| Background:Hemiplegia is the most common complication of brain disorder, the incidence of stroke-induced hemiplegia is as high as60%to80%, which constitutes a formidable burden and disability for patients, their families and communities. Functional assessment is the important basis for personal, scientific rehabilitation nursing and clinical observation in hemiplegic patients. However, nursing care in domestic hemiplegic patients are mostly experiences and general descriptions, the descriptions of current hemiplegic patients’routine care are general, less systematic and comprehensive, current routine cares do not reflect the differences of nursing interventions in patients under varied functional status. Therefore, it is of extremely importance to development systematic, comprehensive and standardized nursing program that matched patients’functions.Nursing Interventions Classification (NIC) is comprehensive standardized language that describes the treatments performed by nurses. It is a clinical tool developed by a research team at the University of Iowa Nursing College that describes and defines the knowledge base for nursing curricula and practice. There are at present554nursing interventions and more than12000nursing activities, the full range of activities that nurses perform on behalf of patients are included, both independent and collaborative interventions and both direct and indirect care. However, the frame of nursing intervention is composed of physiological, families, communities field and so on, there are hardly any nursing interventions related to hemiplegic patients’ functions. So nurses should assess patients’ functions and then select appropriate interventions and activities from NIC, which not only leads to increase nursing workload, but also lead the interventions to be quite different since nurses’ abilities are different. Therefore, in order to preferably play the guidance role of the nursing interventions, the study aims to preliminarily identify the nursing interventions and activities based on functions for hemiplegic inpatients from Nursing Interventions Classification to formulate function-based hemiplegic inpatients’ nursing program. Then, apply the function-based nursing program to hemiplegic inpatients, and observe its effects on motor functions, balance functions, activities of daily living and quality of life in hemiplegic inpatients.Objective:To identify the nursing program from Nursing Interventions Classification related to neuromusculoskeletal and movement related functions for hemiplegic inpatients and guide clinical nurses provide inpatients personalized care, and then explore the influence of nursing program among hemiplegic inpatients.Materials and Methods:1. Three members of the research team initially identified stroke-related functions, meanwhile,18stoke patient in different functional states were continuously cared and recorded by a researcher. The first period of nursing program was identified according to patients’ functions and NIC, the second period of nursing program was improved by pre-consultation for8experts. Then, clinical survey was adopted and30experts from a general hospital of Jiangsu province were surveyed by the questionnaire which was the same with second period of nursing program to determine the third period of nursing program. 2. Delphi method was adopted and41experts from multicenter were consulted by a the questionnaire which contained the third period of nursing program developed by the sixth edition of the NIC and expert advice so as to establish the final nursing program, the reliability and validity of the nursing program were verified then.3. Before-after trial was adopted, and function-based nursing program was applied to patients with acute and convalescents hemiplegia. There were100acute hemiplegic inpatients randomized into observation group with50cases, and60convalescents hemiplegic patients randomized into observation group with30cases in each according to the order of admission time points. Patients in control group were given routine care,while the observation group were given individual and comprehensive nursing program based on their functions. The scores of motor function, balance function, activities of daily life and quality of life were employed to assess the effects before and after the intervention.Results:1. A total of20nursing intervention and307nursing activities were eventually chosen by Delphi method. The Cronbach’a coefficient of the nursing program was0.93, each intervention has better content validity, four common factors were derived by factor analysis and the explained variance for factor analysis was82.95%. So, the reliability and validity of the nursing program were good.2. There was no significant difference in the scores of balance function and activities of daily life between groups with acute hemiplegia before treatment (P>0.05). Compared to control group, the observation group has significant difference in the scores of the balance function and activities of daily life (P<0.05) after application of function-based nursing program. 3. There was no significant difference in the scores of motor function, activities of daily life and quality of life between groups with convalescents hemiplegic before treatment (P>0.05). Compared to control group, the observation group has significant difference in the scores of the motor function of upper and lower extremities (P<0.05),but not in hand function(P>0.05), the scores of activities of daily life and quality of life were significantly higher than those in control group (P<0.05) after treatment.Conclusions:The established function-based nursing program has turned to be systematic, standard and convenient to communicate. The final nursing program were valid and reliable and could be a tool to guide the practice in clinical application, which could also significantly improve patients motor function, balance function, activities of daily living and quality of life. |
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