The Design And Application Of Clinical Nursing Pathway In Transurethral Resection Of The Prostate Guided By Fast Track Surgery

Objective(1)To design a clinical nursing pathway in transurethral resection of the prostate through the methods of evidence-based nursing,guided by fast track surgery.Study the clinical nursing path to shorten hospital stay,reducing medical cost,postoperative pain,early off bed time,and reducing the postoperative complications.(2)To study the satisfaction of the nurses and patients with the new fast track clinical nursing path.(3)To provide evidences for other surgical care,and promote the development of nursing by comparing with other paths.Methods(1)First of all,on the basis of systematic review and evaluation of the literature at home and abroad,through combining nursing pathway of urology and nursing status found the key points which could be improved by Pareto principle,a preliminary clinical nursing pathway for patients with transurethral resection of the prostate has been established.(2)Setting up a reasonable group of experts,used the expert's professional title,years of working experience,qualification for position,education background etc,and then revised the new clinical nursing path by expert panel discussions,according to the expert consultation which used index expert's positive coefficient,authority coefficient,coefficient of variation,and system analysis results.According to the evidence-based medicine and relevant theories,consistent suggestions were made on the criteria of admission path,discharge standard,variation,implementation plan of fast track clinical nursing path,evaluation index of clinical nursing path,etc.so as to form the final clinical nursing path of fast track,and optimal rehabilitation for the perioperative stage of patients undergoing transurethral resection of prostate.(3)According to include and exclude standard choice 92 cases who were with benign prostatic hyperplasia for treatment of transurethral resection of the prostate(TURP),randomized controlled trial was conducted to randomly divided from April to December,2018,in Inner Mongolia Baogang hospital.According to the crossover order were randomly divided into intervention group and the control group,in designated ward.The perioperative period of TURP patients in the control group was treated with conventional nursing methods,and the intervention group was treated with the fast track clinical nursing path.The general data is comparable,early off bed time,pain score,blood pressure change range,postoperative adverse events,postoperative hospital stay and hospitalization costs were observed.SPSS21.0statistical software was used for statistical analysis,with(P<0.05)as the difference,with statistical significance.The nursing staff's job satisfaction was compared with that of routine nursing.The new fast track nursing path was compared with other nursing paths.Descriptive analysis was used for the basic information of patients,and t test was used for the effect evaluation indexes.If the index data did not obey the normal distribution,non-parametric rank sum test was used.Use?~2 test for rate and composition ratio.with(P<0.05)as the difference.Results(1)An expert group was set up in Inner Mongolia BaoGang Hospital to express constructive opinions on the specific nursing content of TURP patients.After preliminary experiments,the fast track clinical nursing path of the TURP patients was formed.(2)There was no statistically significant difference in the general data between the two groups(P>0.05).(3)There were statistical differences between the two groups in hospital stay,medical cost,postoperative pain,early off bed time,and the postoperative complications(P<0.05).(4)The numerical rating scale score(NRS)of the study,the second,sixth,tweny-fourth hour after operation was statistically significant(P<0.05).Perioperative complications of intervention group was significantly lower than the control group(P<0.05).(5)There was a statistically significant difference in the satisfaction of nursers between the two groups(P<0.05).(6)A detailed analysis of the variability factors in the constructed fast-recovery clinical nursing pathway:the variability factors are mainly the recurrence of the patient's underlying disease,the patient's family and social environmental factors,which leads to the patient's failure to follow the normal fast-recovery nursing path.ConclusionsBy the clinical nursing pathway oriented by fast track surgery may be able to short the hospitalization time,decreased hospitalization costs actively,and could improve the patients'and nurses'satisfaction.so it is scientific and feasible.Practicality,the implementation of this clinical nursing pathway can not only reduce the physical and mental burden of patients during the operation,but also effectively improve the quality of care and clinical effects,and provide a favorable reference value and evidence-based basis for the rapid rehabilitation and nursing work of other surgical patients.Worth promoting.