The Establishment And Evaluation Of Transitional Care For COPD And Respiratory Failure Patients Receiving Noninvasive Ventilator Therapy

ObjectiveTo construct a transitional care scheme for COPD patients with respiratory failure treated with noninvasive ventilator.To evaluate the application effect of transitional care intervention in COPD patients with respiratory failure treated with non-invasive ventilator,and to provide basis for clinical nurses to implement scientific transitional care intervention.MethodsThis study was divided into two parts.The first part:On the basis of theoretical basis,literature review and semi-structured interviews,the first draft of the transitional care program for COPD patients with respiratory failure and non-invasive ventilator was drawn up.Sixteen experts were interviewed by Delphi method for two rounds,and the transitional care program for COPD patients with respiratory failure and non-invasive ventilator was constructed.The second part:Experimentation study was carried out to explore the effect of transitional care program in COPD patients with respiratory failure using non-invasive ventilator.From December 2017 to June 2018,72 discharged COPD patients with respiratory failure treated by non-invasive ventilator were divided into two groups by random number table.The control group was given routine nursing program,while the observation group was given continuous nursing program on the basis of the control group.The scores of self-management ability,chronic obstructive pulmonary disease and quality of life were compared before and after intervention.Blood gas analysis and pulmonary function were compared between the two groups.Results?1?16 questionnaires were sent out in both rounds of expert inquiries,and the effective recovery rate was 100%.In the first round of inquiry,several experts put forward suggestions for revision,involving the revision of"ventilator skills","sleep problem response","ventilation technology safety parameters","psychological problem guidance".In the second round,all experts were satisfied with the nursing intervention program,and the enthusiasm of experts was high.The authoritative coefficient of two rounds of inquiry is 0.819,which is higher.The coordination coefficients?W?of two rounds of expert inquiries are 0.46 and 0.40,P<0.05,which can be applied.Two rounds of inquiry data were collated to obtain five types of patients'needs for transitional care program:1.information needs 2.security needs 3.emotional needs 4.social needs 5.spiritual needs;19 secondary indicators and 57 tertiary indicators?intervention indicators?.?2?The ratio of forced expiratory volume?FEV₁?and forced vital capacity?FVC?of FEV₁ in intervention group was better than that of control group?t=4.601¹0.967,P<0.05?;the partial pressure of oxygen?PaO₂?and carbon dioxide?PaCO₂?in blood gasanalysis were better than those of control group?t=2.306².787,P<0.05?.Self-management ability of patients:Symptom management score,daily life management score,emotional management score,information management score,self-efficacy management score and total score of intervention group were higher than those of control group?t=6.805¹3.891,P<0.05?,indicating that self-management ability of intervention group was improved.After intervention,the CAT score of the control group was19.26±4.54and that of the intervention group was 14.73±4.15.The CAT score of the intervention group was significantly lower than that of the control group?t=7.069,P<0.05?.The SGRQ score of the intervention group was lower than that of the control group?t=4.868⁶.779,P<0.05?.The difference was significant,indicating that the life of the patients in the intervention group was lower than that of the control group?Z=-4.211^-2.268,P<0.05?.The quality has been significantly improved.Conclusion?1?Delphi method can be used to construct transitional care intervention program for COPD patients with respiratory failure and non-invasive ventilator.The positive coefficient,authoritative degree coefficient and coordination coefficient of experts are high and feasible.?2?The transitional care program is applied to COPD patients with respiratory failure and non-invasive ventilator,which improves patients'self-management ability,helps patients improve pulmonary physiological function,helps patients improve their quality of life,and provides a basis for clinical nurses to implement scientific transitional care intervention.The method of construction and implementation of this kind of nursing intervention has ideal effect,and has the value of popularization and application.