Application Of Transitional Care In Patients With Chronic Obstructive Pulmonary Disease After ICU

Objective: This study was designed to explore the application of transitional care model(TCM)in Intensive Care Unit survivors of chronic obstructive pulmonary disease.The purpose was to reveal the real experience by a qualitative method.,to evaluate if TCM-based intervention for in post-ICU period improves chronic obstructive pulmonary disease patients' function of mobility,reduce pain,relieve anxiety and depression after Intensive Care Unit discharge.Methods:Qualitative research.This study adopted a qualitative design utilizing semistructured interviews,and which examined the experience of six men and five women.These 11 participants whose ages ranged between 59 and 75 years.The semi-structured interviews focused on patients experiences of a follow-up session following their intensive care experience.The recruitment of prospective participants was done after the patients was permitted to discharged from Intensive Care Unit by their doctors.Participants were selected based on the following inclusion criteria: they agreed to participate in the study;able to describe their experience in the transitional period from Intensive Care Unit to general ward.Colaizzi methods was utilized to analysis the data.Transitional care intervention was based on the qualitative findings.Transitional care model implementation phase.This study was a single-blind,randomized controlled trial.128 patients who had been transferred from Intensive Care Unit to general ward in a third-grade hospital in Shiyan,Hubei Province were included in the study.According to the randomized number table,they were divided into two groups,64 participants in the control group and 64 participants in the intervention group.After discharge from the intensive care unit,the intervention group received the TCM-based intervention while the control group received the conventional intervention conducted by nurse of the ward.Demographic data of the two groups was recorded.In addition,Barthel Index,visual analog scale for pain,BECK Depression Inventory,State-Trait Anxiety Inventory were used at the first day of been transferred to general ward(T0)and the Fourteenth day(T14).The doctor who was neither a member of the research team nor aware of randomization assignment assess the participants.The participants were blinded as well and unaware of the group allocation.To maintain blinding,the patients and any visitors were instructed not to discuss previous interventions with the assessors or the primary care team.All data were entered in a statistical software – SPSS,version 22.Descriptive statistics(frequencies,means,standard deviations)will be calculated to report the outcomes for the four questionnaires.Results: There were five themes structured the meaning of the participants' experience: physical restraint;suffering pain;psychological burden;environmental re-adaptation disorders;seeking professional support.A total of128 participants were recruited into this study.Baseline characteristics were similar between the intervention group and the control group.Compared with the participants in control group,participants in intervention group were higher among Barthel index at a significance level of 0.05.The score of visual analog scale for pain in intervention group was significantly lower than that of the control group at a significance level of 0.05.The BECK Depression Inventory score of the intervention group after intervention.State-Trait Anxiety Inventory score in the intervention group were significantly lower than those in the control group at a significance level of 0.05.The Barthel index was significantly higher in the intervention group than before the intervention at a significance level of0.01.The pain visual analogue scale score was significantly lower in the intervention group than before the intervention at a significance level of 0.01.The BECK Depression scale score was significantly lower in the intervention group.Before the intervention at a significance level of 0.01.the State-Trait Anxiety Inventory score in the intervention group were significantly lower than those before the intervention at a significance level of 0.01.No adverse effects were detected.Conclusion: This study shows that the implementation of transitional care model in patients with chronic obstructive pulmonary disease after Intensive Care Unit is effective,the TCM-based intervention can effectively improve the patient's function of mobility,reduce pain,relieve anxiety and depression.In this randomized controlled trial,TCM-based intervention was feasible and safe to clinical application.