| ObjectiveTo construct a discharge preparation pathway for patients after PCI for acute myocardial infarction;and to verify the clinical effectiveness and feasibility of the discharge preparation pathway for patients after PCI for acute myocardial infarction through class experiments to provide a reference basis for improving the care outcomes of patients after PCI for acute myocardial infarction.MethodsThis study is divided into two parts.Part Ⅰ: According to the current situation of treatment and discharge care for patients with acute myocardial infarction after PCI,based on the literature review,the Delphi method and hierarchical analysis were used to form a discharge preparation pathway with scientificity and rationality for patients with acute myocardial infarction after PCI.Part Ⅱ: Clinical empirical study.Using the method of class experimental study,patients admitted to the cardiology ward of a tertiary hospital in Guangzhou during January to April 2022 were selected using convenience sampling,and the first 35 patients included in the order of admission were the control group,and the 35 patients included during June to September 2022 were the experimental group.The control group received routine care at the time of hospitalization and received telephone follow-up after discharge;the experimental group implemented interventions based on routine care in strict accordance with the discharge preparation pathway for patients after PCI for acute myocardial infarction.The two groups were compared in terms of patient discharge readiness on the day of discharge,patient self-management level in the 1st and 3rd month,anxiety and depression status,BMI attainment rate,incidence of adverse cardiovascular events and readmission rate.ResultsPart Ⅰ: By completing 2 rounds of expert correspondence with 17 experts,a total of 6 time points from admission to post-discharge were finally constructed,divided into 5 modules and 28 entries,and the weights of each entry were determined to finally form a discharge preparation pathway for patients after PCI for acute myocardial infarction.Part Ⅱ: Results of the clinical empirical study.1.A total of 68 patients eventually participated in the study,including 33 in the control group and 35 in the experimental group;the differences in general demographic characteristics data,disease characteristics data and lifestyle characteristics data between the two groups were not significant(P>0.05).2.On the day of discharge,compared with the control group,patients in the experimental group had higher total discharge readiness scores,and the difference was statistically significant(P<0.05),indicating that patients in the experimental group had improved their readiness for discharge;the results of each dimension of the discharge readiness scale showed that patients in the experimental group had higher scores in each dimension than the control group,and the difference was statistically significant(P<0.05);nurses in the experimental group rated the total score of the discharge readiness scale higher than that of the control group,and the difference was statistically significant(P<0.05).The total score of the Readiness for Discharge Scale in the experimental group was higher than that in the control group,and the difference was statistically significant(P<0.05),indicating that the nurses thought that the patients in the experimental group had better readiness for discharge;the scores of all dimensions of the Readiness for Discharge Scale in the experimental group were better than those in the control group,and the difference was statistically significant(P<0.05).3.The total score of self-management ability in both groups had a group effect(P< 0.05),and the patients in the experimental group performed better in the total score of self-management ability in the first month of discharge and the third month of discharge compared with the control group,and the difference was statistically significant(P<0.05);the scores of all dimensions of self-management ability in both groups had a group effect(P<0.05),and all dimensions except the disease knowledge dimension did not have a time effect(P>0.05).After 1 month of discharge,the scores of all dimensions of self-management ability in the experimental group were higher than those in the control group,and the difference was statistically significant(P<0.05);after 3 months of discharge,the scores of all dimensions in the experimental group were better than those in the control group,except for medical compliance,and the difference was statistically significant(P<0.05);after 1 and 3months of discharge,the scores of all dimensions in the experimental group were higher than those in the control group,and the difference was statistically significant(P<0.05).The comparison of the scores of each dimension showed that the scores of the disease knowledge dimension were higher at 3 month of discharge than at 1 month of discharge,and the difference was statistically significant(P<0.05).4.The anxiety and depression in both groups had a group effect(P<0.05),while the anxiety in both groups had a time effect(P<0.05);the anxiety and depression in the experimental group were lower than those in the control group in the first and third months of discharge,and the differences were statistically significant(P<0.05).5.After 3 months of discharge,there was no significant difference in BMI attainment,MACE incidence and readmission rates between the two groups(P>0.05).Conclusion1.The constructed discharge preparation pathway for patients with acute myocardial infarction after PCI is scientific and reliable,and entries are reasonably set;the discharge preparation pathway that combines the discharge service and clinical care pathway is used throughout the hospitalization,and all assessments and contents are clarified;nurses have sufficient time to prepare patients for hospitalization,which is conducive to the implementation of a detailed and comprehensive discharge preparation program for patients with acute myocardial infarction after PCI.2.The Discharge Preparation Pathway for Patients with Acute Myocardial Infarction after PCI can effectively improve patient and nurse discharge readiness,enhance patient self-management ability,reduce anxiety and depression,and facilitate communication between patients and nurses and between patients and primary caregivers.The Discharge Readiness Pathway for Patients with Acute Myocardial Infarction after PCI can be widely applied. |
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