| ObjectEstablished the clinical nursing pathway of laparoscopic cholecystectony. Evaluated the influences of the implementation of clinical nursing pathway of laparoscopic cholecystectomy,such as the length of stay,the cost of hospitalization,the quality of medical treatment service,the patients' satisfaction and so on.Provided scientific basis for the establishment of clinical management of laparoscopic cholecystectomy.Established the mode of continuing nursing of laparoscopic cholecystectomy.Evaluated the influences of the postoperative continuing nursing of Laparoscopic cholecystectomy on patients who discharged from hospital,such as the physical rehabilitation,the functional training,the satisfaction of patients,the probability of choosing our hospital again,the probability of recommending others our hospital and so on.Provided the follow-up support for the implementation of the clinical pathway,and strong protection for the promotion of single-disease clinical management.If we implement the clinical nursing pathway and postoperative continuing nursing of laparoscopic cholecystectomy,we can decrease the length of stay,reduce the cost of hospitalization,increase the turnover of the wards,raise the bed occupancy rate, save health care resources,lower medical costs,promote patients early rehabilitation,enhance patient satisfaction.We also can build a harmonious relationship between doctors and patients,bring about social and economic benefits of the hospital,make up for lack of strength of our community health, provide a favorable support for the implementation of single-disease management, ease the pressure of the public health undertakings of the motherland,and contribute the health development of the motherland. MethodsPart one:The study of clinical nursing pathway of laparoscopic cholecystectomyIn this part,the clinical nursing pathway of laparoscopic cholecystectomy was researched and implemented.First,we formulated the schedule of clinical nursing pathway,and then we selected feasible laparoscopic cholecystectomy patients to study who were divided into two groups,clinical nursing pathway group and parallel control group.According to clinical nursing pathway schedule, the clinical pathway group implemented the treatment table process.The parallel control group completed the treatment according to traditional customs.The data was statistical analyzed by descriptive analysis,rank sum test,chi-square test and so on.Then we compare the differences between two groups of patients hospitalized in length of preoperative and postoperative,length of hospital stay, length of stay,the cost of hospitalization,the average daily hospital cost,after circumstances,health care quality,patient satisfaction,etc.Part two:The study of continuing nursing of laparoscopic cholecystectomy.In this part,we researched and implemented the continuing nursing of laparoscopic cholecystectomy.The postoperative continuing nursing schedule was formulated.We chose patients who jointed the clinical nursing pathway group with the age less than 60-year-old to do this study.They were randomly divided into two groups,named the postoperative continuing nursing group and parallel control group.We gave the postoperative continuing nursing group the continuing care,and did not give any extraordinary nursing service to the parallel control group.Statistical analysis of data using descriptive analysis,t tests,chi-square test, and we compared two groups of patients situation on the physical recovery,the activities of the distance,the activities of the duration,the time to resumption of work,satisfaction,the probability of choosing our hospital again,the probability of recommending others our hospital,etc. Results1.Aspects of clinical nursing pathway1.1 After the operation,clinical nursing pathway group and parallel control group were significant different.The data of the clinical nursing pathway group is much better than that of parallel control group.The patients of the clinical nursing pathway group washed(12.97±5.08 hours) earlier than the parallel control group (16.55±10.18 hours) by 3.58 hours.The first evacuating time(9.34±5.17 hours) of the clinical nursing pathway is earlier than that of the parallel control group (12.61±9.62 hours) by 3.28 hours.The first exercising time(8.19±4.88 hours) of the clinical nursing pathway is earlier than that of the parallel control group (10.20±7.921 hours) by 2.01 hours.The first eating time of the clinical nursing pathway(22.19±1.26 hours) is more regular than that of the parallel control group(21.32±10.39 hours).There is no difference between the two groups of patients(p＞0.05) on the length of the first exercising.1.2 when the patients leaved hospital,all the patients have clearly consciousness,normal urination,entirely self-washing,completely self-eating, completely self-evacuating,completely self-care activating,free exercise, incision classâ… ,healing the best grade,no bleeding,no red,no swelling,no fever,no complications.In defecation,pain,throat,pharyngodynia,nausea, vomiting,the scope of activities,there is no difference(p＞0.05).Pain levels is different(p＜0.05).The patients have different levels of pain.The pain takes different place,as the wound pain,the shoulder and abdominal department.1.3 There are a lot of significant differences between the clinical nursing pathway group and the control group in these aspects,such as pre-operative length of hospital stay,postoperative days in hospital,the total number of days hospitalized,the total length of hospital stay,hospital costs,the average hospital costs(p＜0.01).The clinical nursing pathway group is shorter than the parallel control group.The length of stayed before operation of the clinical pathway group (1.85±0.79 days) is shorter than that of the parallel control group(5.00±2.76 days)by 3.15 days.The postoperative length of hospital stay of the clinical nursing pathway(2.08±0.60 days) is shorter than that of the parallel control group(2.92±1.23 days) by 0.84 days.The total hospital days of the clinical nursing pathway(3.92±0.79 days) is shorter than the parallel control group(7.92±2.91 days) by 4 days.The total number of hour's hospital of the clinical nursing pathway(94.05±18.94 hours) is shorter than that of the parallel control group (190.14±69.74 hours) by 96.09 hours.The hospitalization costs of the clinical nursing pathway(ï¿¥8964.20±2480.10) is less expensive than that of the parallel control group(ï¿¥11353.90±4273.49) byï¿¥2389.7.The mean hospitalization costs per day of the clinical nursing pathway(ï¿¥2420.24±1163.52) is more expensive than that of the parallel control group(ï¿¥1505.46±510.53) byï¿¥914.7. The lengths of activity have no difference between the two groups(p＞0.05),and the satisfaction of the patients also.2.Aspects of postoperative continuing nursing2.1 On the 5th day after postoperative,all patients have no complications, incision normal,urination normal,evacuation normal,the spirit of good,sleep good,eating general diet,a good self-evaluation.54 patients of the postoperative continuing nursing group can eat general diet and can do some exercise outdoor. While,50 patients of the parallel control group can eat general diet,and 1 patient semi-liquid food,only 47 patients of the parallel control group can do a little exercise outdoor.2.2 On the 5th day after postoperative,the exercising distance of the postoperative continuing nursing group(1116.67±470.95 meters) is longer than that of the parallel control group(880.39±435.44 meters) by 236.28 meters.The exercising time of the postoperative continuing nursing group(149.07±57.11 minutes)is longer than that of the parallel control group(93.53±45.82minutes)by 55.54 minutes.2.3 On the 5th day after postoperative,the satisfaction scores of the postoperative continuing nursing group(98.59±1.70points) are higher than that of the parallel control group(96.37±2.97points) by 2.22 points.The postoperative continuing nursing group is easier accepting to discharge from hospital on the 1st day after postoperative,more willing to once again choose our hospital,more willing to recommend our hospital to others,and have higher degree of patient satisfaction.The postoperative continuing nursing group gives the postoperative continuing nursing model very high evaluation.ConclusionThe implementation of the clinical nursing pathway and the postoperative continuing nursing of laparoscopic cholecystectomy can reduce the number of days hospital stayed,reduce hospital costs,lower health care costs,reduce the financial burden of patients,enhance the physician-patient communication,meet the patient's informed right,improve the patient's satisfaction,build a harmonious relationship between doctors and patients,and effectively prevent nursing accidents.Meanwhile,it can effectively use the medical resources to address the masses,solve the problem that is "your doctor,not a doctor",suppress the growth of medical expenses,reduce health care costs to pay,and improve social benefits and economic benefits.In our country,the clinical nursing pathway and the postoperative continuing nursing of laparoscopic cholecystectomy is a new work model which is worth popularizing. |
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