| Objective To introduced the Solution Focused Approach into the implementation of discharge planning.And to constructed a discharge planning for the chronic heart failure(CHF)patients based on the Solution Focused Approach combined with the characteristics of patients with heart failure To explore the effect of discharge planning based on the Solution Focused Approach on the quality of life,disease knowledge,self-efficacy,self-care behavior,and Brain Natriuretic Peptide results in patients with CHF.To explore the effect of the discharge planning based on the Solution Focused Approach(DP-b SFA)on the readmission rate,emergency-admission rate,total hospital stay,and hospitalization costs for patients with CHF during the intervention period.Method Selection of subjects: 80 inpatients with CHF who came from a Third-Grade Class-A Hospital were selected as subjects from April 2017 to December 2017.They were randomly divided into control group and experimental group on the basis of the random number table,with 40 cases in each group.Interventions: Before the formal studay,the DP-b SFA was formed through theoretical study,literature review,and focus group interviews,and then revised though pilot test.In the formal clinical study,the subjects in the control group were conducted conventional nursing and health education of cardiology.Compared with the control group,the subjects in the experimental group were implemented not only the conventional nursing but also the DP-b SFA,which involved assessing the needs of patients and their families,formulating discharge planning,setting up discharge plan files,providing complete care knowledge,monitoring the condition of illness and carrying out regular follow-up and outpatient appointments,etc.And after discharge,telephone follow-up was conducted once a week during 1 to 4 weeks,and every 2 weeks during 1 to 3weeks.Outpatient follow-up was arranged 1st-month and 3rd-month after discharge.Evaluation of nurse effect: The Minnesota Heart Failure Quality of Life Scale(MLHFQ),Atlanta Heart Failure Knowledge Test Version 2(AHFKT-V2),the General Self-efficacy Scale(GSES)and the European Heart Failure Self-care Behavior Scale(EHFSc BS)were evaluated four times,which involved pre-intervention,at discharge,1st-month and 3rd-month after discharge.Moreover,rehospitalization frequency,emergency visits,the duration of hospitalization,hospitalization expense,and the interval time between two admissions were compared when three months after discharge.Result 73 subjects accomplished the study.Among of them,37 cases were in the experimental group(2 cases were removed and 1 case was excluded),36 cases were in the control group(3 cases were excluded and 1 case was excluded).The results of the study as follows: 1.Quality of Life(1)The results of comparison between groups The emotional and total scores of the experimental group were lower than those of the control group at the time of discharge from hospital and at 1st-month and 3rd-months after discharge,while the physical and other scores of the experimental group were significantly lower than the control group at 1st-month and 3rd-month after discharge(P<0.05).There was no significant difference between the groups of the physical and other scores when discharged(P<0.05).(2)The results of repeated measures analysis of variance The with-subject effects,time effects and interactive effect of MLHFQ in the all dimensions and total scores between two groups were statistically significant(P<0.05).(3)The results of multiple comparison For experimental group,the scores of every dimension and total scale before intervention were significantly higher than those of the subsequent time points(P<0.05);the scores at the time of discharge were significantly higher than those either at 1stmonth or 3rd-month after discharge(P<0.05).For the control group,the scores before intervention were significantly higher than those of the subsequent time points(P<0.05);other field measured before intervention were significantly higher than those after intervention(P<0.05).2.Level of Disease Knowledge(1)The results of comparison between groups After intervention,the score of AHFKT-V2 of the experimental group was higher than that of the control group at every assessment time-point(P<0.05).(2)The results of repeated measures analysis of variance The with-subject effects,time effects and interactive effect of AHFKT-V2 between two groups were statistically significant(P<0.05).(3)The results of multiple comparison For the experimental group: at each paired comparison,the score assessed before intervention is significantly lower than any one of three after intervention(P<0.05);the score measured either at the time of discharge or at 1st-month after discharge is significantly higher than that at 3rd-month after discharge(P<0.05);however,there was no significant difference between other time points(P>0.05).For the control group,the score assessed before intervention is significantly lower than any of three times after intervention(P<0.05).3.Self-efficacy(1)The results of comparison between groups After intervention,the score of GSES in the experimental group was significantly higher than that in the control group at each time point(P<0.05).(2)The results of repeated measures analysis of variance The with-subject effects,time effects and interactive effect of GSES between two groups were statistically significant(P<0.05).(3)The results of multiple comparison For the experimental group,compared with the score measured before intervention,any one of three measured at the time of discharge,at 1st-month or 3rd-month after discharge was significantly higher(P<0.05);and there was no significant difference between other time points(P>0.05).For the control group,none of statistically significant difference was found when making paired comparison(P>0.05).4.Self-care Behaviors(1)The results of comparison between groups After intervention,the score of EHFSc BS in the experimental group was significantly higher than that in the control group at each time point(P<0.05).(2)The results of repeated measures analysis of variance The with-subject effects,time effects and interactive effect of EHFSc BS between two groups were statistically significant(P<0.05).(3)The results of multiple comparison For the experimental group,compared with the score measured before intervention,any one of three measured at the time of discharge,at 1st-month or 3rd-month after discharge was significantly higher(P<0.05);the scores at the time of discharge is significantly higher than both scores of 1st-month and 3rd-month after discharge(P<0.05);however,there was no significant difference between 1st-month and 3rdmonth after discharge(P>0.05).For the control group,compared with the score measured before intervention,any one of three measured at the time of discharge,at 1st-month after discharge or 3rd-month after discharge was higher,while the score at discharge is significantly higher than 3rd-month after discharge(P<0.05);however,there was no significant difference among other paired comparison(P>0.05).5.Comparison of BNP(1)The results of comparison between groups The original data was applied to analyze after logarithm transition.There was no significant difference at the time of discharge between two groups(P>0.05).However,the result of experimental group performed a lower level than the control group both 1st-month and 3rd-month after discharge(P<0.05).(2)The results of repeated measures analysis of variance Time effects and interactive effect of BNP between two groups were statistically significant(P<0.05),however,there was no significant difference between two groups in the with-subject effects(P>0.05).(3)The results of multiple comparison For the experimental group,compared with three time points after intervention,the result before intervention was significantly higher(P<0.05),the result when discharge is significantly higher than 1st-month after discharge(P<0.05);however,there was no significant difference among other paired comparison(P>0.05).For the control group,compared with three time points after intervention,the result before intervention was lower(P<0.05);However,there was no significant difference among other paired comparison(P>0.05).6.The Condition of Hospital Stay,Readmission and Cost The total hospitalization days and total hospitalization costs of the experimental group were lower than those of the control group during the intervention(P<0.05).The rate of readmission in the experimental group was significantly lower than that of the control group(P<0.05).However,there was no significant difference in the rate of emergency readmission between the two groups(P>0.05).The interval time of readmission in the experimental group was longer than that of the control group(P<0.05).Conclusion 1.The discharge planning based on the Solution Focused Approach can improve the quality of life of patients with CHF.2.The discharge planning based on the Solution Focused Approach can enhance knowledge of disease of patients with CHF.3.The discharge planning based on the Solution Focused Approach can heighten the self-efficacy of patients with CHF.4.The discharge planning based on the Solution Focused Approach can promote selfcare behaviors of patients with CHF,and raise ability of self-care.5.The discharge planning based on the Solution Focused Approach can contribute to maintain stability of BNP at a relatively lower level for the patients with CHF.6.The discharge planning based on the Solution Focused Approach can reduce readmission rates,prolong the interval time of readmission,decrease medical expenses and save medical resources for the patients with CHF. |
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