Action Research On The Construction Of Case Management Practical Model With Ischemic Stroke Receiving Intravenous Thrombolysis

ObjectiveTo investigate the management status of patients with ischemic stroke intravenous thrombosis;To explore the nursing needs of patients with ischemic stroke intravenous thrombolysis;To establish the case management practice mode of ischemic stroke in accordance with the “Guidelines for Diagnosis and Treatment of Acute Ischemic Stroke(2018 edition)and “Evidence-based Guidelines for Stroke Nursing” as well as “Case Management Mode”;To preliminarily apply in clinical and to evaluate the overall function of this mode in patients with ischemic stroke intravenous thrombolysis.MethodsWith the action research as the main framework and the case management model as the theoretical basis,this study mainly includes the following five parts:(1)Find the problem: The existing problems in clinical practice were compared with the “Guidelines for the diagnosis and treatment of acute ischemic stroke in China(2018 edition)” and the“Guidelines for Stroke Management Practice”.The result showed that the management status of patients with ischemic stroke intravenous thrombolysis was poor,the duration of the key links of thrombolysis was nonuniform,and patients’ nursing service was limited to hospitalization.(2)Analyze the problem: Through literature research,observation and qualitative research,the management status,nursing needs and influencing factors were analyzed and summarized.(3)Form the plan: Based on the analysis of the previous problems,the preliminary model and process of the case management practice of ischemic stroke intravenous thrombolysis were constructed through literature research,practice guide and case management theory.(4)Amend the plan: The process of the preliminary practice mode was amended through expert group meeting.(5)Evaluation and reflection:Using the clinical randomized experimental study,the overall function of this mode on patients with ischemic stroke intravenous thrombolysis was evaluated from the key links of intravenous thrombolysis and the recovery of patients’ neurological function,and the results were evaluated retrospectively.Results1.The duration of the key links of ischemic stroke intravenous thrombolysis varies greatly.The nursing of patients with ischemic stroke intravenous thrombolysis is limited to hospitalization,lacking of individualized and sustained follow-up and support after discharge.2.The nursing needs of patients with ischemic stroke intravenous thrombolysis are different at different stages.The main nursing needs include:(1)the need for rapid and standardized treatment and nursing;(2)the need for obtaining rehabilitation information;(3)the need for health resources utilization;(4)the need for psychosocial support.The main restraining factors to meet the needs of patients’ nursing include:(1)weak awareness of stroke prevention among patients and their families;(2)unsystematic health education and lack of continuing health support after discharge;(3)lack of professional rehabilitation personnel in stroke wards.3.According to Maslow’s hierarchy of needs theory and case management theory,a nurse-led case management practice model for patients with ischemic stroke intravenous thrombolysis from hospital to community was constructed;Case management practitioners are the registered nurses with more than five-year experience in stroke wards,who have received systematic nursing education and specialized training,and have good communication and coordination skills;The key links of intervention include acute hospitalization stage,rehabilitation stage,one month after discharge and three months after discharge;The work includes direct nursing,health guidance and counseling services as well as psychological support.The follow-up methods include ward visits and telephone follow-up.4.The main research results of the case management practice model of patients with ischemic stroke intravenous thrombolysis are as follows: 1.The time in each key link of thrombolysis is significantly shortened.The time of patients between the two groups showed statistical difference from doctors’ office visiting to neurologist clinical reception,from doctors’ office visitingto nurse’s completion of treatment,from doctors’ office visiting to CT report presentation,from doctors’ office visiting to laboratory examination report presentation,family decision-making time,from doctors’ office visiting to intravenous thrombolysis starting(P<0.05).2.Promoting the recovery of neurological function,there was statistical difference in NIHSS score between the two groups 3 months after discharge(P<0.05).3.The activities of daily living of patients in the two groups were improved 1 month and 3 months after discharge,and there was statistical difference(P<0.05).4.Reducing the rate of unplanned readmission.The readmission rates showed statistical difference(P<0.05).Conclusion1.The time spent on the key links of ischemic stroke intravenous thrombolysis varies greatly;The needs of patients’ nursing are not well met.2.The case management practice mode of ischemic strokeintravenous thrombolysis is an effective service mode.It can effectively improve the prognosis of patients,provide the individualized and continuous health nursing,information support and psychosocial support for patients with ischemic stroke intravenous thrombolysis,promote the rehabilitation of patients withischemic stroke intravenous thrombolysis,improve the self-care ability of patients and reduce the utilization rate of medical resources.