| Acute Ischemic Stroke(AIS)is the most common type of stroke,and rt-PA intravenous thrombolysis is the preferred treatment for AIS.The earlier the start of rt-PA intravenous thrombolysis,the better the clinical outcome of AIS patients.The time from admission to the start of intravenous thrombolysis Door-to-Needle(DNT)of AIS patients is one of the important factors affecting the efficacy of rt-PA intravenous thrombolysis.One.Compared with developed countries,my country still has a lot of room for improvement in the quality of AIS intravenous thrombolysis.The DNT compliance rate in my country is still low,and DNT needs to be shortened.The AIS intravenous thrombolytic care model led by trained nurses can improve the quality of care for stroke patients.The level of AIS intravenous thrombolysis treatment in my country needs to be improved as a whole,and the current domestic AIS intravenous thrombolysis nursing model is mostly small sample,short-term,single-center research,and the regional AIS intravenous thrombolytic nursing model is still in the exploratory stage.1 Objectives1.1 To understand the current status of AIS intravenous thrombolysis nursing mode in 22 designated hospitals for stroke treatment in Shenzhen;1.2 To understand the needs of nurses participating in AIS intravenous thrombolysis for the optimization of AIS intravenous thrombolysis care model;1.3 To optimize the AIS intravenous thrombolytic care model,and carry out its clinical application and effect evaluation.2 Methods2.1 Using the cluster sampling method,conduct AIS intravenous thrombolysis nursing model status survey in 22 stroke treatment designated hospitals in Shenzhen,including hospital profile,rules and regulations,staffing,equipment configuration,information system,etc.;2.2 Using the purpose sampling method,semi-structured interviews were conducted with 16 nurses participating in AIS intravenous thrombolysis in 5 stroke treatment designated hospitals in Shenzhen.According to the 7-step analysis method of Colaizzi phenomenological data,the data was coded and classified using NVivo12.0,To extract topics related to this research;2.3 Based on the results of current investigations and qualitative interviews,construct a draft for optimizing the AIS intravenous thrombolysis nursing model,and use brainstorming methods to hold symposiums with clinical experts in related fields to obtain opinions and suggestions on optimizing the AIS intravenous thrombolysis nursing model.Optimize the AIS intravenous thrombolytic care model;2.4 Adopt convenience sampling method,select 3 designated hospitals for stroke treatment in Shenzhen,apply AIS intravenous thrombolysis clinically to optimize the nursing model,and evaluate its clinical effects.The AIS intravenous thrombolysis patients from January 2020 to December 2020 were selected as the research objects,of which the AIS intravenous thrombolysis patients from January 2020 to June 2020 were selected as the control group,from July 2020 to December 2020 Patients with AIS intravenous thrombolysis were included in the intervention group.3 Results3.1 95.45%of designated stroke treatment hospitals have established and activated green channels for stroke treatment,72.73%of stroke treatment designated hospitals have established a stroke treatment system,63.64%have established a pre-hospital information transmission system,27.27%are equipped with a pre-hospital registration system,and 45.45%have been set up For stroke full-time nurses,40.91%regularly organize staff to participate in first aid training;3.2 The five themes that nurses need to optimize the AIS intravenous thrombolysis nursing model are:(1)Stroke emergency nurses need to be set up;(2)Stroke nurses lack standardized training and assessment;(3)Stroke-related information transmission and management methods need to be improved(4)The green channel for stroke treatment is not clear enough;(5)The quality control system of AIS intravenous thrombolysis is not perfect;3.3 The optimization measures for AIS intravenous thrombolysis nursing model include:configuration of AIS intravenous thrombolysis equipment and facilities,standardization of stroke green channel process management,revision of AIS intravenous thrombolysis document and record form,improvement of AIS intravenous thrombolysis quality management system,and standardization of AIS intravenous thrombolysis for nurses.Bolt training;3.4 There are 211 subjects in this study,104 cases in the control group,and 107 cases in the intervention group.The two groups of research subjects had no such aspects as age,gender,marital status,past history,smoking history,drinking history,treatment method,TOAST etiology classification,admission NIHSS score,admission body temperature,admission heart rate,admission blood pressure,admission blood glucose,admission breathing,etc.The statistical difference(P>0.05)is comparable.Compared with the control group,the median DNT of the intervention group decreased from 58 minutes to 44 minutes,and the difference was statistically significant(P<0.001).The compliance rate of DNT<60min increased from 53.85%to 80.37%,and the difference was statistically significant(P<0.001).The time from admission to CT examination(DIT)and the time from CT examination to intravenous thrombolysis(INT)of patients in the intervention group were shorter than those in the control group,and the difference was statistically significant(P<0.05).4 Conclusions4.1 There is a gap in the AIS intravenous thrombolytic care model among the designated stroke treatment hospitals in Shenzhen,and the overall AIS treatment capacity needs to be improved;4.2 It is necessary to set up specialist nurses for stroke first aid,standardize stroke specialist training and assessment,build an intelligent information platform for AIS treatment,optimize stroke green channels and complete AIS intravenous thrombolysis quality system to promote the optimization of AIS intravenous thrombolysis care model;4.3 By configuring AIS intravenous thrombolysis software and hardware equipment,strengthening AIS intravenous thrombolysis related knowledge training and other measures,optimizing the AIS intravenous thrombolysis nursing mode can effectively shorten DNT and increase the rate of DNT<60min. |
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