| BACKGROUNDTotal hip arthroplasty has been one of the most successful surgeries in the20th Century. It is a major advance in the treatment of patients with hip disorders, its successed in reducing pain and improving mobility are well established. THA could improve patients’ quality of lives and make positive effects.Long-term effectiveness has been acquired by THA, but not every patient. undergoing THA could obtain good results. With the increasing number of surgeries, the incidence of complication has been constantly rising along with the time after THA, and postoperative curative effect has been paid more attention by health care professionals. Follow-up researches given done by foreign scholars from the perspective of quality of life became more and more popular for nearly20years, and they found that patients undergoing THA recovered the most quickly during6months after surgery. Many domestic scholars have worked from originally view of morphological rehabilitation to physical and psycholosoical aspects over the past10years. However, those researches and datas were analysed from the view of clinical medicine or rehabilitation science. And system analysis concerning nursing has been lacking, even reports on nursing outcomes have been very few. According to the definition of nursing from the International Council of Nurses in2010, nursing responsibilities include the promotion of health, prevention of illness, and the care of ill, disabled and dying people, promotion of a safe environment, participation in shaping health policy, in patient and in health systems management. Therefore, nusing professionals should not only focus on the pathology of diseases, but also identify how to deal with human s reflection of existing and potential health problems, make nursing plans, carry out nursing interventions, and work with a team member, pay close attention to nursing focal point items. Nursing Concerns should be led by nursing outcomes, which could show the contributions of nursing practice, and revealing the impacts of nusing services in promotion of health, prevention of disease and reduction of disabilities.With permeating of biopsychosocial patterns in China, the principle and concept of clinical nursing have taken place a great deal of transformation, such as from functional nursing to holistic responsibility system, and nursing practice scope has been extended from hospitalization to communities or families. Besides, clinical thinking ability has been changed from single to integrity, and the aims of resolving nursing problems has been changed from physical items to health-related quality of life. The transitions in nursing mode are corresponded with responsibilities and missions of nusing professionals at the present era. Continuity of care is an effective measure that nurses could take part in the rehabilitation processes, analyzing nursing issues and demands from subjective and objective angles to enhance cooperative work among team members.OBJECTIVESTo realize patients’ health-related quality of lives before THA, one year and three years after THA, analyze nursing problems and demands from patients, discuss the guidance and assistance provided by nurses for post-operative patients. To establish continuity of care mode for patients undergoing THA through using Omaha system as framework, take the initiative to discover nursing problems, and make pertinent nursing plans, evaluate nursing outcomes after intervention.Methods and Results 1.1To investigate the health-related QOL in patients undergoing THAMethods:This part of study used validitied tools,including the oxford hip score (OHS), EQ-5D, SF-8and a self-designed questionnaire on life satisfaction Convenience sampling was conducted.127patients were operated from January to June in2008,2010and2011respectively, data was collected from two Three-A hospitals. The patients were individed into three groups:a preoperative group, a group who operated1year ago and a group who had the surgery3years ago. The English version of OHS developed by Jill Dawson was translated and introduced firstly.65patients from two hospitals were selected to testify the reliability and validity of the Chinese version of OHS. Cronbach’s a was calculated for checking internal reliability. The criterion validity of the OHS was tested by examining the correlation coefficients between OHS and SF-8subscales. The Spearman rank correlation coefficients were calculated to assess the test-retest reliability. After testing the OHS, multiple perspective assessment was carried out for127patients. SPSS13.0was used for statistical analysis. Descriptive Analysis was used in analysing patients characterization and problems, chi-square test was used to analysis the difference of patients and variance analysis was used to analysis scores from qustionnaires, bonferroni multiple comparison was used in finding the differences between two groups. Kruskal-Wallis H test was used in analyzing the results of EQ-5D and prominent promblems in patients.Results:①Chinese version of the Oxford hip score was confirmed in terms of reliability and validity. Cronbach’s a for the total scale was equal to0.91, and the test-retest spearman rank correlation coefficients were equal to0.87. The OHS has good Construct Validity.②127questionnaires were responded from130. The scores for each item in the oxford hip score from three time periods were significantly different(p<0.05). The total score from operative patients was36.80,17.28was at1-year group and18.83at3-year after surgery, which had significant difference among three groups (F=82.17, P=0.000). The maximum discrepancy with regard to usual pain and pain at night(F=139.75, P=0.000), the minmum discrepancy was from Putting on socks(F=7.67, P=0.001). Pre-operatively, only7.5%of patients reported no problems in mobility, there were two patients confined to bed at1year and one patient3-year after THA respectively. All preoperative paients have been limping when walking, and almost half of the patients had after postoperation. The scores of physical functioning, role-physical, bodily pain, general health, vitality, social functioning, role-emotional, mental health in SF-8were significantly differences among the groups, and it was better for postoperative groups than the preoperative one. The life satisfaction results showed45%of pre-THA patients were satisfied with their lives,82.98%and85.00%of patients at1and3-year after surgery.Postoperative patients expressed satisfaction in their lives, but satisfaction rate was low in taking a long walk, climbing the stairs and squatting down.③Health status of patients operated on1or3years ago was similar, since none of the differences between them were statistically significant (P>0.05). We found that patients operated on1year ago obtained the highest scores in all the items, it was followed by3-year after THA. But satisfaction and mental status have improved for the group3-year after THA, while worries concerning the illness have reduced.1.2To establish a continuity of care mode for patients undergoing THA using Omaha system as frameworkMethods:This part builded a continuity of care mode for patients undergoing THA, according to the results of part1and reference literatures, using the Omaha system as theoretical framework, and clinical nursing pathway as structure framework. Results:The continuity of care mode was designed for the period of disease in THA patients, which was devided into three parts, including from admission to pre-THA, operation to before discharge, three months after discharge. Nursing practical contents contained assessing, intervention and evaluating outcomes. Issues and nursing outcomes related-THA patients were selected from the Omaha System, then the researchers assessed problems from patients’ kownledge, behavior and status, scores evidence were exemplified.1.3Application of the continuity of care mode in THA patients and evaluating nursing outcomes Methods:Convenient sampling was used,42patients (40patients participated in this part at last) were choosen from patients undergoing THA in one three-A grade hospital from June to November. Descriptive Analysis was used in analyzing patients characterization and problems. The results from different times were analyzed with the matched t test andrepeated measures analysis of variance.Results:①Physiology items were the most frequently (46.31%) from admission to pre-THA, which were followed by health-related behavior items (28.13%). The most common five problems were pain, neuro-musculo-skeletal function, sleep and rest patterns, social contact, mental health. Significant difference was found in knowledge scores from pain, nutrition and sleep patterns (P<0.05), but no significant differences in the status of pain and nutrition (p>0.05), although the scores raised. The status score of sleep patterns was descended, but no statistical differences were found.②Physiology items were the most frequently in the second period, which take up49.87%, which were followed by health-related behavior problems (31.81%). The most five common problems were neuro-musculo-skeletal function, circulation, physical activity, personal-care and bowel function. The scores in knowledge, behavior and status raised with the increasing intervention frequencies after surgery, and significant differences among them (P<0.05).③Health-related problems were the most frequently during three months after discharge. And the most five common problems were physical activity, personal care, neighborhood/workplace safety, social contact, and neuro-musculo-skeletal function. The scores of status were higher than both knowledge and behavior. All the mean socres were greater than4point, except neighborhood/workplace safety and social contact.④Variation tendency of nursing problems in rehabilitation process:pain status was the best before discharge, and had a brief drop at three days and one week at home. Social contact problems were prominent before THA and at two weeks after discharge, Mental problem had a low ebb at some times,for example, admission after hospital, three days after surgery, before discharge, and mitigated when went back home. Nutrition variation had a steady increase during hospitalization, while obvisiouly changed in sleep and rest patterns, especially on the7-day and10-day after THA and before discharge, whose mean scores were nearly to4point and had a drop at three days after surgery. Physical activity scores had a rising trendency before discharge and drop at three days after discharge. The variation tendency of personal care was similar to physical activity, but the rangeability was smaller than physical activity.CONCLUTIONS(1) This study shows a downward tendency in health-related quality of life in3-year after operation compared with1year after THA, but the satisfaction and mental status have improved, and worries concerning the illness have reduced.(2) This study demonstrates that the data of HRQOL are valuable, since they can provide important clues to the understanding of patients undergoing THA for health professionals and supple evidence for how to have satisfied and effective health nursing service mode.(3) This study confirms that it has been beneficial for the medical team to build a mechanism of continuously following up, which could ensure better management of patients undergoing THA, and can improve nursing outcomes. Nurses could be indispensible members of the rehabilitation team, who have a positive effect in the process for patients after surgery.(4) This study confirms that the continuity of care mode could reflect main nursing problems of THA patients from admission to three months after discharge, and it could take longer time in resolving physical items than psychology items.Health-releated items and environmental items are focous nursing problems for patients after discharge. |
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