Application Of Clinical Nursing Pathway In Acute Leukemia Patients Treated With Chemotherapy

Acute leukemia is a malignant disease of hematopoietic system, for cancer mortality, leukemia ranks No. 6(male)and No. 8(female), and it also ranks No.1 among children and adults under 35. Acute leukemia progresses rapidly,if not be treated in time, patients usually die within few weeks. For untreated acute leukemia patients, the survival time of them is only 3 months on average. Chemotherapy is the primary means of treatment of acute leukemia,and it is also the best way to solve the problem. Applying DA in the treatment of acute leukemia,remission rate can be 65%～85%,but at the same time, for chemotherapy drugs kill leukemia cells, chemotherapy often causes varying degrees of damage to the body. Some patients died not directly from leukemia,but from chemotherapy induced side effects. If a therapy cures the patients at the cost of their health, we cannot say it is successful. To evaluate the efficacy of disease mitigation only by whether the disease is cured is a method that increasingly shown its limitations. Nowadays,we must evaluate a disease mitigating method from both the remission of the disease and the improvement of the quality of life. Side effects of chemotherapy treatment directly hinder the implementation of the program, increase the time and costs in hospital,and damage the patient's body functions and quality of life. Trying to avoid the side effects is very important and has practical significance for clinicians of the subject. Even though some side effects are difficult to avoid,we should minimize them as far as possible. So we can cure the patients'diseases with the improvement of their living quality and the prolongation of their life at the same time.Clinical nursing path is a nursing model based on daily standard nursing plan and set for a special class of patients. It is implemented in comparison to the traditional nursing method. In traditional method, each nurse's personal path differs from location, hospital, medical care groups, working process and culture. After using the clinical nursing path,all these difference in nursing method can be avoided,and the arbitrariness and divergence can be eliminated , thus making nursing model standardized. It is a new managing model of nursing quality. Clinical nursing path is developed according to time and the development of medical model, characterized by reducing the incidence of complications, shortening the average length of stay, lowering medical costs, avoiding divergence in nursing, improving the quality of nursing care and promoting the relationship between nurses and patients. Clinical nursing path is guided by evidence based medicine and guidelines, combined with nursing, quality assurance and other advanced specialized management ideas, corresponding with the development of medical science. It is the care and treatment for a specific disease, and it documented and tabulated the nursing work. It can guide nurses to take the initiative to work with predictability, and make sure that nursing service can be consistent and continuous. At the same time, clinical nursing path can also make the patients have a clear knowledge of the nursing target, cooperate with the nurse and join in the process of nursing care, so the patients and the nurses can interact with each other, and get the best effect of nursing care finally.ObjectiveWith the continuous deepening of health care reform,clinical nursing path is gradually developed and perfected in practical application. Clinical nursing path has been used in surgical department, medical acute disease, maternity department, neonatology department, psychological care, health education and clinical teaching, and gets great result. This study is drawn on the researching method of clinical nursing path at home and abroad in recent years, using the clinical nursing path on the patients who take acute leukemia chemotherapy. It also uses psychological care to improve patients'adherence to treatment through scientific, professional, systematic care, in order to provide a predictable, scheduled and continuous nursing guide to potential problems. It is purposed to take care of the patients by professional nursing knowledge, to minimize side effects of chemotherapy as far as possible,to change life quality of the patients,to shorten the days of hospital stay, to reduce the costs in hospital and to prolong the patients'life.MethodsThis study collected 100 cases from acute leukemia patients who took chemotherapy medical care in hematology and oncology of Jilin University China-Japan Friendship Hospital, from October 2010 to October 2011. Those patients who all take chemotherapy by DA program the first time, randomly divided into path group and control group. The path group has 32 males,18 females, aged from 19 to 66, using method of clinical care path. The control group has 33 males, 17 female, aged from 17 to 65, using conventional chemotherapy nursing care. The study observed nausea & vomiting, phlebitis, alopecia, infection, bleeding incidence, how long of patients live in hospital and cost of each patients.Typing in data to excel database, dealing with the data by statistical software SPSS13.0,measurement data follows a normal distribution. By t test,rank sum test does not meet the normal distribution. Checkout the measurement data, P<0.05 makes the data fits statistically standard.ResultsThe patients in these two groups have no difference in sex, age, culture and diseases composition(P>0.05),so they are equilibrium comparable. Nausea and vomiting, phlebitis, alopecia, oral mucositis, duration of fever and bruise of punctured site of the path group are all obviously lower than the control group. The difference fits statistically standard (P<0.01)and indicates that the implementation of clinical nursing path improved the quality of nursing. The average length of stay, hospital costs of the path group are significantly lower than the control group. The significant difference(P<0.01)means the implementation of clinical nursing path can shorten the average length of stay of patients and reduce their hospital costs. Conclusion 1. Using clinical nursing path in the chemotherapy on acute leukemia patients will reduce the incidence of getting nausea and vomiting, phlebitis, alopecia, oral mucositis and bruise of punctured site; also it can reduce the duration of fever.2. Using clinical nursing path can shorten the days of hospital stay, reduce the costs in hospital and release the financial burden for the patients.3. Using clinical nursing path can reduce the incidence of side effects of chemotherapy,improve the patients'life quality.This study provides a reference to all kinds of diseases that can be treated with clinical nursing path. It is a forward-looking guidance.