| Objective1. To build a doctor-nurse-integration clinical nursing model of stroke. To promote the formation of "exchange-cooperation-complementation" relationship among doctors and nurses, to promote mutual recognition of each other's work and role identify between doctor and nurse, and improve both the doctors and nurses'job satisfaction.2. To discuss the feasibility and validity among the doctors, nurses and patients together develop and implement the project which include treatment, nurse, recovery. To optimize the linkage of the doctors and nurse and patients. To improve the quality of good care service. To optimization of doctors, nurses and patients three party linkage. To improve the recognition and satisfaction of patients.3. Using the whole medical process common quality management and risk prevention measures together. To discuss the effect of doctor-nurse-integration clinical nursing model of stroke on quality of care and defects in nursing work. To valuate the value and significance of the model in high quality nursing service.4. To discuss the effect of doctor-nurse-integration clinical nursing model of stroke on patients' activity of daily living, nerve function, motor function of limbs, anxious, depressive negative emotion, self efficacy,living quality, patients' behavior of following doctor's instruction, active participation and self-nursing ability, length of stay and Cost of Hospital Stay.Methods1. Adopting experimental methods of historical for this research, total of 89 stroke patients who meeting the inclusion criteria were selected from hospital from January 2015 to June 2015 and staff(15 doctors and 17 nurses). The subjects received clinical treat and nurse by the traditional medical and nursing service mode(control group). And total of 90 stroke patients who meeting the inclusion criteria were selected from hospital from July 2015 to December 2015 and staff(14 doctors and 17 nurses). The subjects received treat and nurse by clinical nursing service mode of integrated health care nurse (experimental group). Then compare the two groups'data.2. Interventions:patients of the two groups were treated according to the conventional stroke treatment and care. The control group were adopted the traditional working mode, divided the health care treatment, care, rehabilitation after the collective morning shift. The doctor grouping of medical rounds on the patients. The nurse carries on the bed shift. Except the conventional treatment, the nurse gave patients diet, exercise, psychological care and health education according to nursing routine for cerebral apoplexy. The experimental group adopted the doctor-nurse-integration clinical nursing model of stroke. Established a doctor-nurse-integration clinical nursing model of stroke diagnostic care group, from admission to discharge hospital for patients to provide treatment, care, rehabilitation of the whole process of continuous medical services by multidisciplinary team form of health care integration.3. Information collection:information were collected by specially trained group members, collected the patients'general information and efficacy index (BI, CSS, Fugl-Meyer, FMA, anxious, depressed) at first. Evaluated the health economic indicators and patient satisfaction indicators when patients discharge hospital. Intervention 1 months, second evaluation efficacy indicators and patients'self efficacy, quality of life. Evaluation of patient compliance, secondary complications, self efficacy, quality of life, and third evaluation criteria of efficacy at 3 months. Staff collected the general information, the quality of nursing, the doctors'satisfaction level on nursing job and the nurses'job satisfaction before and after the implementation of the integrated model of health care.4. Statistical analysis:all data have been made statistical analysis with SPSS 17.0.Results1. Baseline data:there were no significant differences statistically of two groups of patients in the aspect of age, gender, occupation, marital status, degree of education, associated diseases, smoking and alcohol drinking, type of stroke, locus of stroke, stroke staging, etc (P>0.05). Before Interventions, there were no significant differences statistically of two groups of patients in the aspect of BI, scoring of nervous dysfunction severity, FMA, SAS, MMADD, etc (P>0.05). There were no significant differences statistically of two groups of nurse and doctors in the aspect of gender, age, degree of education, professional title, working life, etc(P>0.05), baseline data were consistent and comparable.2. Comparison of BI and FMA:each group compared the BI and FMA when the patients entered hospital and after the intervention for a month and three month. The repeated measurement of data variance analysis shows that the experimental group's improvement were better than that of control group, the differences of BI and FMA were statistically significant (P<0.05).3. Comparison of CSS,SAS,BDL and HRSD:each group compared the CSS score,SAS score,BDL score and HRSD score when the patients entered hospital and after the intervention for a month and three month. Statistical the control group's and the experimental group's CSS score, SAS score,BDL score and HRSD score, the analysis of variance of repeated measurement data showed that the CSS score, SAS score,BDL score and HRSD score of the experimental group was lower than that of the control group. The differences of CSS,SAS,BDL and HRSD were statistically significant (P<0.05).4. Comparison of self efficacy and living quality:each group compared the self efficacy and living quality when the patients after the intervention for a month and three month, analysis of non parametric test results showed that the self efficacy scores and living quality scores of the experimental group was better than that of the control group, the differences of self efficacy were statistically significant (P<0.05).5. Comparison of patient medical compliance behavior and secondary complications: each group compared the patient's scores of medical compliance behavior and secondary complications after the intervention for three months. The research on data's two independent samples t-test and chi square test results show that the patient medical compliance behavior of the experimental group was better than that of the control group,The differences were statistically significant (P<0.05). The secondary complications of the experimental group was better than that of the control group. The differences of shoulder subluxation, hand-shoulder syndrome, occurrence of foot drop were statistically significant (P<0.05).6. Comparison of hospital day,hospitalization and patient satisfaction:each group compared hospital day,hospitalization and patient satisfaction when patients left hospital, the non parametric test and two independent samples t-test were used in comparing and analyzing the two groups'data, the result showed that hospital day.hospitalization and patient satisfaction of the experimental group was better than that of the control group. The differences were statistically significant (P<0.05).7. Comparison of medical staffs cooperation, quality of care and satisfaction of doctor and nurses:compared the doctors and nurses'attitudes and feelings of medical staff's cooperation, the quality of care and the doctors'satisfaction level on nursing job and nurse's job satisfaction scores before and after the intervention of the doctor-nurse-integration clinical nursing model of stroke. The two independent samples t-test and chi square test were used in comparing and analyzing the two groups'data, the result showed that medical staffs cooperation, the basic nursing quality, master of the professional, qualified rate of nursing plan, effectiveness of rehabilitation guidance and satisfaction of doctor and nurses of the experimental group were brtter than that of the control group. The differences were statistically significant (P<0.05).Conclusion1. The clinical application of doctor-nurse-integration clinical nursing model of stroke on the stroke patients can improve the degree of neurological deficits and improve the ability of daily life and the function of body movement and relieve the patients'anxiety and depression. It can also reduce the incidence of secondary complications and improve patient self efficacy, medical compliance behavior and quality of life. The model can shorten the average length of patients'hospital day, reduce average hospitalization expenses and improve patient satisfaction.2. The doctor-nurse-integration clinical nursing model of stroke can improve the nurses'professional knowledge and professional quality, reduce the occurrence of nursing defects and errors, ensure nursing safety better, improv the nursing quality. It meets the requirements and objectives of high quality nursing service effectively.3. The doctor-nurse-integration clinical nursing model of stroke have won the recognition and cooperation of the clinicians and nurses. Medical cooperation attitude and cooperation feelings, doctors'satisfaction level on nursing job and nurses' job satisfaction were improved significantly than the model before the implementation. |
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