Study Of Application And Effects Of Collaborative Care Model On Patients With Total Hip Peplacement

Objective To understand the psychological feelings of patients with total hip replacement(THR) on operation and postoperative life; to develop intervention program of collaborative care and explore the impact of collaborative care model on the self-care ability, hip function, anxiety, depression and social support of patients with THR, providing a reference for establishing a collaborative care intervention model for patients with THR and promoting the application of this model in clinical nursing..Methods This study was divided into two parts, the first is qualitative research and the second is intervention study.In the qualitative research, phenomenology method was used to carry out semi-structured interviews in respondents, and the interview data was obtained with the aid of observation method; data collection terminated and the sample number was not further increased once the data and information became saturated. In this study, the interview data of 16 patients was collected and then analyzed using 7-step analytical method. According to the qualitative research results, the problems existing in routine care were summarized to provide basis for collaborative nursing intervention.In the intervention study, 64 eligible patients,who were from a third-grade class A hospital, were selected and evenly and randomly divided into the control group(n=32) and the intervention group(n=32) according to the chronological order of admission. The patients in the control group was treated with the routine care. In the intervention group, the patients was given with the routine care and collaborative care intervention. Then, the exercise of self-care agency scale, Harris hip score system, self-rating anxiety scale, self-rating depression scale and social support rating scale were used to evaluate the intervention effects before the intervention, at the third month and the sixth month of the intervention, respectively. With SPSS18.0 statistical software for data analysis, the main statistical methods included descriptive analysis, t test, ?2 test, Wilcoxon Rank Sum test, ANOVA of Repeated Measure and LSD Post Hoc.Results1 In the qualitative research, three themes for 16 patients with THR were summarized, they were respectively bodily sensations, emotional responses, and needs and support.2 They were 30 patients who finished study, either in the control group or in the intervention group. Before intervention, according to the equilibrium test between both groups in terms of basic information and various evaluation indexes, the difference was not statistically significant(P>0.05).3 After 3 months intervention, except for self-care sense of responsibility at 3rd month of intervention that the difference of the control group(18.40?1.40) and the intervention group(18.87?1.01) was not statistically significant(P>0.05); the self-care total scores(115.23?6.16) and all dimensions scores in the intervention group were higher than the self-care total scores(105.37?6.47) and all dimensions scores in the control group; After 6 months intervention, the self-care total scores(122.77?5.14) and all dimensions scores in the intervention group were higher than the self-care total scores(105.70?6.40) and all dimensions scores in the control group, indicating statistically significant differences(P<0.05).4 After 3 months intervention, the harris hip scores(87.03?6.95) the social support scores(39.73?2.18) and all dimensions scores in the intervention group were higher than the harris hip scores(75.57?8.18) the social support scores(36.20?3.42) and all dimensions scores in the control group(P<0.05); After 6 months intervention, the harris hip scores(97.90?2.47) the social support scores(42.93?2.48) and all dimensions scores in the intervention group were higher than the harris hip scores(88.70?5.92) the social support scores(37.07?3.90) and all dimensions scores in the control group(P<0.05).5 After 3 months intervention, the anxiety scores(42.97?3.20) depression scores(33.50?4.33) in the intervention group were lower than the anxiety scores(47.13?4.10) depression scores(36.53?4.79) in the control group; After 6 months intervention, the anxiety scores(32.60?2.22) depression scores(27.67?2.82) in the intervention group were lower than the anxiety scores(35.83?2.68) depression scores(32.00?5.24) in the control group(P<0.05), indicating statistically significant differences(P<0.05).Conclusion1 Three main problems in routine care of THR patients included failing to meet the psychological demand, self care and social support.2 Based on the results of qualitative research, the collaborative care intervention program for patients with total hip replacement has been developed. When applied to the care of postoperative patients, it has achieved satisfactory results, including effective improvement of patients’ self-care capacity and social support level, reduction of anxiety and depression degree and effective restoration of hip functions, which evidences its promotion and application value in clinical practice.