Development Of Post-stroke Nursing Quality Evaluation Indicator System Of Shanghai Geriatric Care Institutions

Objective: This research is designed to develop the Post-Stroke Nursing Care Quality Evaluation Indicator System of Shanghai Geriatric Care Institutions based on the current post-stroke care status of Shanghai Geriatric Institutions,and to validate its clinical effectiveness and feasibility,so as to improve the post-stroke care quality of Shanghai Geriatric Institutions,and promote stroke patients' clinical outcomes,and realize the maximum benefits.Methods: The researcher developed the post-stroke nursing care quality evaluation indicator system draft based on the theory of “clinical pathway”,and through inventory survey of Shanghai Geriatric Institutions including nursing homes,community health centers and comprehensive hospital that have geriatric care beds,and evidence based nursing.Then a Delphi Method was adopt to consulting the evaluation indicator system until the expert panel reached unanimity.The next step is applicating the evaluation indicator system in nursing home which is in the supervision category of Shanghai Geriatric Care Manegement quality Control Center to validate its clinical effectiveness and feasibility.Results: 1.Inventory survey showed that the stroke patients in Shanghai Geriatric Institutions trend to be advanced age with the patients over 80 y took a proportion of 55.39% in 2015.There were more women than men,for women took a proportion of 55.40%.The length of stay were between 10 to 637 days.And the nursing care of ADL assessment,nervous system function assessment of stroke patients varies in all kinds of geriatric care institutions.2.From the evidence based nursing process,we retrieved 20 papers including 10 systematic reviews,6 evidence summaries and 4 guidelines,and extracted 52 pieces of evidence related to stroke nursing.At the same time,the research team refered to “ stroke specialized care”,then developed the Post-Stroke Nursing Care Quality Evaluation Indicator System of Shanghai Geriatric Care Institutions draft.3.Through 2 round expert panels,we finally developed the Post-Stroke Nursing Care Quality Evaluation Indicator System of Shanghai Geriatric Care Institutions which included 29 indicators that through acute stage to the rehabilitation stage of stroke.Also,there were some operation procedures and assessment tools.4.The empirical study indicated that the Post-Stroke Nursing Care Quality Evaluation Indicator System of Shanghai Geriatric Care Institutions was proved to be applicable,and can guide clinical nursing care and management.What's more,the experimental nursing home showed an increase in Barthel Index and limb function and an improvement in post-stroke care quality.Patients' average length of stay were decreased from 98.69±15.72 days to 90.73±12.25 days,and the difference had statistical significance(p<0.05).The medical cost for the two groups had no statistical significance(p>0.05).While,the average nursing care cost for per person per day were decreased from 27.18±4.54 yuan to25.16±3.68 yuan after applicating post-stroke care quality control,which also has statistical significance(p<0.05).Conclusion: 1.This research developed the Post-Stroke Nursing Care Quality Evaluation System of Shanghai Geriatric Care Institutions through inventory survey,case analysis,evidence based nursing and expert panel which was applicative for geriatric care institutions.This nursing quality evaluation system included 29 indicators that through acute stage to the rehabilitation stage of stroke.Also,there were some operation procedures and assessment tools.2.Clinical validation verified that the application of the Post-Stroke Nursing Care Quality Evaluation Indicator System of Shanghai Geriatric Care Institutions could improve stroke patients' s activities of Daily Living,promote stroke patients' limb function,decrease their length of stay and nursing care cost,and it could control the nursing adverse events effectively.Thus the Post-Stroke Nursing Quality Care Evaluation Indicator System of Shanghai Geriatric Care Institutions is applicable to other Geriatric Care Institutions.