| 1 BackgroundTotal hip arthroplasty(THA)is an artificial hip joint prosthesis that replaces the hip joint that has developed lesions,providing an effective and feasible treatment for severe hip joint disease.Probable dislocation after THA is the second largest complication after prosthesis loosening.The incidence of dislocation after initial hip arthroplasty is 2.4%to 3.9%,which is one of the most important causes of revision.Once the prosthesis dislocation occurs after THA,the lighter needs to be closed again under anesthesia,supplemented with external plastering for 6 weeks;in severe cases,it needs to undergo revision surgery,and the rate of dislocation after revision is as high as 28%.Dislocation of the prosthesis not only increases medical expenses,prolongs hospital stay,occupies limited medical resources,and even jeopardizes hip function.Therefore,prevention of prosthesis dislocation after hip replacement is one of the focuses of orthopedic work.Instructors who guide patients during postoperative functional exercise and activities,inaccurate or inaccurate assessment of patients may also lead to hip dislocation in patients during hospitalization or even after discharge.The theoretical model of Knowledge-attitude-belief-practice Model(KABP Model)has been successfully used in nursing work,and has achieved remarkable results in health education,nursing management,and risk prevention.There are few reports on the investigation and intervention of nurses to prevent prosthesis dislocation after hip replacement.2 ObjectiveIn this study,we used the self-developed Orthopaedic Nurse's Knowledge Base for the Prevention of Prosthetic Dislocation after Hip Replacement,and conducted cross-sectional observation on the prevention knowledge,attitude and behavior of prosthetic dislocation after hip replacement in Shenzhen orthopedic nurses.survey.The nurses were trained in the prevention of hip dislocation after hip replacement using the self-edited "Human Hip Replacement Health Education Handbook" nurse version and patient version.After training,the nurses intervened to compare the joint function of the patients before and after the intervention.And the incidence of dislocation,etc.,to provide reference for the prevention of prosthesis dislocation management after hip replacement.3 Method3.1 Cross-sectional studyIn January 2018,a pre-survey was conducted on 19 orthopedic nurses using the self-developed Orthopaedic Nurse's Knowledge Base for Prevention of Prosthetic Dislocation after Hip Replacement.After the reliability and validity test,in 2-3 months from 2018 to 2018,260 students from 8 tertiary hospitals,6 second-class hospitals and 1 orthopedic hospital in Shenzhen were selected by questionnaires.Orthopedic nurses issue and recycle questionnaires.Statistical methods:SPSS 23.0 software was used for data analysis.The knowledge,attitude and behavior of prosthetic dislocation after hip replacement in orthopedic nurses were statistically described.The measurement data of normal distribution was described by mean ± standard deviation(x ±S).The state distribution is represented by the median and the quartile;the number of use cases of the count data and the composition ratio are described.T-test,one-way ANOVA,Mann-Whitney U or Kruskal-Wallis H test were used to compare the knowledge,attitude and behavior scores of prosthetic dislocation after hip replacement in orthopedic nurses with different academic qualifications and titles.P<0.05 was considered statistically significant.3.2 Experimental researchAccording to the latest literature at home and abroad,the "Human Hip Replacement Health Education Handbook" nurse version and patient version were produced,and a health education video was recorded.Eighty patients who underwent total hip arthroplasty from January 20 to March 2018 were enrolled in the control group for routine care.Seventy-six patients who underwent total hip arthroplasty from May 2018 to July 1818 were enrolled in the experimental group.In April 2018,the nurses of the Artificial Hip Replacement Health Education Handbook were used to train 35 nurses in the orthopedic department of a top three hospital in Shenzhen.The trained nurses gave health guidance to the patients according to the Patient Edition of the Artificial Hip Replacement Health Education Handbook,and issued the patient version of the Artificial Hip Replacement Health Education Handbook to the patient.Evaluation index:Patients in the two groups of hip arthroplasty were followed up for 1 month,3 months,and 6 months after discharge.Regular X-ray examination of the hip was performed.The patients in the two groups were compared 1 month and 3 months after the intervention.The number of cases of prosthesis dislocation occurred at months and 6 months;the two groups were compared with the Harris score and the self-care ability(ADL)score at discharge,1 month discharge,3 months discharge,and discharge for 6 months.The tube bed doctor and the tube bed nurse are responsible for the scoring during the hospitalization,and the returning doctor is responsible for the scoring after discharge.Statistical methods:SPSS23.0 statistical software was used for data analysis.The demographic data of patients were measured by mean standard deviation,percentage,?2 test.The incidence of prosthesis dislocation was compared with ?2 test.The Harris and ADL scales were scored by t test.Mann-Whitney U rank sum test and repeated measures analysis of variance were statistically significant at P<0.05.4 Results4.1 Cross-sectional survey results:comparison of scores of patients with prosthetic dislocation after hip replacement in Shenzhen orthopedic nurses with different demographic characteristics.The score of prevention knowledge of prosthetic dislocation after hip replacement in Shenzhen orthopedic nurses was 35.0(30.0,40.0),and the cases of excellent,good,and poor were 50(19.8%),123(48.8%),and 79(31.3%);the prevention attitude score was 47.0(44.0,50.0),and the positive,neutral,and negative cases were 224(88.8%),27(10.7%),and 1(0.4%);preventive behavior The score was 49.5(43.0,54.0),and the scores were positive,neutral,and negative:177(70.2%),66(26.2%),and 9(3.6%).There was a statistically significant difference in the scores of prosthetic dislocation after hip replacement in orthopedic nurses of different ages,education,professional titles and seniority(P<0.05).There was a statistically significant difference in the knowledge,attitude and behavior scores between the orthopaedie nurses and the orthopaedic nurses who received the continuing education of the specialists in the prevention of prosthetic dislocation after hip replacement(P<0.05).4.2Interventional findings4.2.1 Comparison of scores of nurses' knowledge and behavior before and after trainingThe pre-training knowledge,attitude and behavior scores of 35 orthopedic nurses were(32.71 ±7.61),(46.31 ±3.14),and(49.25±6.20),respectively,after training(47,57±5.34),(49.40±0.88),(52.89±3.34),the knowledge,attitude and behavior were statistically significant before and after training(P<0.05).4.2.2 Scores of Harris and ADL in hip replacement in the two groupsAt the time of discharge,there was no difference in Harris and ADL scores between the two groups(P>0.05).The Harris and ADL scores of the observation group were higher than those of the control group at 1 month,3 months,and 6 months after discharge.The difference was statistically significant.Significance(P<0.05).The incidence of prosthesis dislocation at 1 month,3 months,and 6 months after surgery was 1.32%,0%,and 0%in the experimental group and 4.88%,4.88%,and 0%in the control group.There was no statistical difference(P>0.05).The total incidence of dislocation in 6 months was 1.32%and 9.76%in the experimental group and the control group,respectively,which was statistically significant(P<0.05).5 Research conclusions5.1 Shenzhen orthopedic nurses have a good knowledge of hip dislocation dislocation and prevent positive attitudes and behaviors.High-age,high-educated,high-ranking nurses have a good knowledge of hip prosthesis dislocation prevention.Orthopedic nurses who have received specialist nurse training and participated in continuing education training have good knowledge,attitudes,and behaviors,and will prevent hip arthroplasty.The knowledge,attitude,and behavior scores of orthopedic nurses with post-prosthesis dislocation as departmental quality indicators were good.5.2 Using the Nurses Edition of the Artificial Hip Replacement Health Education Handbook to train nurses can effectively improve the scores of nurses' prevention of hip prosthesis dislocation.5.3 Trained nurses use the "Human Hip Replacement Health Education Handbook"patient version and health education videos for nursing interventions,which can effectively improve the Harris score and ADL score at 1 month,3 months,and 6 months after hip replacement.Reduce the incidence of prosthesis dislocation. |
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