| ObjectiveThe application effect of cluster nursing in patients with dysphagia after acute ischemic stroke was discussed,and scientific and effective methods were provided for clinical nurses.MethodsThis study was divided into two parts:1 Based on evidence-based and Delphi method of acute ischemic stroke patients with dysphagia cluster nursing program.Use the PIPOST model to structure clinical issues,retrieve and apply existing evidence.Systematic retrieval of the U.S.National Guideline Clearinghouse(NGC),the Scottish Intercollegiate Guidelines Network(SIGN),the National Institute for Health and clinical Excellence,NICE),The New Zealand Guidelines Group(NZGG),The Registered Nurses'Association of Ontario(RANO),medical maitong Guidelines,wanfang,China biomedical database,cnki,wipo,Cochrane library,PubMed,Embase,Web of science and other evidence resources,Relevant methodological quality evaluation was conducted on the literature,in which the evidence of systematic evaluation/Meta analysis was reevaluated to determine the level of evidence quality.The guidance only summarized and extracted the evidence,The summarized evidence was combined with the clinical situation and patients'intention to form a questionnaire.Delphi method was used to conduct two rounds of questionnaire survey for senior experts,and experts were asked to evaluate the rationality and scientificity of the evidence.Excel 2010 and SPSS 17.0 were used for statistical description and analysis.With mean,standard deviation,and percentage of basic situation,said experts with questionnaire and effective recovery coefficient actively,said experts with academic level as well as experts familiar with the entry level and judgment basis to express the degree of experts with importance assignment mean(x),the recognition rate(Cj),out of frequency(Kj),coefficient of variation(CV)and item weight value importance and experts said that the purpose of individual opinion concentration,Kendall's W coordination coefficient according to experts'coordination degree.x>3.5,CV<0.25,Cj?50%,Kj?20%,otherwise modify or delete.Finally,a cluster nursing program meeting clinical needs will be formed.2 Convenience sampling method was adopted to select 72 patients admitted to the department of neurology of a hospital affiliated to a university in henan province on June 3,2017 and June 3,2018 as research objects,to explore the application effect of intensive care in patients with AIS dysphagia.General data questionnaire,wintan drinking water test,swintan swallowing ability assessment,modified Beck oral assessment scale and swallowing specific quality of life scale were used to investigate the patients.Data were entered by Excel,and SPSS17.0 software was used for statistical description and analysis.Data were tested for normal distribution,counting data were expressed by percentage(%),measurement data by mean and standard deviation(x±s),continuous variables by t test,and classified variables by?~2 test.The statistical difference test was a bilateral test,and P<0.05 was a significant level.Results1 Develop cluster care programs(1)This study strictly based on the inclusion and exclusion criteria of the literature,a total of 9 articles were included,including 4 guidelines and 5 meta-analyses.The obtained evidence was summarized and the Delphi questionnaire was formed through the joint discussion of the cluster nursing formulation group.(2)15 senior experts in neurology and rehabilitation medicine in henan province were selected,with an average age of 42.30±6.51(32~58)years.Average working years:21.35±6.02(15~38)years.(3)After two rounds of correspondence and consultation,the positive coefficients of the experts were respectively 83.3%and 88.2%.The degree of authority was 0.81 and 0.82,respectively.Kendall's W coordination coefficient is 0.331 and 0.267,respectively.(4)According to the inclusion and exclusion criteria,"drinking water test can be used as part of the screening and evaluation for stroke patients"in this study.In"oral care","patients with dysphagia maintain good oral health"Cj=40%,CV=0.28;In the"diet care","encourage patients to eat by themselves",Cj=33.33%and Kj=20%,so its three entries were deleted.In"screening and evaluation","drinking water test"was added to"screen stroke patients for dysphagia within 24 hours after admission,before taking food,drugs and liquids".(5)Cluster nursing included:(1)screening and evaluation:within 24 hours after admission,before eating,drugs and liquids,patients with stroke were screened for dysphagia by drinking water test;Swallowing function was assessed 24h,72h,and 1 week after admission.(2)swallowing training:20 minutes before meals,2 times a day,pharyngeal cold stimulation;Intermittent oral-gastric tube nutrition was used for exercise of swallowing function.(3)oral care:improved Beck oral assessment form was used for oral assessment of patients;Effective oral care.(4)diet nursing care:eating and 30 min,after eating up 30°to45°of the head of a bed;Guide the patient to eat the first meal(Change the character and structure of food;Eating environment and utensils;Medication care).2 Application effect of cluster care in patients with AIS dysphagia(1)Before the intervention,there was no statistical significance(P>0.05)in age,marital status,occupation,family income,payment method,current residence,smoking,drinking and other general patient data and clinical data such as drinking water test,swallowing ability,history of coronary heart disease,history of diabetes,history of hypertension and other chronic medical history between the two groups,with comparability.(2)At the time of admission,MBOAS was used to evaluate the patients in the two groups.The score of the control group was 17.08±1.11,and that of the experimental group was16.67±1.30.The difference was not statistically significant(P>0.05).At discharge,MBOAS was used to evaluate the patients in the two groups.The score of the control group was 10.44±1.18,and that of the experimental group was 8.14±1.78,and the difference was statistically significant(P<0.01).(3)There was no significant difference in swallowing related quality of life between the two groups before intervention(P>0.05).Comparison of swallowing related quality of life between the two groups after the intervention showed that there was no statistically significant difference in verbal communication between the two groups(P>0.05).There were significant differences in appetite,fear and fatigue(P<0.05).There were significant differences in symptom frequency,eating time,diet choice,mental health,psychological burden,social interaction and sleep(P<0.01).(4)After the intervention,there were statistically significant differences in efficacy and incidence of aspiration between the two groups(P<0.05).After the intervention,the two groups of patients'hospitalization days and hospitalization costs:the average hospitalization days in the control group were17.33±1.60,and the average hospitalization costs were 9780.50±1637.19.The average days of hospitalization in the experimental group was 16.14±1.50,and the average hospitalization cost was9085.94±1133.64,the difference was statistically significant(P<0.05).ConclusionsThe development of cluster nursing based on evidence-based nursing can meet the clinical needs of patients with AIS dysphagia,effectively improve the oral health,quality of life and efficacy of patients with AIS dysphagia,reduce the rate of aspiration,hospitalization cost and hospitalization days,which has important clinical value. |
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