| Objective:Combining literature review and expert consultation,this study aims to establish a scientific,effective and feasible clinical nursing pathway based on the concept of cardiac rehabilitation.The study is done to analyze the clinical nursing pathway's influence on the self-care behavior and quality of life of patients with chronic heart failure and evaluate its effect.It provides references for the composition and development of future clinical special nursing work and single path disease care pathway.Method:This study consisted of two parts.The first part,based on the concept of cardiac rehabilitation,constructed a clinical care pathway table for chronic heart failure.Evidence-based resources,such as relevant clinical practice guidelines,consensus,and systematic evaluation in this field,had been reviewed in literature review method.The study mainly based on the "Clinical Path of Heart Failure" issued by the National Health and Family Planning Commission in 2016,the "Guidelines for Clinical Path Management of Medical Institutions" issued in 2017,and the"Development and Implementation of Clinical Paths for Medical Institutions"issued by the Ministry of Health of the People's Republic of China in 2012.Through the hospital information management system,medical records were reviewed,patient's hospitalization time,main medical treatment and nursing project information were extracted.On the basis of evidence-based nursing preliminarily,this clinical nursing pathway for patients with chronic heart failure was formulated.15 medical and nursing experts in the fields of cardiovascular medicine,rehabilitation,and Chinese medicine had been conducted two rounds of Delphi expert consultation in order to determine each items of the clinical care path table for chronic heart failure based on the concept of cardiac rehabilitation.The second part implemented and evaluated the clinical nursing pathway for chronic heart failure based on the concept of cardiac rehabilitation.This study was conducted on chronic heart failure patients who were enrolled in the Department of Cardiology,Second Affiliated Hospital of Kunming Medical University from May 2018 to December 2018 and also met the inclusion and exclusion criteria.All patients were numbered according to the order of admission and grouped according to the random number table.The odd number was the control group and the even number was the intervention group.Except the late lost follow-ups,79 patients were included in,including 38 in the intervention group,41 in the control group.In the control group,the traditional doctor-dominated and nurse-care model was adopted,and routine nursing and post-discharge follow-up were performed.Based on the routine nursing care,the intervention group was implemented the clinical nursing pathway and out-of-hospital path follow-up of chronic heart failure on the concept of cardiac rehabilitation.The self-care behavior and quality of life scores of the two groups were compared statistically before the intervention,1 month of intervention,and 3 months of intervention,and the hospitalization time and hospitalization expenses were statistically analyzed.Results:The first part:the two-round expert's positive coefficient is 100%.The two-round judgment coefficient Ca is 0.866 and 0.873.The familiarity degree coefficient Cs are 0.91 and 0.92,respectively,and the expert authority degree Cr is 0.888 and 0.897 respectively.After the second round of enquiries,the coordination coefficients of the first-level,second-level and third-level indicators were 0.343,0.179,and 0.234,respectively,indicating that the opinions of experts tended to be consistent and the degree of agreement on project indicators was high.Experts gave revisions to the items and,based on expert opinions,a clinical care pathway for chronic heart failure based on the concept of cardiac rehabilitation was established.The second part:firstly,the hospitalization time and hospitalization expenses of the intervention group were lower than the control group,and a significant difference(P<0.05)was shown.It can be seen that the implementation of the clinical nursing pathway can significantly reduce the hospitalization time and hospitalization of patients' cost.Secondly,there was no significant difference in self-care behavior scores between the two groups before intervention(P>0.05).The scores of self-care behaviors of the intervention group were lower than the control group at 1 month and 3 months after intervention in statistically significance(P<0.05).Thirdly,there was no significant difference in the scores and total scores of the quality of life between the two groups before intervention(P>0.05).The scores of the physical,emotional,and other areas of the intervention group were lower than those of the control group at 1 month and 3 months after intervention in statistically significance(P<0.05).Conclusion:The clinical nursing path based on the concept of cardiac rehabilitation fully reflects the characteristics of specialist nursing and the advantages of rehabilitation nursing,enabling the nursing staff more time and energy to observe comprehensively,accurately and timely the changes of the condition and to implement personalized nursing for the patients.Compared with conventional nursing,this pathway can reduce patient hospitalization time and hospitalization costs,and improve patient self-care behavior and quality of life.It is of great practical significance and effect to maximize the economic and social benefits of cardiac rehabilitation and clinical care pathways,and to achieve personalized chronic heart failure path management under multidisciplinary collaboration. |
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