| The onset of spinal cord injury(SCI)is sudden,which has various complications,high probability of disability and poor prognosis.The incidence of SCI is increasing year by year,which seriously affects the quality of patient' life and increases the burden of medical care system and the whole society.Rehabilitation practice is beneficial in reducing complications and improving the quality of life of patients,which has been regarded as a bridge for patients to return to their families and society.Rehabilitation medicine started late in our country,and barely meet the growing rehabilitation needs of patients.The question of how to meet the rehabilitation needs of patients is a key concern of clinical practitioners.It is widely accepted that rehabilitation needs can be investigated,tested and assessed through scientific methods.A survey showed that there are few tools for assessing rehabilitation needs in clinical practice and most of them lack of scientific supports.There are few health guidance manual for rehabilitation needs.Therefore,it is meaningful and innovative to seek a scientific tool for assessing rehabilitation needs and construct a rehabilitation guidance manual on the basis of it.on the basis of relevant literature and qualitative interviews,combined with Omaha problem classification system,this study used Delphi expert consultation and clinical observation to form a questionnaire on rehabilitation needs of SCI patients.The questionnaire was used as an evaluation tool to investigate the actual situation of rehabilitation needs of SCI patients.Expert consensus and small sample pre-experiment were used to construct the Guidance Manual for Rehabilitation Needs of Spinal Cord Injury Patients,and to verify its clinical practical value.Objective1.Based on the Omaha question classification system,a questionnaire was constructed to investigate the rehabilitation needs of SCI patients.2.Construct a guidance manual for rehabilitation needs of patients with spinal cord injury.3.To verify the clinical practical value of the guidance manual for rehabilitation needs of SCI patients,and to provide scientific evidence for the evaluation of rehabilitation needs and health guidance of clinical SCI patients.MethodThis study is divided into three parts,the specific contents are as follows:1.Construction of rehabilitation needs questionnaire for spinal cord injury patients under Omaha problem classification system(1)Formation items of rehabilitation needs questionnaire for patients with spinal cord injuryA qualitative study was conducted by carrying out semi-structured interview on rehabilitation needs of 20 patients with spinal cord injury.Data were extracted and analyzed subsequently.The initial items of rehabilitation needs questionnaire for patients with spinal cord injury were formed by combining Omaha problem classification system and clinical observation.(2)Modification and confirmation of items of rehabilitation needs questionnaire for patients with spinal cord injuryUsing the method of two rounds of Delphi expert consultation and small sample(10 patients)pre-experiment,the dimensions and items of the questionnaire were demonstrated,revised and sorted out according to the experts' opinions and pre-experiment results.Finally,the rehabilitation needs questionnaire of spinal cord injury patients under the Omaha problem classification system was formed,which provided an evaluation tool for the construction of the follow-up guidance manual.?2.Construction of Guidance Manual for Rehabilitation Needs of Spinal Cord Injury Patients(1)Survey of rehabilitation needs of patients with spinal cord injury300 patients with spinal cord injury admitted to three hospitals in Yangzhou City from May 2018 to January 2019 were investigated with the rehabilitation needs questionnaire of spinal cord injury patients under the Omaha problem classification system,and the differences between the needs were analyzed.(2)Construction of Guidance Manual for Rehabilitation Needs of Spinal Cord Injury PatientsBased on the survey of rehabilitation needs of patients with spinal cord injury in the early stage,the first draft of rehabilitation needs guidance manual for patients with spinal cord injury was established by studying literature and reference-guidances.The framework and content of the manual were revised and demonstrated by expert consensus method,and finally the Guidance Manual for rehabilitation needs of patients with spinal cord injury was formed.3.Clinical Practical Validation of Guidance Manual for Rehabilitation Needs of Spinal Cord Injury Patients under Omaha Problem Analysis SystemSixty-four patients with spinal cord injury admitted to the Department of rehabilitation medicine from February to June 2019 were selected and divided into control group and observation group by random number table.The control group was given routine rehabilitation treatment and nursing intervention.The observation group was intervened by the rehabilitation needs guidance manual of SCI patients based on the control group.The general situation of the two groups was compared in aspects like data,negative emotions before and after intervention,incidence of common complications,ADL,WHOQOL-100,patient satisfaction and nurse satisfaction.Research1.A questionnaire of rehabilitation needs of spinal cord injury patients with clear and scientific items was constructed.Through qualitative interviews on physical-psychological-social needs of 20 patients with spinal cord injury admitted to our department from January 2018 to June 2018,in-depth analysis and repeated analysis,induction and extraction of interview results combined with Omaha classification system,extraction of patient data,concise questionnaire topics,clinical observation and Delphi specialty were carried out.A questionnaire on rehabilitation needs of spinal cord injury patients based on Omaha problem classification system was formed by clinical observation,expertise consultation and small sample size pre-experiment.The questionnaire consists of three parts:(1)general data of patients;(2)rehabilitation needs questionnaire of spinal cord injury patients under Omaha problem classification system,which consists of environment(3 items)and social psychology(4 items).Items,physiology(9 items),health-related behavior(7 items).In total,there are 4 fields and 23 items;(3)Choice of health guidance methods.2.The Guidance Manual of Rehabilitation Needs for Patients with Spinal Cord Injury was constructed.Through investigating the needs of 300 patients with spinal cord injury,combining with literature review,clinical observation and expert opinions,the Guidance Manual of Rehabilitation Needs for Patients with Spinal Cord Injury is constructed,which is guided by rehabilitation needs.The manual is composed of general introduction,introduction of basic knowledge of spinal cord injury,guidance of rehabilitation needs,and points based on Omaha problem.There are four parts of the health needs questionnaire under the category system.3.Guidance manual for rehabilitation needs of patients with spinal cord injury is helpful for improving their psychological condition and quality of life.There months after the intervention with the Guidance Manual for Rehabilitation Needs of Spinal Cord Injury Patients,it was found that the scores of SDS and SAS in the two groups were lower after the intervention,and the decrease in the observation group was greater than that in the control group(P<0.05);the observation group had respiratory tract infection,urinary tract infection,pressure ulcer,urinary calculi,constipation and urinary retention.The total incidence of DVT was 6.25%,which was lower than 25.00%in the control group(P<0.05);ADL score and WHOQOL-100 score were higher in the two groups after intervention than before,and the increase in the observation group was greater than that in the control group(P<0.05);the satisfaction of patients and nurses in the observation group(87.50%,87.5%)was higher than that in the control group(59.38%.54.17%)(P<0.05).ConclusionThe questionnaire for rehabilitation needs of patients with spinal cord injury based on Omaha problem classification system has the characteristics of clear structure and comprehensive scientific items.The questionnaire for rehabilitation needs of patients with spinal cord injury can accurately assess the rehabilitation needs of patients.The questionnaire is used as an evaluation tool to investigate the rehabilitation needs of patients with spinal cord injury cross-sectionally.Based on the results of expert consensus and guided by rehabilitation needs,the Guidance Manual for the Rehabilitation Needs of Spinal Cord Injury Patients is constructed.The Manual has good clinical practicability.Its application has accumulated in the psychological status,quadriplegia,occurrence of complications,activities of daily life and quality of life of patients with spinal cord injury.It is also beneficial for improving patient satisfaction and enhancing the enthusiasm of nurses.The health guidance manual for rehabilitation needs of spinal cord injury patients based on Omaha problem classification system has good clinical practical value and is worth further exploration and application. |
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