ease of use,usage attitude and usage intention.The nurses from a cardiovascular ward in a tertiary hospital who participated in the cross-sectional survey in May 2018 are selected from the purposive sampling as participants in February 2019.Nurses' feelings about using discharge guidance informatization module is interviewed based on the interview outlines using the descriptive qualitative research.The number of participants in the interview is based on data saturation.Data saturation is reached when the information obtained in the interview appears repeatedly and the data analysis no longer provides new theme.The data are statistically analyzed by descriptive statistics using SPSS version 17.0.Qualitative research methods are used to extract interview points.Part three: The informatization knowledge base of discharge guidance for patients with angina not receiving interventional treatment is formed based on the Omaha System and the Technology Acceptance ModelAccording to the results of the randomized controlled trial,the cross-sectional survey and the descriptive qualitative research,combined with literature review,experts consulting,application status of the module and clinical practice,the researcher determines the framework,content and presentation mode of the informatization knowledge base of discharge guidance,proposes detailed functional requirements of the knowledge base.The informatization knowledge base of discharge guidance is developed and embedded into the discharge guidance informatization module already constructed for patients with angina not receiving interventional treatment based on the Omaha System.Results:Part one: A randomized controlled trial on the application effect of Omaha System-based discharge guidance in patients with angina not receiving interventional treatmentThe eligible patients with angina not receiving interventional treatment who were randomly assigned to the intervention group received discharge guidance based on the Omaha System.The duration of intervention is from three days before discharge to day of discharge.The baseline demographic data of the two groups are not statistically different and are comparable.Improvements in knowledge(t=10.72,P<0.001),behavior(t=12.36,P<0.001)and total score(t=11.70,P<0.001)of the intervention group were significantly higher than the control group.This indicates that Omaha System-based discharge guidance starting three days before discharge is effective at enhancing knowledge and behavior in patients with angina not receiving interventional treatment.Three days before discharge,there are mainly 18 nursing problems and 20 intervention targets in the intervention group for patients with angina not receiving interventional treatment.The key points of discharge guidance for patients with angina not receiving interventional treatment are clarified.Part Two: Construction of discharge guidance informatization module for patients with angina not receiving interventional treatment and investigation of nurses' feelings about using based on the Technology Acceptance ModelDischarge guidance informatization module according to the Omaha System includes patient diagnosis and general information,problem classification,intervention classification,problem rating for outcomes,and discharge guidance query statistics.In the cross-sectional survey,35 nurses from a cardiovascular ward participating in the application of discharge guidance informatization module are investigated by the Technology Acceptance Survey Scale.The scores of all items in the survey scale are above 6.This indicates that nurses have good acceptance of perceived usefulness,interface perceived ease of use,operation perceived ease of use,presentation perceived ease of use,usage attitude and usage intention of the new technology.In the interview,semi-structured interviews are conducted with 15 nurses from a cardiovascular ward participating in the application of discharge guidance informatization module.Analyze the interview data and form three themes: obvious advantages,facing challenges,development needs.Part three: The informatization knowledge base of discharge guidance for patients with angina not receiving interventional treatment is formed based on the Omaha System and the Technology Acceptance ModelThe formed informatization knowledge base of discharge guidance covers Omaha System-based discharge guidance framework and definition,discharge guidance path diagram based on the Omaha System,ranking of the Omaha System nursing problems at discharge,ranking of the Omaha System intervention classification at discharge,the Omaha System detailed nursing interventions at discharge.The informatization knowledge base can be used as a basis when nurses initially use the Omaha system for discharge guidance,and it can also be used as a reference to find the key points in the process of using the Omaha system for discharge guidance.Conclusion:1.Omaha System-based discharge guidance starting three days before discharge can improve the knowledge and behavior of patients with angina not receiving interventional treatment and is an effective new method of discharge guidance for patients.2.The discharge guidance informatization module including patient diagnosis and general information,problem classification,intervention classification,problem rating for outcomes,and discharge guidance query statistics is constructed.Investigate and interview nurses' feelings and suggestions about using informatization module based on the Technology Acceptance Model and take them as the feedback basis for constantly improving the module..3.The informatization knowledge base of discharge guidance covering Omaha System-based discharge guidance framework and definition,discharge guidance path diagram based on the Omaha System,ranking of the Omaha System nursing problems at discharge,ranking of the Omaha System intervention classification at discharge,the Omaha System detailed nursing interventions at discharge,which can play the role of guidance and reference when nurses apply Omaha System-based discharge guidance.In the future,we can try to expand this new discharge guidance method.When needed,nurses can log in the knowledge base to consult reference materials,which can guide clinical discharge guidance. |
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