Research Of Family-centered Care To Children With Congenital Heart Disease During Peri-operative Period

Objective By applying family-centered care to child with congenital heart disease (CHD)during their peri-operative period,so as to promote CHD patients'heart function recovery after surgery,alleviate patients' pain,relief patient parents' anxiety level and improve family's satisfaction with clinical nursing care.Method Case control quasi experimental research design.52 CHD patients undergoing surgery in Children's hospital Fudan University from October 8th,2007 to January 2008 were selected as control group through subjective sampling.51 patients were selected from Feburary 2008 to May 2008 as intervention group.The control group used the current mode of pediatric clinical care,while "family-centered care" model was carried out among the intervention group,including full implementation to provide information and psychological support,parental involvement in perioperative care,family to family support platform developing.General information questionnaire was used to collect basic information on children and their families demographic and disease data.The incidence of postoperative complications,the average days of hospitalization and heart function degree were used to evualate the patient's recovery.State Anxiety Inventory(SAI) was used to evaluate the parents' anxiety degree during the whole peri-operative period.Face Legs Activity Cry Consolability(FLACC) questionnaire was used to assess patients' pain level and trend. Measure of Processes of Care(MPOC-56) and Client Satisfaction Questionnaire(CSQ-8) were used to evaluate the satisfaction of clinical care service from the CHD family.SPSS 15.0 was used to analysis the datas.Mean,Std deviation,percentage,one-sample T test,independent-sample T test,Chi-square test,Pearson relative analysis,Kaplan-Meier and Lon-rank test were used in different datas.Result There is no significant difference of the demographic data and disease data between two groups.There is no sighificant difference of the FLACC pain scale of the first day after surgery between the intervention group and the control group(P＞0.05);the FLACC scale of the intervention group was sighificantly lower than the control group from the second to sixth day after surgery(P＜0.05);there is also no sighificant difference of the FLACC pain scale of the seventh and eighth day after surgery between two groups (P＞0.05);the median day of intervention group children's pain changing from sever to moderate was 0.4 day earlier than the control group patients(P＜0.05);the median day of intervention group children with their pain level changing from sever or moderate to mild was 1 dayearlier than the control group patients(P＜0.01). The median day of heart function from levelⅢ/Ⅳconvert to levelⅡin intervention group was 0.95 days earlier than the control group(P＜0.05);there is no significant difference of the incidence of postoperative complications and the average hospitalized days between two groups.The SAI scores of pre-operation,intraoperation,CCU admition and post-operation in control group were significantly higher than the national norm(P＜0.01);the SAI scores of pre-operation,intraoperation,CCU admition in intervention group were significantly higher than the national norm(P＜0.01),but there is no significant difference of the post-operation SAI score between the intervention group and the national norm(P＞0.05); parents of two groups have the same anxiety changing trend,that is intra-operation is the most serious period,followed by pre-operative period,CCU admition and post-operative time(P＜0.05);the SAI scores in 4 stages were signinificantly lower in intervention group than in control group(P＜0.05).The total score and 5 dimensions'scores(Enabling & Partnership,EP;Providing General Information,PGI;Providing Specific Information about the Child,PSI;Coordinated and Comprehensive,CCC;Respectful and Supportive care,RSC) of MPOC-56 were significantly higher in intervention group than in control group(P＜0.01);the total score of CSQ-8 was also significantly higher in intervention group than in control group (P＜0.01).Conclusion "Family centered care" could provide excellent health care to the CHD patients and their family during perioperative period,to meet with their different needs, could promote CHD patients' heart function recovery after surgery,alleviate patients' pain, relief parents' anxiety and improve the family's satisfaction during their hospitalization with clinical nursing care procedure.