Study On Hand Function Rehabilitation Nursing Program For Patients With Hand Burns During Hospitalization

Objectives:1.To explore the main influencing factors of hand function rehabilitation of patients with hand bums during hospitalization.2.To build a hand function rehabilitation nursing program for the patients with hand burns during hospitalization.3.To evaluate the barriers/motivators of the implementation of the program,translating the barriers,and promoting the translation of the theoretical program into clinical practice.4.To evaluate the effects of knowledge translation.That is to evaluate the feasibility and effectiveness of the hand function rehabilitation nursing program for patients with hand burns during hospitalization through controlled clinical trial.Methods:This study is divided into three parts.The specific research methods of each part are as follows:Part ?:Study on the related influencing factors of hand function rehabilitation in patients with hand burns during hospitalization1.Literature reviewWe retrieved systematically relevant literatures at home and abroad about functional rehabilitation of burn patients and summarized the related influencing factors of hand function rehabilitation of patients with hand burns.2.Qualitative interviewThe interview outlines were listed according to the factors analyzed through the literature review,and the semi-structured interview method was used to interview doctors,nurses,rehabilitation therapists and hospitalized patients with burns of the burn department.The main influencing factors of the hand function rehabilitation of patients with hand burns during hospitalization were analyzed,in order to provide the basis for the construction of the program.Part II:The construction of hand function rehabilitation nursing program for patients with hand burns during hospitalizationThe Knowledge to Action Cycle(KTA)model was used as the theoretical framework.Based on the steps that were advocated by KTA model,and knowledge retrieval and knowledge integration were finished according to the main influencing factors of previous research,then hand function rehabilitation nursing program for patients with hand burns during hospitalization was preliminarily built.The medical experts,nursing experts and rehabilitation experts of burn research fileds were selected to consult in order to confirm the gap between preliminary theoretical program and practice,and assess barriers/motivators of this program in process of implementation.Then translating the barriers,neatening experts'suggestions,constantly revising,adjusting and improving the program,the final hand function rehabilitation nursing program for patients with hand burns during hospitalization was built.Part III:Clinical effects evaluation of hand function rehabilitation nursing program for patients with hand burns during hospitalizationThe semi-experimental study was used.60 inpatients with hand burns of a burn institute who met the inclusion and exclusion criteria were divided into the intervention group and the control group.30 burn patients of the control group were treated by routine rehabilitation nursing intervention from January to May in 2018,30 burn patients of the intervention group were treated by hand function rehabilitation nursing program for patients with hand burns during hospitalization from June to October in 2018.The clinical effects of hand function rehabilitation nursing program for patients with hand burns during hospitalization were preliminarily tested from daily life activity ability,pain degree,comprehensive health situation and rehabilitation knowledge awareness of patients with hand burns.Descriptive analysis,independent sample t-test,chi-square test,and nonparametric rank sum test were used to analyze data,inspection level a=0.05.Results:1.The influencing factors of the hand function rehabilitation of burn patients were summarized by the literature review,including?The factors are associated with diseases:the depth of burn,the total burn surface area burn severity,whether to have surgery operation or not,operation time,operation way,pain,bleeding wounds burst,etc.?The factors are associated with rehabilitation treatment:the time of rehabilitation intervention,intensity of training,manufacture and wearing of splint,rehabilitation knowledge education,whether to supervise patients to regularly train,etc.?The psycho-social factors:rehabilitation knowledge,economic status,psychological acceptance,social support,marital status,education level,etc.2.The main problems of hand function rehabilitation were analyzed by semi-structured interview.The four major parts which can carry on the rehabilitation nursing intervention were selected,which included hand function management,pain management,psychological nursing and health education.The problems of hand function management included insufficient attention to rehabilitation of medical staff,insufficient or incorrect cognition of rehabilitation of patients,lacking of whole-course rehabilitation concept.The rehabilitation therapists mainly follow doctor's advice for rehabilitation treatment,which lack of initiative in rehabilitation assessment.The department has not established the specialized rehabilitation evaluation system,and rehabilitation evaluation is mostly based on experience.The department lacks of unified rehabilitation intervention program and implementation process.In addition to,lacking of rehabilitation nurses,insufficient supervision of daily rehabilitation training.Some patients refused to carry out early rehabilitation because of worrying about wound bleeding.The problems of pain management included weak consciousness of pain management of medical staff,inadequate pain assessment,lacking of standardized drug analgesia program and non-drug analgesia program,the side effects of analgesics were not accepted by the patients.The psychological problems include anxiety,depression,inferiority,fear,etc.Lacking of professional psychological intervention.The problems of health education included the monotonous form of education,which is dominated by oral education.Lacking of a unified and systematic rehabilitation propaganda program and education process.3.A scientific,standard and operable hand function rehabilitation nursing program for patients with hand burns during hospitalization was constructed and the implementation process was made.4.Analyzed the barriers/motivators of the program implementation,translated the most barriers,and made the evidence-based program localized.5.Compared clinical intervention effects of the intervention group with the control group,from admission to discharge,patients in both groups showed significant improvements in activity in daily life,the degree of pain,the situation of hand function recovery,comprehensive health status,and awareness of patients'rehabilitation knowledge.The intervention group had statistical significance(P<0.05)than the control group in alleviating burn background pain,improving the hand function and comprehensive health status,enhancing the awareness of patients'rehabilitation knowledge.Conclusions:1.The hand function rehabilitation nursing program for patients with hand burns during hospitalization was built based on KTA model is scientific and feasible,which promoted the high-quality rehabilitation nursing knowledge to translate into clinicalpractice.2.The hand function rehabilitation nursing program for patients with hand burns during hospitalization standardized the currently hand function rehabilitation nursing practice implemented,promoted the best evidence to translate into practice,and improved the level of rehabilitation nursing practice.3.The hand function rehabilitation nursing program for patients with hand burns during hospitalization contributes to improve their activity in daily life,relieve their pain,improve their comprehensive health conditions and hand function,etc.At the same time,it enriches patients' rehabilitation knowledge,cultivates patients' correct rehabilitation cognition and strengthens medical staff's attention to burn rehabilitation.