Application Of Omaha System In Continuous Nursing Of Patients With Anticoagulant Therapy After Mechanical Heart Valve Replacement

Objective In the course of anticoagulant therapy for patients with mechanical heart valve replacement,the Omaha system-based continuous nursing scheme was implemented to determine the existing or potential nursing problems of patients after discharge,analyze the problems and carry out individualized interventions,evaluate the changes of nursing problems before and after intervention,and explore the effect of the scheme on the cognition,compliance and complications of anticoagulant therapy in patients with mechanical heart valve replacement.Method1.A questionnaire survey was covered among 106 patients with mechanical heart valve replacement in Cardiovascular Surgery of some grade a class-three hospital in Yunnan by convenient sampling method.The questionnaire includes three sections:general information questionnaire,anticoagulant therapy status and demand survey.SPSS 17.0 statistical software was used for data processing.2.On the basis of fully evaluating and analyzing the nursing problems in anticoagulant therapy of patients with mechanical heart valve replacement,according to Omaha system theory,combining with the physiological and disease characteristics of patients with mechanical heart valve replacement,a continuous nursing scheme of anticoagulant therapy for patients with mechanical heart valve replacement based on Omaha system was preliminarily constructed.Under the guidance of this scheme,quasi-experiment were carried out.The patients with mechanical heart valve replacement included in the study were divided into intervention group and control group by random number table method,with 46 cases in each group.The control group was given routine continuous nursing.The compiled“The educational content of continuous nursing of anticoagulant therapy for patients with mechanical heart valve replacement” was carried out twice a week and 10-15 minutes per time.A total of 48 Wechat intervention with circular pushing lasted for 6 months.The intervention group was implemented a continuous nursing scheme based on Omaha system.The scheme was divided into three stages according to intervention time:from the discharge day to the end of the first month after discharge,from the beginning of the second month after discharge to the end of the third month after discharge,from the beginning of the fourth month after discharge to the end of the sixth month after discharge.The intervention methods were as follows:Before and after each stage of intervention,14 nursing problems were estimated or evaluated in the cognition,behavior and condition aspects,in view of the total score < 9 points of nursing problems,Individualized continuous nursing service was implemented according to the“The educational content of continuous nursing of anticoagulant therapy for patients with mechanical heart valve replacement”,Wechat guidance twice a week and 10-15 minutes a time,intervention for six months.The evaluation of intervention effect was as follows: before intervention,the first month after intervention,the third month after intervention and the sixth month after intervention,the outcome evaluation score of Omaha systematic nursing problem,the related knowledge score of anticoagulant therapy,the compliance treated with warfarin,the standard-reaching rate of INR value and the occurrence of related complications were compared between the two groups.SPSS 17.0 statistical software was used for data processing.Result1.Patients with mechanical heart valve replacement had a low level of knowledge about anticoagulant therapy(4/5 of the items below the threshold of 70% of the cognitive level evaluation);poor compliance with anticoagulant therapy(The score was 8.68 ± 1.159 and lower than the cut-off point(9 points)of the compliance evaluation);and the requirements for anticoagulant knowledge was high in patients with mechanical heart valve replacement(88.68%).2.In view of the anticoagulant therapy for patients with mechanical heart valve replacement,a continuous nursing scheme was constructed and formed,which was guided by14 nursing problems,implemented stage-by-stage individualized intervention,and evaluatednursing outcomes from cognition-behavior-condition aspects.The continuous nursing service of anticoagulant therapy for patients discharged from hospital after mechanical heart valve replacement was implemented for 6 months with the help of Wechat platform.The results showed that:(1)After intervention,the scores of Omaha systematic nursing problem outcome evaluation,the related knowledge of anticoagulant therapy and the compliance treated with warfarin were higher than those before intervention in intervention group,and the difference was statistically significant(P<0.05).(2)There was no significant difference between the two groups in the scores of Omaha systematic nursing problem outcome evaluation,the related knowledge of anticoagulant therapy,the compliance treated with warfarin and the standard-reaching rate of INR value before intervention(P>0.05).After intervention,the intervention group was higher than the control group,and the difference was statistically significant(P<0.05).Conclusion1.The continuous nursing scheme based on Omaha system is suitable for the anticoagulant treatment of patients discharged from hospital after mechanical heart valve replacement.2.The continuous nursing model based on Omaha system can be guided by comprehensive assessment of problems and improve the nursing outcomes of patients’ cognition,behavior and condition by implementing individualized interventions.3.The continuous nursing scheme based on Omaha system can improve the cognition of anticoagulant therapy and the compliance treated with warfarin in patients with mechanical heart valve replacement,and reduce the incidence of related complications.