Construction And Empiricalstudy Of Integrated Care Path For Patients With Ischemic Stroke

PartⅠCONSTRUCTION OF INTEGRATED NURSING CARE FOR PATIENTS WITH ISCHEMIC STROKEobjectiveWith patients as the center,through literature research,theoretical research,medical history review,based on Canadian Stroke Best Practice Recommendations: Managing transitions of care following Stroke Guidelines Update 2016,combined with the actual situation of hospital and the opinions of clinical experts,according to the development steps of clinical pathway,the integrated nursing care pathway for patients with ischemic stroke was constructed.Method1.Through literature research,medical history review,actual situation of hospital and opinions of clinical experts,the integrated nursing care pathway for patients with ischemic stroke was proposed.2.Referring to the development steps of clinical pathway and applying the action research method,the integrated nursing care pathway of a cyclic process for patients with ischemic stroke was constructed by raising questions,analyzing problems,putting forward ideas,formulating plans,revising plans,observing and reflecting.Result1.Through literature research,it is found that there is an early rehabilitation nursing path and a health education path for ischemic stroke in clinical practice,but the clinically implemented nursing path content is relatively simple,and lacks guidance for patients after discharge.The discharge preparation plan reflects continuous care and can provide guidance for patients during hospitalization and certain stages after discharge.Therefore,this study builds an integrated care pathway that combines early rehabilitation care,health education,discharge preparation planning,and basic care activities with reference to the Canadian Stroke Best Practice Recommendations: Managing transitions of care following Stroke Guidelines Update 2016,PDCA Cycle,and Clinical Path Development Steps.2.Through action research method,the specific content of the pathway was discussed and analyzed,and the standard time of integrated nursing care pathway was 14 days and the content of the pathway included basic nursing activities,health education,discharge preparation plan,early rehabilitation nursing,influencing factors and variation.conclusionIn this study,the integrated nursing care pathway for patients with ischemic stroke was constructed using the action research method,which provided a new method for the nursing of patients with ischemic stroke.It could reduce the delay of rehabilitation and waste of resources for patients with ischemic stroke,enable patients to return to social life as soon as possible and reduce the heavy burden on society and family.Part ⅡAN EMPIRCAL STUDY OF INTEGRATED CARE PATHS IN PATIENTS WITH ISCHEMIC STROKEObjectiveThe patients with ischemic stroke were cared by the integrated nursing care pathway,and its application effect was evaluated to verify the feasibility and scientificity of the pathway.Methods1.Using the quasi-experimental study,the patients with ischemic stroke diagnosed in a general hospital in Taian from April to November,2018 were selected as the research objects,which met the inclusion and exclusion criteria,daily activity ability,length of stay,hospitalization expenses,health knowledge mastery and satisfaction of patients were evaluated,and the effect of integrated nursing pathway was verified.2.The data collected were input into SPSS 22.0 statistical software,and the results are analyzed by statistics.ResultThere were no significant differences in sex,age,education level and monthly income of patients between the two groups.The hospitalization days of patients in the pathway group were less than those in the control group(t=7.34,P=0.000),and the difference was statistically significant.The NIHSS scores of the pathway group at discharge and 30 days after discharge were lower than those of the control group,and the difference was statistically significant(time effect F=552.68,group effect F=19.73,P<0.05),and the BI index score of the pathway group was higher than that of the control group,and the difference was statistically significant(time effect F=129.08,group effect F=22.71,P<0.05).The satisfaction of nursing care in the pathway group was higher than that in the control group,and the difference was statistically significant(t=-6.88,P=0.000).The score of health education knowledge mastery in the pathway group was higher than that in the control group,and the difference was statistically significant(t=3.27,P=0.002).However,the hospitalization expenses of patients showed that although the hospitalization expenses of the patients in the pathway group were less than those in the control group and there was no significant difference(t=-1.73,P=0.088).conclusionIntegrative nursing care pathway for patients with ischemic stroke can improve their neurological function and daily activity ability,shorten the hospitalization days,improvethe patient’s satisfaction and knowledge of health education.