| Objective1.To explore the discharge preparation needs of elderly stroke patients and caregivers;2.Construct a dyadic discharge preparation intervention program to improve the discharge readiness of elderly stroke patients and caregivers;3.Implement the dyadic discharge preparation intervention program and verify its effect.MethodsThe study consists of three parts:1.Qualitative research stage: Objective sampling method was adopted to select elderly stroke patients and their caregivers who met the inclusion and exclusion criteria in the wards of neurology department as interview objects.Semi-structured in-depth interview method was applied to conduct joint interviews with patients and their caregivers based on the interview outline.Interview data were sorted out and analyzed according to the seven-step Colaizzi analysis method and themes were extracted.To clarify their real experience and needs in the process of discharge preparation.2.Construction stage of intervention program for dyadic discharge preparation:Clinical problems were determined based on the preliminary qualitative research results,and search terms were formulated according to the research objectives.A total of 11 Chinese and English literature databases were systematically searched,including China Biology Medicine(CBM),China National Knowledge Infrastructure(CNKI),National Guideline Clearinghouse(NGC),Pub Med,etc.The search period was up to March 15,2022.The documents that meet the inclusion and exclusion criteria are evaluated strictly according to the quality evaluation tools.Based on the literature review and the Theory of Dyadic Illness Management and IKAP health education model,the initial draft of the intervention plan was formed,and the preliminary draft of the bivariate discharge preparation intervention plan was formed after discussion by the research group.In order to ensure the scientific nature and applicability of the intervention plan,a meeting of experts in the hospital was organized to revise and improve the draft of the intervention plan,and the preliminary test was further carried out to modify the intervention problems in the preliminary test,and finally the test draft of the dyadic discharge preparation program was formed.3.The application stage of the dyadic discharge preparation progrom: From May to October 2022,according to the inclusion and exclusion criteria,elderly stroke patients and their caregivers in the neurology ward of a third-class A general hospital in Henan Province were conveniently selected as research objects.In order to reduce the risk of bias and avoid the effect of contamination,the non-synchronous control method was used for group intervention in the same ward.The subjects from May to July 2022 were set as the control group,and the subjects from August to October 2022 were set as the intervention group.The sample size required for the two groups was 46 pairs each based on the pre-test results.The control group received routine nursing in neurology department,and the intervention group received dyadic discharge preparation intervention program on the basis of routine nursing.Data of the two groups were collected at admission,discharge,one month after discharge and three months after discharge.The applied research tools included general data questionnaire,Readiness for Hospital Discharge Scale(RHDS),caregiver Readiness Scale(CPS),Stroke Knowledge Questionnaire(SKQ),The Self-Care Self-Efficacy Scale(SCSES),The Caregiver Self-Efficacy in Contributing to Patient Self-Care Scale(CSE-CSC),caregiver Stress Scale(CSI),IBM SPSS26.0 statistical software was used for statistical analysis of the two groups of data,and the test level was α=0.05.Results1.Qualitative research stage:14 subjects were selected for qualitative interviews,and three themes and nine subthemes were extracted: theme 1: disease-related information needs,including disease related knowledge needs,home-based nursing skills needs,information access needs,and discharge preparation cognitive needs;Topic 2: psychological support needs of both parties,including the need to adapt to role changes,the need for patients to manage negative emotions,and the need for caregivers to relieve care pressure;Topic 3: Demand for continuous medical services,including discharge rehabilitation plan demand and continuous health service demand.2.Construction stage of intervention program for dyadic discharge preparation: A total of 1798 literatures were retrieved,18 were finally included,and the first draft of intervention plan was formed by summarizing the included literatures.Ten experts were invited to participate in the expert meeting,and the expert authority coefficient was 0.84,facilitating the selection of 8 research objects meeting the inclusion criteria for pre-test.Finally,the frequency of intervention was 7 times from the four aspects of disease information education,knowledge and skill training,health belief enhancement and discharge preparation.The intervention content mainly included disease information education,care skills training,dual psychological education,discharge nursing planning and continuous health support.3.The application stage of the dyadic discharge preparation progrom:(1)85 pairs of elderly stroke patients and caregivers successfully completed the study,including42 pairs in the control group,with a sample loss rate of 8.7%,and 43 pairs in the intervention group,with a sample loss rate of 6.5%.There was no statistical difference between the two groups in general data(P >0.05).(2)At discharge,the total score of discharge readiness and scores of all dimensions in the intervention group were higher than those in the control group,and the difference was statistically significant(P < 0.05).At discharge,the total score of caregiver readiness in the intervention group was higher than that in the control group,and the difference was statistically significant(P < 0.05).Compared with each item,there were statistically significant differences in the scores of caregivers’ physiological needs readiness,emotional needs readiness,service preparation readiness,stress management readiness,access to medical information readiness and overall care readiness between the two groups(P < 0.05).(3)Before intervention(at admission),there were no statistical differences in the distribution of stroke knowledge scores between the two groups of patients and the two groups of caregivers(all P > 0.05),but after intervention,there were statistical differences in the distribution of stroke knowledge scores between the two groups of patients and the distribution of caregivers(all P < 0.05).Compared with all dimensions,there were statistical differences in the score distribution of the dimension of threatened symptoms,risk factors,behavior and rehabilitation knowledge between the two groups of patients(P < 0.05),while there were statistical differences in the score distribution of the dimension of threatened symptoms,first aid treatment,risk factors,behavior and rehabilitation knowledge between the two groups of caregivers(P <0.05).(4)Before intervention(at admission),there were no significant differences in self-efficacy scores between the two groups of patients and caregivers(all P > 0.05).At discharge and after intervention(one month after discharge),the scores of patients and caregivers in the intervention group were higher than those in the control group,with statistical significance(all P < 0.05).Repeated measure analysis of variance showed that there were statistical differences in the time effect and interaction effect of self-efficacy score between the two groups of patients(P < 0.05),and there were statistical differences in the time effect and intergroup effect of self-efficacy score between the two groups of caregivers(P < 0.05).(5)There was no statistically significant difference in the scores of caregiver care pressure between the two groups before intervention(at admission)(P>0.05).The scores of caregiver care pressure in the intervention group were lower than those in the control group at discharge and after intervention(one month after discharge),and the difference was statistically significant(both P<0.05).The repeated measurement analysis of variance showed that there were significant differences in the time effect and interaction effect of caregiver care stress scores between the two groups(P<0.05).(6)The unplanned readmission rate of patients in the intervention group(7.0%)was lower than that in the control group(23.8%)one month after discharge,the difference was statistically significant(P<0.05);The cumulative unplanned readmission rate of patients in the intervention group(16.3%)was still lower than that in the control group(33.3%)three months after discharge,but the difference was not statistically significant(P>0.05).Conclusion1.In the process of discharge preparation,elderly stroke patients and their caregivers have a variety of information needs,such as disease-related knowledge,home-based nursing skills,mutual psychological support and continuous health services.2.The dyadic discharge preparation intervention can significantly improve the discharge readiness level,stroke knowledge level and self-efficacy level of elderly stroke patients and caregivers,and effectively reduce the caregiver care stress and reduce the readmission rate of patients. |
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