The Study On Readiness For Hospital Discharge And Its Influencing Factors In Patients After Total Hip Arthroplasty

BackgroundTotal hip arthroplasty(THA)refers to a common joint reconstruction procedure in which the injured hip joint is replaced by an artificial joint prosthesis to relieve pain and restore the motion function of patients.Patients after THA are usually discharged during 7 ~14 days after surgery,but the patient's functional recovery takes half a year or longer.During hospitalization,if patients do not master professional knowledge and skills and the necessary self-care awareness,they will often cause poor recovery of limb function and even lead to complications,which may endanger their lives in serious cases.Readiness for Hospital Discharge(RHD)can help medical staff determine whether the patient's body and mind have been adapted to the transition from hospital to family,whether there is a certain degree of understanding of its condition and complications,and can prevent controllable factors.ObjectiveThis project is aim to understand the status of RHD of patients after THA,to explore the correlation between RHD and anxiety/depression and the hip function,and to analyze the influencing factors.In addition,understand the true feelings of THA patients about the readiness for discharge.In order to provide theoretical basis for strengthen nursing intervention within hospital and continuing nursing outside hospital,so as to reduce the incidence of post-discharge complications and the number of re-admissions,and improve their quality of life.MethodsThe combination of quantitative research and qualitative research is designed.1.Quantitative research:patients were selected from three tertiary hospitals in Henan Province during July 2017 to October 2018 who met the inclusion criteria after THA to conduct a questionnaire survey.Survey tools include self-designed general data questionnaire,RHD Scale,Hospital Anxiety and Depression Scale,and Harris Hip Score.All the data were checked by two persons and entered into Excel to establish a database,and SPSS21.0 software was used for statistical analysis.Specific statistical methods include statistical description,single sample t-test,independent sample t-test,analysis of variance,Pearson correlation analysis,and multiple stepwise linear regression analysis.2.Qualitative research: nine patients were selected from the subjects of quantitative study for semi-structural analysis.In the research,Colaizzi phenomenological method was used to analyze the data and refine the theme.Results1.The RHD score of patients after THA The RHD score of patients after THA was(94.56±10.31),and the standardized score was(7.88±0.86).Compared with the result of Weiss(8.0 +0.9),there was no significant difference(P>0.05)between them by using singlesample t-test.It indicates that THA patients had better the score of readiness for discharge is higher.Among the RHD score,the individual status dimension score was(23.83±3.31),the adaptability dimension score was(35.94±6.16),and the expected support dimension score was(34.88±4.70).After standardizing the scores of each dimension,the highest score was the expected support dimension(8.72±1.18),followed by the personal status dimension(7.94±1.10)and the adaptability dimension(7.19±1.23).2.The Anxiety and Depression score of patients after THA The patient's anxiety score was(5.24±3.02),including 128 patients with no obvious symptoms(79.5%)whose anxiety score was(4.05±1.84),24 patients with suspicious symptoms(14.9%)whose anxiety score was(8.75±0.74),9 patients with definite symptoms(5.6%)whose anxiety score was(12.78±1.99);The patient's depression score was(4.93±3.46),including 132 patients with no obvious symptoms(82.0%)whose depression score was(3.66±2.03),17 patients with suspected symptoms(10.6%)whose depression score(9.12±0.86),12 patients with definite symptoms(7.5%)whose anxiety score was(13.00±2.56).3.The correlation between RHD and anxiety and depression in patients after THA There was a negative correlation between RHD and anxiety score in patients after THA(r=-0.324,P<0.01).And there was also a negative correlation between RHD and anxiety score in patients after THA(r=-0.358,P<0.01).The RHD of patients after THA was positively correlated with hip function(r=0.484,P<0.05).4.The factors influencing the RHD of patients after THA The analysis of variance showed that different ages,education levels,type of surgery,type of disease,type of prosthesis,anxiety score,depression score,hip Harris score,whether there were complications or whether there were patients among relatives or friends had statistically significant on patients' RHD(P<0.05).The multiple linear regression analysis showed that the education level,disease type,anxiety score,and hip Harris score together explained the variance of 34.2% of RHD(P<0.05).5.Analyse the results of semi-structured interviews and identify four themes: psychological state,lack of knowledge,trust the clinic staff and receive support.Conclusions1.The readiness for hospital discharge in THA patients keep in medium level.Among three dimensions,the highest score is the expected support dimension,and the lowest is adaptability dimension.2.The RHD of patients after THA is negatively correlated with anxiety and depression scores.The RHD of patients after THA is positively correlated with hip function.3.The main influencing factors of RHD of patients after THA are education level,disease type,anxiety score and hip Harris score.In clinic work,medical staff should take more attention to the patients with low cultural level,poor mental state,slow recovery of joint function and acute fracture in clinical work.4.Medical staff should focus on improving the psychological status of patients with THA,helping them to build confidence in a good prognosis and trust in medical staff,effective measures should be used to improve the mastery of disease-related knowledge.Encouraging patients to communicate with patients and improve social support.