| Objective:Combining the theory of TCM syndrome differentiation with modern medical management theory(evidence-based medicine theory,health economics theory,quality management theory,humanistic theory),evidence-based nursing,expert consensus,empirical research and other methods are used to construct asthma(Clinical nursing pathway(CNP)),which explores the traditional Chinese medicine characteristic nursing technology and provides a relatively standardized Chinese medicine nursing model for asthma and improves the quality of Chinese medicine care.Methods:1.Retrospective analysis stage:Through r-eviewing relevant literature in the past 10 years,the relevant contents of CNP construction of asthma Chinese medicine were extracted,including Chinese and Western nursing measures for asthma,CNP construction methods,path evaluation and evaluation methods,and path variation.Based on the Pareto rule(28 principle),the effective medical order was extracted as a reference for the construction of specific content of Chinese medicine CNP by reviewing the medical records of 100 patients with asthma in hospital from January to December in 2017.2.Expert consensus stage:Based on the review of the literature and medical records,organizing the experts in the hospital to initially discuss and formulate the text of CNP for Chinese medicine and prepare an expert letter.Finally,two rounds of Delphi expert consultations were conducted on 15 medical and nursing experts from relevant disciplines inside and outside the province fr-om Aprial to July in 2018.According to the rationality of the correspondence,the content of the path is screened,and the reliability and authority of the information expert are tested.The results of the consultation and analysis are analyzed,and the text content of the Chinese medicine CNP is revised on the basis of the result of the consultation.3.Empirical research stage:Based on the PDCA continuous improvement theory,we carry out preliminary-experiment and discuss the implementation effect of CNP in asthma initially from October to December in 2018,further optimize the implementation and development of CNP in asthma,and realize the sustainable development of CNP in asthma.Results:Through the retrieval of relevant literature for nearly 10 years and retrospective analysis of the hospitalized medical records of 100 patients with asthma in January-December 2017,the content and path structure of CNP in asthmatic patients are initially determined,and the nursing measures for Chinese and Western medicine for asthma were extracted.40 articles and 6 factors of variation,extracting 40 effective doctors and 20 effective guards.Combined with the above evidence,a consensus meeting of experts in the hospital was held to draft a preliminary draft of the textbook of Chinese medicine for asthma and an expert letter.In the end,a total of 15 experts participated in the entire inquiry,in line with the basic requirements of the expert's letter.The first round of expert consultations deleted f-our secondary indicators and 28 third-level indicators,added 16 third-level indicators,and revised one primary indicator,eight secondary indicators,and 26 third-level indicators.The second round of the letter revised five third-level indicators,and there were no deleted indicators.It was finally determined to be 5 first-level indicators,25 second-level indicators,and 216 third-level indicators.Expert opinions tend to be consistent.Among them,the expert authority coefficient(Ca)= 0.88,the degree of expert authority is higher.Among the experts' opinions,the first round of expert coefficient of variation(CV)=0.11,the second round of CV=0.09,the first round of expert coordination coefficient(w)=0.22,the first round of w=0.24,the coefficient of variation is reduced,coordination The increase of the coefficient indicates that the degree of coordination of the experts' opinions is getting higher and higher;the X2 test of the degree of consistency of the experts shows that P<0.01.indicating that the experts have a high degree of credibility.Through the research and consultation of experts,the textual content of CNP in Chinese medicine was initially determined.A total of 26 patients with asthma were enrolled in the empirical study(pr-experimental)phase,including 13 patients in the routine care group and the path-care group.There were no cases of shedding,and the general situation of the patients was not statistically different.The scores of TCM syndrome before and after intervention in the two groups were P=0.979,the effective rate was P=0.716,the CAT score was compared with P=0.169,the satisfaction of TCM nursing service was P=0.075,and the TCM nursing technique was compared with P=0.117>0.05,There was no significant difference in the results,but the mean scores of symptom scores,the mean scores of symptom scores,the mean value of CAT scores,the mean scores of satisfaction scores,and the average number of operators of TCM nursing techniques were greater than those of the conventional control group.The total income of TCM nursing technology operation between the two groups was P=0.038,and the hospitalization days were compared with P=0.034<0.05,there were significant statistical differences in the results.The average score of satisfaction scores of CNP used by medical staff in traditional Chinese medicine nursing care was 73.92±2.43.The highest scores were the three items of medical staff's willingness to operate TCM nursing techniques,the practicality of Chinese medicine CNP,and the guiding significance of Chinese medicine CNP to clinical nursing work.It is 9.69 points.In the application of CNP mode,a total of 3 patients had negative mutations,and 8 patients had positive mutations.Conclusions:In this study,a combination of clinical actual case review,literature research,expert correspondence and empirical research has successfully constructed a traditional Chinese medicine CNP with distinctive Chinese medicine characteristics.In the process of path construction,the scientific and rigorous methodology has been strengthened,making the path more implementable,providing a guiding basis for the clinical practice of asthmatic Chinese medicine nursing work,and for the development of other single diseases,especially chronic diseases.The CNP provides a methodology reference.In the empirical research stage,through the implementation of preliminary experiment to implement the traditional Chinese medicine CNP model for asthma patients,the operation volume of traditional Chinese medicine nursing technology was improved,the standardization of Chinese medicine nursing technology was improved,and the satisfaction of Chinese medicine nursing service was improved,which finally improved.The quality of Chinese medicine care for asthma. |
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