Application And Evaluation Of Case Management Model In Prevention Of High Risk Pressure Injury In Elderly Inpatients

Objectives:To establish a high-risk pressure Injury prevention case management model for the elderly inpatients.Evaluation of the effect of the high-risk pressure Injury prevention case management model for the elderly inpatients.Methods:1.To establish a high-risk pressure Injury prevention case management model for the elderly inpatients.Through searching,checking out and classifying recent literature related to pressure Injury prevention in the elderly inpatients,initially establish case management model based on nursing theory,with problem assessment and intervention system in the Omaha System.Then we establish a high-risk pressure Injury prevention case management model for the elderly inpatients by consulting 15 experts in relevant fields.2.Evaluation of the effect of the high-risk pressure Injury prevention case management model for the elderly inpatients.Five department included 100 patients with high incidence of pressure injury in a third-A-grade hospital in Yunnan were selected from May to November 2018.The patients in each department were in accordance with the age,the scores of Braden and the main risk factors for the pressure injury,then randomly divided into two groups,with 50 patients in each group.The experimental group implemented the high-risk pressure Injury prevention case management model for the elderly inpatients based on the routine nursing program.On the day of hospitalization,on the fourth day after hospitalization,and before the discharge,the nursing problems were found and improved,evaluated from three aspects of Knowledge-Behavior-Status(K-B-S).The control group implemented a routine care regimen.On the day of hospitalization,on the fourth day after hospitalization,and before the discharge,the investigators used Pressure Ulcer Scale for Healing(PUSH),the Braden evaluation form,Nutrition Risk Screening 2002(NRS-2002)for evaluation.Observe the occurrence of pressure injury,hemoglobin(HB),serum albumin(ALB)detection indicators.Results:1.After two rounds of expert consultation,14 valid questionnaires were collected,the effective recovery rate was 93.33%,and the authority coefficient was 0.97.The enthusiasm and authority of the experts was higher.Finally,the high-risk pressure Injury prevention case management model for elderly inpatients was established,including:? high-risk pressure Injury prevention case management nursing record table for elderly inpatients.?An example of the high-risk pressure injury prevention case management effectiveness score of elderly inpatients.?Implementation plan for high-risk pressure injury prevention case management for elderly inpatients,including assessment,intervention,and effectiveness improvement evaluation of nursing problems.2.100 patients were recruited in this research.They were divided into two groups by the pairing design method,with 50 patients in each group.During the research,2 patients were quitted form the experimental group,and 1 was quitted form the control group.The dropout rate was 3%.There were no significant differences in baseline data of age,sex,education,family economic income between the two groups(P>0.05).? The experimental group had 503 nursing problems during hospitalization,including health-related behaviors(39.36%),physiological areas(34.19%),social psychological(15.11%),medical devices and surgery fields(10.93%),and environmental fields(0.40%).There are 11 common nursing problems(incidence rate? 30%):neuro-muscle-skeletal function,skin,personal care,care,health care and supervision,physical activity,device use,nutrition,mental health,drugs Treatment plan,circulation.? Analyzing the common nursing problems'improvement of the effectiveness in the experimental group,we can found that comparing on the day of hospitalization,except for the neuro-muscle-skeletal function and circulation status scores,the K-B-S scores on nursing issues were statistically significant(P<0.05),before the discharge.?The experimental group' incidence of PI was lower than the control group.The difference was statistically significant(P<0.05).?The PUSH scores of the three times in the two groups were significantly different with time gone on(P<0.05).There were no significant differences between the two groups(P>0.05).?The total scores of of the Braden evaluation form and other areas in the two groups varied with time goes on,which had statistically differences(P<0.05).There was an interaction between intervention methods and the time(P<0.05).On the day of hospitalization,there was no significant difference in the total scores and other areas between the two groups(P>0.05).On the fourth day after hospitalization,and before the discharge,except the feeling,the difference was statistically significant(P<0.05).?The NRS-2002 scores of the two groups gradually decreased with the time goes on,and the difference was statistically significant(P<0.05).On the day of hospitalization and the fourth day after hospitalization,the NRS-2002 scores of the two groups were no statistically significant(P>0.05).Before the discharge,the scores of the two groups was statistically significant(P<0.05).? There was no significant difference in BH between the two groups on the day of hospitalization and the fourth day after hospitalization(P>0.05).There was significant difference in HB before the discharge(P<0.05).There was no significant difference in ALB between the two groups on the day of hospitalization(P>0.05).There was a statistically significant difference on the fourth day after hospitalization and before discharge(P<0.05).Conclusions:1.The research confirms that the case management model can analyze nursing problems in the environmental,social psychological,physiological.health-related behaviors,medical devices and surgery fields during hospitalization,and objectively evaluate the effectiveness of interventions.2.The case management model can reduce the incidence of pressure injuries in elderly inpatients with high-risk pressure injuries.