| Rheumatoid arthritis is a chronic,autoimmune,progressive,and erosive disease.The number of patients in China is large and complex.Many patients can not recover,need long-term medication to control the progress of the disease,adverse drug reactions,economic pressure and psychological pressure,resulting in poor patient compliance,repeated fluctuations in the disease,prone to joint deformity and loss of function in the late stage of the disease,seriously affecting the quality of life.And with the deepening of China's medical reform,the average hospitalization day is shortened,patients are usually discharged immediately after the end of the acute phase of treatment,there are still many professional treatment and care needs.Therefore,how to help them master effective post-discharge self-management skills to improve symptoms and prognosis,delay disease progression,and improve quality of life is an important issue that needs attention.Transitional care can help patients to receive coordinated,continuous health services when they move between different levels of health care institutions.The Omaha system is one of the theoretical foundations that are widely used in transitional care.However,the Chinese and English literature reports on the transitional nursing of patients with rheumatoid arthritis have not been retrieved.The applicability and application of the Omaha system remain to be tested.Therefore,this study attempts to construct and apply a transitional care programme for rheumatoid arthritis patients based on the Omaha system,providing an evidence-based support for the in-depth development of transitional nursing practice in China.Objective:1.To investigate the quality of life and related factors of rheumatoid arthritis patients,especially the intervening factors,were found as one of the clinical basises for constructing the transitional care model for patients with rheumatoid arthritis.2.The theoretical basis is combined with the clinical basis,and qualitative research is combined with quantitative research to construct and apply the transitional nursing programme of rheumatoid arthritis patients with the Omaha system as the framework.Method:1.Cross-sectional survey and analysis of its influencing factorsUsing the convenient sampling method,patients with rheumatoid arthritis who were treated in the outpatient departments of two large-scaled hospitals from March to June 2017 were selected as subjects.Questionnaires were surveyed using the General Information Questionnaire,the World Health Organization Quality of Life-BREF,the Hospital Anxiety and Depression Scale,the Perceived Social Support Scale,the Herth Hope Index,and the Disease Activity Score-28.Univariate analysis,correlation analysis,mediation effect analysis,multiple linear regression analysis and other methods were used to analyze the influencing factors of quality of life.2.Construct a transitional care programme based on the Omaha systemAccording to the holistic nursing theory,Maslow needs theory,Omaha system and other theoretical basises,as well as the clinical basis of the first part of the survey,literature review and semi-structured interviews,the transitional care programme for rheumatoid arthritis patients based on the Omaha system was initially constructed.Then,after pilot study and expert group discussion,the transitional nursing programme of rheumatoid arthritis patients with Omaha system was finally formed.3.Application of transitional care programme to conduct clinical randomized controlled trialsFrom February to August 2018,inpatients from the immunization department of a large-scaled hospital were invited to participate in this single-blind two parallel group randomized controlled trial in the single center.The sample size was calculated by 44 people in each group,a total of 88 people.The control group received routine care and routine telephone follow-up in the hospital.The study group received routine care and Omaha transitional care.Baseline data were collected within 72 hours of hospital admission,and data were collected using the Arthritis Self-Efficacy Scale-8 and the Health Assessment Questionnaire-Disability Index 24 hours before discharge,2 weeks after discharge,and 4 weeks after discharge.The chi-square test,t-test,repeated measurement analysis of variance and other statistical methods were used to evaluate the intervention effects of the transitional care programme.Result:1.Current status and influencing factors of quality of life in patients with rheumatoid arthritisA total of 242 questionnaires were distributed and 221 valid questionnaires.The effective recovery rate was 91.32%.The total quality of life of patients with rheumatoid arthritis was 64.66±10.48,the physiological dimension(t=-17.094,P<0.05)and the psychological dimension(t=-4.283,P<0.05)were lower than the norm,and the environmental dimension(t= 5.679,P<0.05)is higher than the norm.The mediation effect analysis showed that the mediation effect between the level of hope and the quality of life is 0.08,and the mediating effect accounted for 10.91% of the total effect.Multiple linear regression analysis showed that anxiety,depression,pain,and erythrocyte sedimentation had a negative impact on patients' quality of life;while family monthly income,social support,and positive action had positive effects on quality of life.The selected independent variables explained the 62.4% variation in quality of life(P<0.05).2.Transitional care programme for patients with rheumatoid arthritis based on the Omaha systemTransitional care programme for rheumatoid arthritis patients based on the Omaha system include: transitional care assessment-intervention-evaluation record form for patients with rheumatoid arthritis,KBS scoring method for patients with rheumatoid arthritis,transitional care implementation method for patients with rheumatoid arthritis and rheumatoid arthritis health education handbook.3.Omaha transitional care programme application effectIn this part of the study,a total of 129 patients with rheumatoid arthritis were identified,35 of whom did not meet the inclusion criteria.Three patients refused to participate in the study and three patients were discharged before randomization.Therefore,a total of 88 patients with rheumatoid arthritis agreed to participate.The study was randomly assigned to 44 people in each group.In the end,81 patients(41 in the study group and 40 in the control group)completed the study.Patients in the study group received Omaha transitional care interventions,with 377 and 405 nursing problems during and after hospitalization,respectively.There were 12 common nursing problems during hospitalization.The top 5 were pain,neuro-muscle-skeletal function,circulation,physical activity,and self-care.There were 13 common nursing problems after discharge.The top 5 were pain,neuro-muscle-skeletal function,physical activity,self-care,and circulation.The 12 common nursing problems before discharge in the study group and 13 common nursing problems after discharge were significantly improved,and the KBS scores were statistically significant(P<0.05).Baseline data of the two groups were not statistically significant at the time of initial admission(P>0.05).After intervention,the between-group effect,within-group effect and interaction effect of self-efficacy scores of the two groups at different time points were statistically significant(P<0.05).The self-efficacy of the two groups of patients showed an upward trend.The patient's self-efficacy was higher in the study group than in the control group.Over time,the self-efficacy of the study group increased more than the control group.The between-group effect and within-group effect of health assessment questionnaire scores of the two groups at different time points were statistically significant(P<0.05).There were interaction effects in all dimensions except the activity dimension.The health status and physical function of the two groups of patients increased,and the health status of the study group was higher than those of the control group.In addition to the activity dimension,other dimensions changed with time,and the health status and physical function of the study group increased more than the control group.Conclusion:1.The overall quality of life of patients with rheumatoid arthritis is low.Medical staff should take effective measures according to their influencing factors such as family monthly income,anxiety,depression,pain,social support,and taking positive actions to specifically intervene patients and improve their quality of life.2.This study constructed and applied a transitional care programme for patients with rheumatoid arthritis based on the Omaha system.Compared with conventional care,patients improved self-efficacy of self-management diseases and improved health and physical function.The research on transitional care programme in China has just started.This transitional care programme has important practical significance for encouraging patients with rheumatoid arthritis to strengthen self-management diseases and use community medical resources to reduce dependence on hospitals.The randomized controlled trial in this study was conducted in only one of the large-scaled hospitals.The results of the study were limited,so the results should be interpreted cautiously.In the future research,the transitional care programme can be tried to be applied to other medical service institutions or other groups of people. |
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