| ObjectiveTo investigate the demand status of disabled elderly for discharge planning services,describe the level of preparation for discharge of disabled elderly,and explore the influencing factors;On this basis,the service model of discharge plan is taken as the theoretical framework to construct a service model of discharge plan for disabled elderly that is suitable for China's national conditions.Methods1.Cross-sectional survey method: We used convenience sampling to select 230 elderly patients with disability from 5 third-grade Class A hospitals in Qingdao City from October 2018 to March 2019 as the research object.The purpose is to investigate the current needs of discharge services and the level of readiness of discharged patients.The survey results used descriptive statistics,single factor analysis,multiple linear regression analysis of statistical methods to explore the current state of readiness of the disabled elderly and analyze their influencing factors.2.Literature review method: On the basis of investigating the readiness of disabled elders to discharge,a bibliometric method is used to search for disabled elders at home and abroad,disabled elders,discharge plan,discharge readiness,discharge plan service,discharge preparation service,discharge Relevant documents such as the planning model,the discharge planning service model,etc.,form a network of documents,and provide a theoretical system for the formulation of letter inquiry files.3.Semi-structured interview method: Make an interview outline according to the research purpose.A total of 20 experts engaged in hospital health service and management,community health service and management,health administration,university clinical nursing,geriatric nursing,community nursing graduate educators,network information engineers,dietitians and rehabilitation therapists were selected for semi-structured interviews.To understand the service content and management of the disabled elderly by hospitals and community health service institutions,the implementation path and important links of the discharge plan service,the roles and functions of each institution and how to carry out interaction and cooperation,so as to provide a factual basis for the development of the questionnaire.4.Expert pre-inquiries: After the interview,an expert consultation questionnaire was prepared.Before the formal correspondence,the research team used the objective sampling method to select 10 experts in the relevant fields of Qingdao for pre-correspondence.After the questionnaire was revised and improved,a formal expert letter inquiry volume was formed.5.Delphi expert correspondence method: Select 28 experts from related fields in this research to conduct two rounds of communication,and combine the index inclusion criteria(average value of importance> 3.5,coefficient of variation <0.25)and expert opinions to form errors.Service model for elderly discharge plans.6.Analytic Hierarchy Process: After forming all levels of indicators for the disabled elderly discharge plan service model,use Yaahp10.1 software to establish a hierarchical structure model,construct a judgment matrix,determine the weights of various indicators,perform hierarchical single ordering and consistency inspection,Determine the weight of each indicator and the weight of the combination.7.Statistical methods: The first part of this study is the current status of incapacitated elderly people's readiness to discharge and analysis of its influencing factors: SPSS 20.0 statistical software was used for data entry and analysis.Quantitative data are described by frequency,percentage,and mean ± standard deviation;when performing single factor analysis,two independent samples t test is used for binary classification variables,and single factor analysis of variance is used for multi-categorical variables that meet the homogeneity of variance.Parameter test(Kruskal-Wallis H test);Pearson correlation analysis was used for discharge readiness,discharge guidance quality,and social support,and multivariate linear regression analysis was used for multifactor analysis.The second part is based on Delphi method to build a service model for the discharge plan of disabled elderly: using Excel 2016,SPSS20.0 and yaahp10.1 statistical software for data entry,collation and analysis.The general information of the experts is described by frequency and percentage.The enthusiasm of the experts is expressed by the recovery rate of the effective questionnaire and the percentage rate of the opinions.Kendall's W test was used to coordinate the opinions of all entries.Results 1.Status of disability preparedness for disabled elders and analysis of influencing factorsThe total disability readiness for disabled elders is(93.28 ± 16.32)points,and the standardized scores for each dimension from high to low are the expected help(8.95±1.26),personal status(7.75±1.48),and ability to adapt(6.85±1.72).Multiple linear regression analysis showed that the quality of discharge guidance,perceived social support available,social support utilization,decreased self-care ability,and length of hospitalization were factors that affected the readiness of disabled elders to be discharged.2.The readiness of disabled elders to discharge is closely related to the quality of discharge guidance and social supportThe quality of discharge guidance is positively correlated with discharge readiness,and the scores in the dimensions of discharge guidance are positively correlated with discharge readiness,indicating that the higher the quality of discharge guidance for disabled elders,the better the preparation for discharge;social support and discharge readiness for disabled elders There was a positive correlation,and the scores for each dimension of social support were positively correlated with discharge readiness.This suggests that the better the social support for disabled elders,the better the preparation for discharge.3.Representation,motivation and reliability of expert consultationIn this study,28 Delphi correspondence experts were selected,of which 25 persons completed two rounds of consultation,all of whom were engaged in hospital health services and management,community health services and management,health administration departments,college aged care,community nursing graduate education,etc.The work came from 9 provinces,cities and regions of the country,and the representativeness of the experts was good;the effective questionnaire recovery rates of the two rounds of correspondence were 89.29% and 100%,indicating that the enthusiasm of the experts is good;the experts have rich theoretical knowledge and With practical experience,40% of the experts have master's and doctoral degrees,76% have titles of sub-senior level or above,and have worked for more than 10 years.The authoritative coefficient of the experts is 0.75?0.98.This shows that the results of this study are persuasive and highly reliable.4.Scientificity of expert consultationIn this study,experts were consulted in accordance with the standards and procedures of the Delphi method.The research team modified the indicators based on expert opinions and the index selection criteria,so that the changes in the indicators could be based on evidence.In addition,combined with Delphi and AHP,subjective judgments of experts are quantified to improve the objectivity and scientificity of the research results.The consistency ratios of the hierarchical indicators in the study are all <0.1,which indicates that the weight distribution of each indicator is reasonable.Therefore,taking the service plan of discharge plan as the theoretical framework,the service model of discharge plan of disabled elders constructed through the combination of Delphi method and AHP has good science.5.Expert consultation resultsThe Kendall's W coordination coefficients of the two rounds of expert consultation were 0.123 and 0.167(both P < 0.01).After two rounds of expert enquiry,according to the index selection criteria,expert opinion,and group discussion,to revise,revise item(one delete,modify,7,11),and ultimately determine the disability elderly discharge planning services model,including 4 first-level indicators(role function,implementation path,the core part,the main service content),11 secondary indexes,66 tertiary indicators.Conclusion1.The discharge readiness of disabled elderly needs to be improved.Medical personnel should strengthen and improve discharge guidance for the disabled elderly and their primary caregivers,strengthen humanistic care,and help the disabled elderly to establish an effective social support system.Special attention should be paid to disabled elderly patients with low self-care ability and long hospital stay,so as to improve their preparation for discharge and ensure their safety after discharge.2.The established service model of discharge plan for the disabled elderly is scientific and reliable,which can provide a basis for the practical application and construction of continuous nursing model in China. |
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