| Research Purpose:In order to solve the problem of continuing care for patients with moderate and above burns after discharge,a preliminary entry of discharge plan for patients with moderate and above burns was constructed by conducting a survey on the needs of continuing care for patients with moderate and above burns and their caregivers after discharge.Delphi method was used to consult the items of discharge plan for patients with adult moderate and above burns,and to construct the items of discharge plan for patients with adult moderate and above burns,so as to provide reference for clinical nursing practice.Research Methods:1.Using homemade adult moderate or above and burn patients and caregivers of continuity care after discharge demand questionnaire(patients and caregivers),in November 2018-May 2019,extraction respectively at the second hospital affiliated to medical school of zhejiang university of acute adult medium and above 152 burn patients,caregivers,the questionnaire survey to 163.The survey included the general information of the respondents,the demand for continuous care after discharge,the discharge service content,the form of service,the time of service,and the demand for service providers.There were 28 items in the patient version and 30 items in the caregiver version.Likert is rated on a scale of very much needed,comparative needed,uncertain,not very needed,and not at all needed,from high to low.Finally,there is an open question:other requirements.Using descriptive statistics,two independent samples t test,single factor variance analysis and multiple linear regression method to analyze the adult medium and above burn patients and caregivers the continuity of care needs,and factors that influence for adult patients with moderate or above burns discharge planning items preliminary build and provide reference for the establishment of personalized discharge planning.The reliability and validity of the patient-and caregiver-version questionnaires were tested.2.Based on literature review,burn related guidelines,brainstorming and post-discharge continuous nursing needs survey of patients and caregivers with adult moderate and above burns,an expert consultation questionnaire was constructed for the items of discharge plan for patients with adult moderate and above burns,and Delphi method was used to consult the items.Descriptive statistics were used for basic information of experts;The concentration degree of expert opinion is expressed by mean and full scale.The expert positive coefficient,the degree of authority and the degree of coordination of expert opinions are expressed by the effective recovery rate,the authority coefficient and the coefficient of variation of the consultation questionnaire respectively.Finally,the contents of discharge plan for adult patients with moderate and above burns were formed.Research Results:1.A total of 152 adult patients with moderate or above burns and 163 caregivers were investigated in the survey of continuing nursing needs after discharge.The score of continuous nursing needs of adult patients with moderate or above burns after discharge was 3.68±1.05,and the total discharge service content was 35.34±9.91(wound nursing guidance 4.01±1.10,pain management guidance 3.82±1.16,and burn related knowledge guidance 3.77±1.20).Total score of service form:21.38±4.12(outpatient follow-up 4.20±0.71,discharge instruction manual 3.74±1.14,telephone follow-up 3.69±0.92);The total service time was 16.20±4.83(3.52±1.10 in case of unmanageable emergencies,3.42±1.23 in one month after discharge,and 3.40±1.27 in one week after discharge).The total score of demand for service providers was 22.53±6.05(4.25±0.95 for the lead doctor,4.08±1.15 for the responsible nurse,and 3.70±1.31 for the professional team).The score of continuous nursing needs of the caregivers after discharge was 3.68±1.02,and the total score of discharge service content was 45.30±11.36(wound care instruction 4.14±1.07,complication prevention instruction 3.96±1.11,burn related knowledge instruction 3.92±1.07,pain care instruction 3.92±1.18).The total score of service form was 22.74±4.15(outpatient follow-up4.54±0.66,telephone follow-up 4.07±0.94,discharge instruction manual 4.05±1.09).The total service time was 17.46±4.80(3.91±1.01 in case of emergency that could not be handled,3.56±1.22once a week after discharge,and 3.50±1.21 once a month after discharge).The total demand for service providers was 22.93±5.31(4.18±0.93 for the lead doctor,3.92±1.31 for the psychologist,and 3.87±1.27 for the rehabilitation doctor).Results of one-way analysis of variance(anova):7independent variables of adult patients with moderate or above burns:age,marital status,education,work status,special site burns,monthly family income and payment method.Caregivers:age,gender,marital status,education level,relationship with patients,self-assessment of sleep status,nursing experience were statistically different(P<0.05).Multiple linear regression results showed that the payment method and monthly family income of adult patients with moderate and above burns were statistically different(P<0.05),R~2=0.504.There were statistically significant differences in caregiver gender,age,education level,relationship with patients,and caregiver experience(P<0.05),R~2=0.471.The Cronbach's coefficient of the patient version of the post-discharge continuous nursing needs questionnaire was 0.950,the half-reliability was 0.850,the KMO value was 0.824,and the Bartlett's sphericity test value was 4114.562(P<0.01).The Cronbach's coefficient of the questionnaire for continuing care needs after discharge for caregivers was 0.951,the half-reliability was 0.835,the KMO value was 0.841,and the Bartlett's sphericity test value was 4841.212(P<0.01).2.In this study,20 experts were invited to conduct two rounds of consultation.The recovery rates of the two rounds of expert consultation questionnaires were 83%,100%,100%,45%and10%,respectively.The expert authority coefficient was 0.78 and 0.85,and the expert coordination coefficient(importance)was 0.175 and 0.220.(feasibility)0.156,0.218,significance test results P<0.01.There were 19 items of importance and 4 items of feasibility,and the mean of importance and feasibility of each item was>4.There were 77 items in the initial expert consultation questionnaire and 63 items in the final.3.Finally,the contents of the discharge plan for adult patients with moderate or above burns were determined,including three first-level items,five second-level items and 55 third-level items,including discharge plan evaluation,discharge plan implementation measures,and post-discharge plan implementation evaluation.Research Conclusion:1.In this study,the degree of continuous nursing needs of adult patients with moderate and above burns and their caregivers after discharge was basically the same,and the order of scores in each dimension was slightly different.Patients with the same and high scores in terms of the requirements of patients and caregivers:wound care guidance in discharge services,knowledge needs related to burns,pain management guidance or pain care guidance;Outpatient follow-up,telephone follow-up and discharge instruction manual in the form of service;The service time is mainly divided into three time nodes:in case of unmanageable emergencies,once a week after discharge,and once a month after discharge.The service provider is the competent doctor.The difference is that the score of complication prevention guidance in the dimension of discharge service content of the caregivers is relatively high,and the patients'demand for providers is dominated by responsible nurses and professional teams,while the caregivers are dominated by psychologists and rehabilitation doctors.Age,marital status,and educational level were the same influencing factors for patients'and caregivers'continuing care needs after discharge.However,different influencing factors were different payment methods of patients,gender of caregivers,relationship with patients,and nursing experience.The investigation and analysis of influencing factors on the continuous nursing needs of patients and caregivers with moderate and above burns after discharge not only provide a basis for the establishment of discharge plans for patients with moderate and above burns,but also provide a reference for the development of personalized discharge plans.2.The consulting experts invited in this study were familiar with the"discharge plan for adult patients with moderate and above burns",and their opinions and Suggestions were authoritative,and the data analysis results were reliable.The hospital discharge plan for patients with moderate or above burns was constructed to provide reference for clinical nursing practice. |
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