Construction Research On The Evaluation Indicator System For Nursing Classification Of Patients With Stroke At Home

ObjectivesTo develop a nursing classification evaluation indicator system for patients with stroke at home,then to evaluate the nursing classification indicator system,and finally to explore the method of dividing the nursing care level of patients with stroke at home.MethodsThis study was performed in three stages.The first stage: To develop the nursing classification evaluation indicator system for patients with stroke at home.Firstly,using literature research to analyze the existing long-term care tools and stroke assessment tools and form a pool of the nursing classification evaluation indicator system for patients with stroke at home;Secondly,Ten stroke patients,six caregivers,and seven community medical staff were conducted qualitative interviews to supplement the pool of the nursing classification evaluation indicator system;Six experts were asked to discuss the indicator pool to form the first draft;Finally,Finally,19 experts in related fields were asked to complete three rounds of Delphi expert consultation,screening core indicators,and using AHP to determine indicator weights.The second stage: To evaluate the nursing classification evaluation indicator system for patients with stroke at home.The pre-assement of 10 patients with stroke was carried out.Convenient sampling was used to evaluate the nursing classification of 210 patients with stroke at home in community in Zhengzhou,and the reliability and validity were tested by IBM SPSS Statistics 21.0.Six experts were selected to test the content validity.The third stage: To explore the method of dividing the nursing care level of patients with stroke at home.The scores of the first-level indicators of 210 patients with stroke in the second stage were listed as data table.The Matlab2014 a and weighted rank sum ratio method was used to construct the linear regression equation with probability unit Probit as the independent variable X and WRSR as the dependent variable Y.According to the probability unit corresponding to the cumulative area of the regression equation,the classification table is determined,and the scores of the first-level indicators of the patients with stroke at home are combined to explore the classification of the nursing care level of the patients with stroke at home.ResultsThe first stage: the literature research found five first-level indicators including physiological function,daily living ability,mental and psychological function,family environment,community resources,19 second-level indicators,60 third-level indicators;qualitative interview found four themes of physiological function,psychological states,self-care ability,social support and 15 sub-themes,37 three-level codes are obtained;The first draft of the nursing classification indicator system for patients with stroke at home includes four first-level indicators,19 second-level indicators,47 third-level indicators are formed through discussion by the expert group meeting.The nursing classification evaluation indicator system for patients with stroke at home formed by three rounds Delphi expert consultation includes a total of 4 first-level indicators,30 second-level indicators,and 120 scoring standards.The weight distribution of the first-level indicators is: severity of illness(0.475),daily Living ability(0.313),mental state(0.128),social support and environmental resource utilization(0.084).The second stage: the standard deviation of the evaluation scores of the second-level indicators is greater than 0.65.The correlation between the scores of the indicators and the total scores is 0.439~0.852(P? 0.01).the value of scale-level content validity index(S-CVI)was 0.733,S-CVI was 0.927,item CVI ranged from 0.83 to 1.00.and the exploratory factor analysis has four common factors,the cumulative variance contribution rate is 64.99%,and the Cronbach's ? coefficient of the overall level of the indicator 0.928.The Cronbach's ? coefficient of each dimension is above 0.700.The Guttman Spilt's half-factor coefficient of the overall level of the questionnaire was 0.794,and the Guttman Spilt of each dimension level was above 0.700.The four common factors were renamed as social support and psychological status(0.141),professional medical care related symptoms(0.234),self-care ability related functions(0.445),neurological function injury related symptoms(0.180).The third stage: The regression equation constructed by the weighted rank sum ratio method is Y=0.8071-0.0608*probit,66 people in grade one care,31 in secondary care,32 in tertiary care,and 88 in grade four,which forms a simple judgment card for the nursing care level of patients with stroke at home.According to the score of nursing level combined with the score characteristics of patients with stroke in the home,the scores of the four first-level indicators of the patients with stroke in the home are as follows: professional medical care related symptoms: level 0 is 0 points;level1 is 1~2 points;levels 2 is 3 points;level 3 is 3 point above;self-care ability related functions: level 0 is 0 points;level 1 is1~4 points;level 2 is 5~7 points;level 3 is 8 points and above;Neurological function injury related symptoms: level 0 is 0 points;level 1 is 1 point;level 2 is 2 points;level 3 is 3 points and above;social support and psychological status: level 0 is 0~3 points;level 1 is 4~6;level 2 is 7~10 points;level 3 is 11 points and above.ConclusionsThe weight distribution of the nursing classification evaluation indicator system for the patients with stroke at home formed by the research is reasonable,and the scoring method is feasible;The assessment questionnaire has good reliability and validity;The simple decision card for the nursing classification of patients with stroke at home is simple,practical and operability.