Study On The Application Of Discharge Planning Pattern In Ventricular Septal Defect With Pulmonary Hypertension

Background:Congenital heart defect (CHD) is a defect in the structure of the heart and great vessels which is present at birth. Heart defects are among the most common birth defects and are the leading cause of birth defect-related deaths. Pulmonary arterial hypertension (PAH) is a common complication of congenital heart disease, which leads to increased pulmonary vascular resistance. Infants with CHD-PAH before surgery have more chance to get complications. The mortality of infants with ventricular septal defect (VSD) and PAH is2.6times higher than those without PAH. With the change of medical environment, infants after heart surgery are taken care of at home longer than in hospital. When mothers look after their babies with CHD-PAH at home, they suffer increased stress and low self-efficacy. They must acquire special knowledge and ability for infant care. Now, discharge planning helps to make sure that patients leave the hospital safely and smoothly and get the right care after that. Good planning can leads to improved patient and carer satisfaction. This research aims at evaluating the effect of discharge planning upon infants with VSD and PAH.Objective:To evaluate the effectiveness of discharge planning on mother’s special knowledge, ability for infant care and general self-efficacy. To evaluate the effectiveness of discharge planning on the weight, re-hospital, infection level of infants.Methods:This is a quasi-experimental study,60children and their mothers took part in the study during6to11in2013. They were divided into the intervention group and control group, each group had30children, so did their mothers. The control group was given conventional treatment and care in ward, while the intervention group was given both the conventional treatment and care, and discharge planning, which include evaluated mothers’needs after they came in hospital, made the discharge plan and put in into effect. Researcher gave mothers health education and skill training, which they needed after discharge. When the children discharged from hospital, mothers could ask questions from the researcher. And the researcher also gives them a call one week, one month, three months later after discharge. Before discharge, we used the discharge preparedness scale, VSD and PAH knowledge questionnaire, care behavior questionnaire, customer satisfaction degree questionnaire and the general self-efficacy scale to assess mothers. One month, three months after discharge, we used self-designed questionnaire to follow-up the children and used VSD and PAH knowledge questionnaire, care behavior questionnaire, customer satisfaction degree questionnaire, the general self-efficacy scale to assess the mothers. Results:57children and their mothers, incluing29in the intervention group (n=29) and28in the control group (n=28) finished the study.(1) The discharge preparedness of mothers in the intervention group was significantly higher than that in the control group (t=3.35, P=0.001); The knowledge level of mothers in intervention group was siginificantl higher than that in the control group (t=12.60, P=0.000; t=6.44, P=0.000; t=5.95, P=0.000); Mothers’knowledge level in the intervention group significantly improved after intervention (t=8.41, P=0.000; t=8.45, P=0.000; t=8.55, P=0.000) than that in the control group one month, three months after discharge (t=6.71,P=0.000; t=6.96, P=0.000). The care ability of mothers in the intervention group was significantly higher than that in control group (t=4.81,P=0.000; t=2.90, P=0.006; t=3.43, P=0.001), and the care ability of mothers in control group improved one month than before discharge but it was decreased than three months after discharge; The degree of nursing saticefaction in intervention group is much higher than that in control group (t=-2.26,P=0.024; t=-2.12,P=0.034; t=-1.84, P=0.033); The general self-efficacy of mothers in intervention group is higher than that in the control group, but there was no obvious difference between the two groups (p>0.05); The general self-efficacy of mothers in intervention group before discharge and one month after discharge was higher than base line;(2) The weight of children in both groups increased after discharge, however, there was no obviously different between two groups. The rate of readmission in intervention group is much lower than that in control group after discharge, but there was no significant difference between the two groups.Conclutions:(1) Discharge planning model could improve the diacharge preparedness of mothers, improve the knowledge level of mothers, improve the care ability of mothers and the effectiveness could last for3moths; it has no significant effect on the general self-efficacy of mothers.(2) Discharge planning model has no significant effect on the weight of children; discharge planning model has no significant effect on the rate of readmission.