Study On The Construction Of Continuing Nursing To Patient Oriented

Objective: 1. According to the Ministry of Health Hospital Management Institute "transitional care needs questionnaire survey", combined with clinical practice in Sichuan, construction of "Sichuan Province transitional care needs questionnaire survey". 2. With this questionnaire, the author wants to figure out the needs of transitional care service content, mode, frequency of patients after discharge from hospital in Sichuan Province. 3 Patients demand should be the orientation to the construction of transitional care mode, the writer is attempt to provide patients for a full range of continuous health care services and improve the quality of life. Methods: 1.According to the " transitional care needs questionnaire survey" of the hospital management institute of the Ministry of health, the author made the self-designed questionnaire named “Sichuan Province transitional care needs questionnaire survey ”, and estimate its reliability and validity. 2.With this questionnaire, we randomly selected 400 patients which were all met the inclusion and exclusion criteria in a major hospital of Sichuan Province, cross-sectional survey conducted in patient who isabout to be discharged from hospital. 3.According to the survey results, expertise and combined with the Domestic and foreign literature on the transitional care and transitional care model, the author set up the basic framework for the transitional patient demand-oriented care model.By using the Delphi method, the author send our questionnaire to 30 nursing experts for consulation at twice, then the transitional patient demand-oriented care model was established. 4.Used Microsoft Excel database and SPSS17.0 statistical software for data processing. Results: 1. "Sichuan Province transitional care needs survey",the internal consistency coefficient of 0.846, 0.895 content validity. 2. The results of transitional care demand content was as following: The patient health education, disease related instruction and rehabilitation training requirements was higher, the health guidance was 72.46%, disease related guidance was 82.64%, rehabilitation training was 71.9%. The demand for professional nursing service ranking top 3 was to maintain the PICC line(32.51%), management(29.21%), catheter drainage management(18.18%). 3. The results of the transitional care demand mode was at list : In the six transitional care services, out-patient review and telephone follow up occupy the highest proportion, respectively 31.94% and 39.13%. Mobile phone short message, network communication, home visit and health visit also had a certain proportion. 4. The attitude towards to the care implementers of transitional care demand: The 85.4% of the patients was willing to choose nurses to provide transitional care, and the choice was provided by community nurses continuing nursing of the patients was 65.29% χ2=35.8, P<0.01. 5. The frequency and time of transitional care: 59.23% of the patients want to receive 1 month transitional care after discharge from hospital. 51.24% of the patients willing to get telephone follow-up 1 time per week, 46.01% of patients hope the frequency was once every two weeks. The best follow-up time in 8:00-10:00; 10:00-12:00 and 18:00-20:00. 6. Four parts, 16 entries in the transitional patient demand-oriented care model was set up. Four parts, including the mode of purpose, organizational structure, job responsibilities and job requirements, job content. Two rounds of expert consultation questionnaire effective recovery rate was 100%, 0.88 was the authority coefficient of experts, expert Kendall(Kendall’s W) the harmonious coefficients were 0.20 and 0.22, the Kendall coefficient of concordance test of significance of P<0. 05, the results were statistically significant. Conclusion: 1. The "Sichuan Province transitional care needs survey" has good reliability and validity. It is able to reveal the actual situation of patients who wanna to acquire transitional care after discharge from hospital, the needs of the content, method and frequency are all included in this study. 2. The majority of patients are willing to receive the information of health-related education, disease-related guidance and rehabilitation guidance training after discharging; Transitional care services for specialist needs to focus on pipeline maintenance. The follow-up methods are more inclined to outpatient services and telephone follow-up review. And also, patients desire to the transitional care could be conducted by specialist nurses. 3. Experts who construct the transitional care model all have good enthusiasm and representativeness. This model contain the building purposes, organizational structure, job responsibilities and job requirements, and this four platescan provide a scientific working methods to ensure the continuity of transitional care in discharged patients..