Application Of The Nurse-led Comprehensive Geriatric Assessment In The Elderly Patients With COPD

Objective:1.To analyze the status and problems of comprehensive geriatric assessment nursing research in China to provide a reference for future researches in this field.2.To develope a comprehensive assessment questionnaire for elderly patients with chronic obstructive pulmonary disease and test reliability and validity of the questionnaire.3.To evaluate the effect of Comprehensive Geriatric Assessment nursing model in elderly patients with chronic obstructive pulmonary disease.Methods:1.Using the major database,including China CNKI,Wanfang,VIP,Web of science,Cochrane,PubMed,Wliey Online Library and CINAHL,the thesis analyzes the literatures on comprehensive assessment of China geriatric nursing research,which were published before December 31,2017.2.From February to June 2018,15 provincial experts were selected by Delphi method to prepare the comprehensive assessment questionnaire for elderly patients with chronic obstructive pulmonary disease?COPD?.It was convenient to investigate the elderly patients with COPD in respiratory department or geriatrics department of three level A hospitals.The items were analyzed and screened by correlation coefficient method?Critical ratio method?coefficient of variation method and cronbach's?method,and the reliability and validity were tested.3.From July 2018 to March 2019,106 elderly patients with COPD who met the criteria in a tertiary hospital were selected and divided into two groups:intervention group?53 cases?and control group?53 cases?.CGA nursing model was used in the intervention group and routine nursing measures were used in the control group.Pulmonary function test?Modified Medical Research Council dyspnea scores?mMRC??Comprehensive assessment questionnaire for elderly patients with COPD?Medical Coping Modes Questionnaire?MCMQ??patient experience and satisfaction questionnaire were measured before and after intervention,1 month after intervention and 3 months after intervention.Finally,evaluate the effect of implementation.Results:1.It is found that 117 articles in total were included,among which the first one was published in 2007,and the rate has grew significantly since 2016.The first authors mainly concentrated in the eastern region of our country,with less funds support.Most literatures focus on the applied research on comprehensive geriatric assessment of nursing model,which account for 70.94%;experimental studies is the main research type,accounting for51.28%.Among the 82 experimental studies,the top 5 outcome indicators are quality of life,patient satisfaction,the incidence of adverse events,health economic indexes and patient function.2.Finally,the 15 experts who completed two rounds of correspondence,the average authority coefficient of experts was 0.84,the coefficient of variation of index of two rounds was 0.05 and 0.27,the coefficient of coordination of Kendall was 0.374 and 0.407,respectively?all P<0.01?.According to the results of consultation,the entry"teeth"and"continuing nursing care"was added.The principle of item analysis and screening was to delete two or more items that met the exclusion criteria,to delete items such as"eyesight""incontinentia urinae""medication""social support""continuing nursing care""living environment";According to the results of three exploratory factor analyses,the items"times of hospitalization""cognitive impairment""economic status"were deleted in reliability and validity tests.The final questionnaire consists of 4 dimensions and 16 items,cumulative variance contribution rate was 64.033%.The cronbach's?coefficient of the total questionnaire was 0.875,the content validity index of the item and the questionnaire level were 0.859 and 0.844 respectively,and the reliability and validity were good.3.Before intervention,there was no significant difference in pulmonary function,comprehensive assessment questionnaire and medical Coping Modes Questionnaire between the two groups?P>0.05?.After intervention,there was a significant difference in the scores of comprehensive evaluation questionnaire between the two groups?P<0.05?,and there was a significant difference in patient satisfaction and medical coping style?P<0.05?.The pulmonary function of the intervention group was better than that of the control group,but there was no significant difference between the two groups?P>0.05?.1month after intervention,there was a significant difference in the scores of comprehensive evaluation questionnaire between the two groups?P<0.05?,mMRC)?P<0.05?,but there was no significant difference in FEV₁%pred?FEV_l/FVC?P>0.05?.3 months after intervention,there was a significant difference in the scores of comprehensive evaluation questionnaire between the two groups?P<0.05?,and there was a significant difference in FEV₁%pred?FEV_l/FVC?mMRC scores between the two groups?P<0.05?.Conclusion:1.There are few literatures about the comprehensive nursing evaluation of the elderly in China,and their quality is low in general.So we should strengthen the key research of the evaluation tools,and explore a multi-dimensional comprehensive geriatric assessment of nursing model.2.The reliability and validity of the comprehensive assessment questionnaire for elderly patients with chronic obstructive pulmonary disease is feasible.3.The comprehensive evaluation nursing model for the elderly can improve the coping style of elderly patients with chronic obstructive pulmonary disease,improve the satisfaction of patients,and optimize their comprehensive health status and pulmonary function to a certain extent,but the effect is slow.