| Objective To explore the application and effect of nurse-led case management in stroke patients with dysphagia.Methods This was a quasi-experimental design.72 stroke patients with dysphagia from the rehabilitation department of a third-grade hospital in Wuhan city between Oct.2017 and Oct.2018 were selected by judgment sampling method.36 patients between Oct.2017 and Apr.2018 were included in the control group and 36 patients between May 2018 and Oct.2018 were included in the case management group.Routine medical,nursing,and rehabilitation procedures were performed for both groups of patients.On this basis,patients in the experimental group were given nurse-led case management,which was conducted in accordance with the 5 procedures of assessment,planning,implementation,coordination,supervision,and evaluation.Evaluation criteria included clinical effects(swallowing function assessment and tube feeding rate),quality of care(incidence of complications,oral hygiene status,swallowing-related quality of life),clinical cost(hospitalization cost),and satisfaction(patient satisfaction to nursing care,self-care ability).Data were recorded using EPidata3.0 software and statistically analyzed using SPSS22.0.A P<0.05 was considered statistically significant.Results1.Comparison of indicators for clinical effect evaluation(1)Comparison of swallowing function revealed significant differences in standardized swallowing assessment(SSA)total score,swallowing organ score,5ml water swallow score and 60 ml water swallow score(P<0.05)between the two groups.(2)The tube feeding rate decreased from 58.33% pre-intervention to 16.67% postintervention in the test group(P<0.05),and from 50% pre-intervention to 38.89% postintervention in the control group(P>0.05),with the difference was statistically significant between the two groups(P<0.05).2.Comparison of indicators for nursing quality evaluation(1)Comparison of the incidence of complications showed that the incidences of stroke-related pneumonia,malnutrition,mis-inhalation and dehydration in the experimental group were lower than that of the control group,with statistically significant differences(P<0.05).(2)Comparison of oral hygiene status between the two groups of patients:(1)Comparison of oral hygiene score: There was no difference between the two groups in preintervention oral hygiene score(F=0.877,P=0.355);post-intervention oral hygiene score showed interaction effect between time and group;specifically,in the test group,there was statistically significant difference between oral hygiene scores at 1d after admission(21.37±4.11)and at 1d before discharge(17.47±1.18)(P<0.05);in the control group,there was statistically significant difference between oral hygiene scores at 1d after admission(22.07±1.71)and at 1d before discharge(23.35±1.38)(P<0.05);at 1d before discharge,there was statistically significant difference in oral hygiene score between the test group(17.47±1.18)and control group(23.35±1.38)(P<0.05).(2)The results of oral flora culture showed that there was a statistically significant difference in oral infection rate 1 and 6 days after admission and 1 day before discharge(P<0.05).Infected bacteria mainly included Pseudomonas aeruginosa,Acinetobacter baumannii,Staphylococcus aureus and Candida albicans.(3)Comparison of swallowing-related quality of life between the two groups revealed statistically significant differences in scores of swallowing burden,swallowing symptoms,the willingness to eat,food choice,fear of eating,language communication,mental health and sleep between the two groups(P<0.05).No statistically significant differences in the scores of eating time,social function and fatigue were observed between the two groups(P>0.05).(4)Comparison of self-care ability between the two groups indicated that the overall score of self-care ability and score of each item in the experimental group were statistically higher than those in the control group(P<0.05).3.Comparison of indicators for clinical cost evaluationNo significant differences in the cost of total hospitalization were observed,examination,medical treatment and between the two groups(P>0.05);Cost of examination and medication in the experimental group was significantly decreased compared with that of the control group with statistically significant difference(P<0.05);cost of rehabilitation in the experimental group was significantly increased compared with that of the control group,and the difference was statistically significant(P<0.05);and cost of speech training(ST)accounted for 31.5% of the total rehabilitation cost in the experimental group and 23.6% in the control group.4.Comparison of indicators for patient satisfaction evaluation(1)Comparison of patient satisfaction to nursing care between the two groups showed that the total score of nursing care satisfaction in the experimental group was significantly higher than that in the control group,and the difference was statistically significant(P<0.05);differences in the scores of nursing service and health education between the two groups were statistically significant(P<0.05).Conclusions1.Nurse-led case management of stroke patients with dysphagia improves the swallowing function of patients.2.Nurse-led case management of stroke patients with dysphagia reduces the incidence of complications and improves the oral hygiene as well as the quality of life of patients.3.Nurse-led case management of stroke patients with dysphagia reasonably allocates the hospitalization expenses of the patients.4.Nurse-led case management of stroke patients with dysphagia improves satisfaction to nursing care and self-care ability of the patients. |
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