| Objective:To construct the nutrition management model of stroke nasal feeding patients based on Omaha system,to evaluate the main nursing problems existing in the process of stroke nasal feeding patients from intubation to extubation,and to carry out problem-oriented targeted intervention.By dynamically evaluating the Knowledge,Behavior,and Status outcomes of patients and their caregivers,we should understand the service needs of patients and caregivers,and further improve the quality of comprehensive management.The effect of multi-disciplinary cooperative management model based on Omaha system on the incidence of nutritional status and nasal feeding related complications after intubation in patients with stroke nasal feeding was discussed by using the method of quasi-experiment.To prove the effectiveness of Omaha system in nutrition management in patients with stroke nasal feeding.Method:1.Taking the nutrition management of stroke patients as the core and introducing Omaha system as the theoretical guidance,the main problems of stroke nasal feeding patients were determined on the basis of retrospective analysis,literature classification and field evaluation.Multidisciplinary personnel in the general neurology,rehabilitation,nutrition,mental Health and information sections work together to develop standardized interventions.Revisions were made through expertadvice and panel discussions,culminating in the development of the Omaha Comprehensive Assessment form.2.The problems existing in the patients in Omaha Comprehensive evaluation table were evaluated by Omaha outcome Evaluation system,and the time of the patients was intubation,2 weeks after intubation and 1 months after intubation.According to the results of the problem assessment to clarify the priority of patient problem solving,the implementation of targeted intervention.3.In the effect evaluation stage,65 patients with stroke nasal feeding from December 2017 to February 2018 were selected to carry out routine intervention in the control group,and 65 cases from March 2018 to May were intervened in the intervention group based on the multi-disciplinary cooperation of the Omaha system in nasal feeding nutrition management model.The changes of nutritional status of two groups of patients after intubation,the incidence of nasal feeding related complications 1 months after intubation,and the change of Knowledge,Behavior,and Status outcomes of Omaha in the intervention group during intubation,2 weeks after intubation and 1 months after intubation were compared.Results:1.In this study,130 patients with stroke nasal feeding were included,and in the course of the study,3 cases died due to aggravated illness,9 cases of gastric tube were restored in January after intubation,and 60 cases were eventually controlled in the control group,58 cases in the intervention group,the sample wastage rate was9.2%.There was no statistically significant difference between the two groups in terms of sex,age,monthly income per household,type of disease,type of health care,sex of caregiver,level of education of caregivers,relationship with caregivers,chronic diseases,NIHSS scores,serum albumin and MNA scores(P>0.05).2.The serum albumin was significantly higher in the intervention group 2 weeks after intubation than in the control group,and the difference was statistically significant(P<0.05).The Mini Nutritional Assessment(MNA)score was alsosignificantly improved in the intervention group,and the difference was statistically significant(P<0.05).3.1 months after intubation,the incidence of diarrhea,inhaled pneumonia,constipation,accidental extubation and gastric retention in the intervention group was significantly reduced,the difference was statistically significant(P<0.05),but there was no significant improvement in the incidence of vomiting and blockage,and there was no statistically significant difference(P>0.05).4.There were 15 main nursing problems during intubation in the intervention group,namely income,health,communication with community resources,mental health,care,language expression,oral hygiene,skin,nerve-muscle-bone,digestion-hydration,defecation function,infection/infection,nutrition,rest and sleep,family planning.Environmental field: Knowledge and Behavior scores on income and health issues improved significantly after intervention,with statistically significant differences(P<0.05),but Status 1 months after intubation was lower than 2 weeks of intubation.Psychosocial field: Communication with community resources the behavior and Status score of 2 weeks after intubation was improved,and the score was significantly higher 1 months after intubation than during intubation,and the difference was statistically significant(P<0.05).Mental health and care issues continued to increase after scoring interventions.Physiological field: In addition to oral problems,there was no statistically significant difference between 2 weeks after intubation and 1 months after intubation(P>0.05),and the Knowledge and behavior scores of the remaining 7 problems were improved in different degrees,and the difference was statistically significant(P<0.05).However,in terms of Status,the improvement of language expression,nerve-muscle-bone and infection was not obvious.Health-related behavioural field: nutritional,rest and sleep and family planning problems of Knowledge and Behavior scores significantly increased,the difference is statistically significant(P<0.05),only nutritional problems after the Status score of 2 weeks and 1 months of comparison difference is not statistically significant(P>0.05).Conclusion:Nutritional management of stroke patients under the framework of Omaha system promotes the overall comprehensive assessment of the needs of patients and their caregivers by medical staff,providing direction for the development of targeted interventions.Through the evaluation of nursing problems in Omaha Outcome evaluation system,it is helpful to understand the priority order of patients ’ problems,and can be used as dynamic feedback of nursing outcome,which makes the management of stroke nasal feeding patients more standardized and improves the quality of nursing care.In addition,the intervention of nutrition management model in patients with stroke nasal feeding based on multi-disciplinary cooperation in Omaha system can significantly improve the nutritional status of patients and reduce the incidence of nasal feeding related complications after intubation.It is explained that this model is suitable for the management of stroke nasal feeding patients,which is beneficial to improve the care skills of carers and promote the recovery of patients ’condition,and is worthy of further exploration and popularization. |
PDF Full Text Request