Construction Of Bladder Function Rehabilitation Program In Patients With Spinal Cord Injury And Clinical Application

Objective: Based on evidence-based medicine and review the progress of rehabilitation bladder function research. Use retrospective analysis and qualitative interview to study currently status quo of bladder functional rehabilitation training of spinal cord injury patients. Based on the current situation research,and through literature review, clinical observations, expert meetings and other methods to build scientific cand standardized bladder functional rehabilitation program in patients with spinal cord injury. Apply the programs to clinical, and improve rehabilitation programs through clinical empirical research.The aim is to provide scientific and standardized bladder function rehabilitation measures wih spinal cord injury patients for nurses, persistent to reduce the incidence of urinary system complications, promote the bladder function rehabilitation of patients, improve the spinal cord injury patients’ quality of life.Methods: 1. Using cluster sampling method to collecte 100 cases from spine department and rehabilitation department of two General Hospitals and 61 cases from a spinal cord rehabilitation center from January 2010 to July 2014 in Shanghai then do descriptive analysis; Using convenience sampling method to select 13 health care workers from general hospitals, orthopedic hospital and rehabilitation center in Shanghai from April to May in 2014 to do a qualitative interviews, and analysis the current bladder function rehabilitation status quo in patients with spinal cord injury.2. Based on evidence-based nursing theory and through literature review to recommend high level of research evidence, then to draft rehabilitation plan, and then demonstrate the plan through expert meetings. 3. Using quasi-experimental research method,and use convenience sampling method to selecte 15 SCI patients as control group form January to June in 2014 in the rehabilitation, and selected 15 SCI patients as intervention group which use bladder function rehabilitation nursing program form July to December in 2014. Use bladder training effect, the incidence of urinary tract infections, length of stay, health education Knowledge of patient satisfaction index as indicators to validate the rehabilitation training program for clinical. The patient’s General information use descriptive analysis, for normally distributed measurement data using two independent samples t test, when compare rates use the chi-square test, when P <0.05 was considered statistically significant.Results: 1. Through retrospective analysis of 100 cases from spine department and rehabilitation department of two General Hospitals and 61 cases from a spinal cord rehabilitation center, obtain current problems are: pay less attention on bladder function with patients after spinal cord injury in top three hospitals, not pay attention to bladder function recovery in the top three hospitals rehabilitation department, rehabilitation centers are exploring bladder rehabilitation methods; Through qualitative interview study, obtained six themes: lack of bladder functional rehabilitation concept, bladder functional rehabilitation liability is not clear, not understand the bladder function rehabilitation knowledge, patients with poor self-care ability, have doubts on intermittent catheterization, and follow-up mechanisms are inadequate.2. Through literature review research, building bladder function rehabilitation training draft with SCI patients, including 9 parts :bladder function management stage, bladder function assessment,diagnosis and classification,bladder function rehabilitation training, drug treatment, common complications, and long-term follow-up rehabilitation, health education, bladder function training effect evaluation. Through expert meeting to discusses the structure and content of the project and modify it, finally formed the bladder function rehabilitation training program text with SCI patients.3. Compare bladder function training situation of the program group and control group, patients’ bladder capacity increased, the number of days of hospitalization reduced, patient satisfaction improved, health knowledge degree increased on bladder function rehabilitation of the program group, the difference was statistically significant(P> 0.05); Although it has not statistically significant difference in the bladder training effect that reach the equilibrium bladder state and the incidence of urinary tract infections, after the implementation of bladder rehabilitation training program, a increase of 26.67% of bladder function and a decrease of 20% of urinary tract infection which compared to the previous.Conclusions: Through retrospective analysis of medical records and qualitative interview study to analyze the current bladder training status of SCI patients, On this basis, based on evidence-based nursing theory and by literature review to draft bladder function rehabilitation training protocol with SCI patients, finally revised and and form a rehabilitation text by experts meeting. Using quasi-experimental study to do clinical validation protocol, it displayed good results in reducing the incidence of urinary tract infection, shortering hospital stay and improving bladder function, improving patient satisfaction and health aspects of the knowledge, which is in line with the purpose of the program design.