| Objectives:To understand the true needs of patients with ischemic stroke hemiplegia and their caregivers for discharge plans through qualitative research;based on this,a literature research method and expert consultation method are combined to construct a discharge plan evaluation system for patients with ischemic stroke hemiplegia according to needs Contents and evaluation results to formulate a discharge plan based on the Timing It Right;to explore the application effect of the discharge plan based on the timing theory in patients with ischemic stroke hemiplegia and their caregivers.It provides reference for the evaluation of the discharge plan of stroke patients and the provision of special high-quality discharge preparation services.Methods:The research is divided into three parts.The first part:A qualitative study of the needs of patients with ischemic stroke and hemiplegia and their caregivers' discharge plan.Using phenomenological research methods in qualitative research,15 patients with ischemic stroke hemiplegia and 15 caregivers were interviewed in semi-structured in-depth interviews.Colaizzi analysis was used to encode,analyze,classify and refine the data To provide a basis for the discharge plan.The second part:to construct a discharge plan evaluation system for patients with ischemic stroke and hemiplegia,including the discharge plan screening table and evaluation table.On the basis of literature research,a basic framework for the evaluation system of discharge plan for patients with ischemic stroke and hemiplegia was preliminarily formulated.Using the Delphi method,15 experts from the top three general hospitals in different provinces and cities and medical colleges and universities in the field of cerebrovascular clinical nursing and rehabilitation nursing were selected.Two rounds of expert consultations were used to screen and revise the indicators to determine patients with ischemic stroke hemiplegia Discharge plan evaluation system.The third part:The application of discharge plan based on Timing It Right in patients with hemiplegia after ischemic stroke and their caregivers.Convenient sampling method was used to treat patients with ischemic stroke hemiplegia and their caregivers who met the inclusion and exclusion criteria in the neurology department of a top three hospital in Kunming from May to December 2019.The control group took routine neurology nursing,and the intervention group implemented discharge planning intervention based on timing theory.The BI index scale,discharge preparation scale,and caregiver preparation scale were the main evaluation tools.The intervention effects were evaluated at the time of admission,discharge,1 month after discharge,and 3 months after discharge,Hospitalization costs,complication rate and readmission rate were statistically analyzed.Results:The first part:The needs of discharge plans for patients with ischemic stroke and hemiplegia are summarized into 5 topics:disease knowledge,rehabilitation exercise,psychological support,financial support,and referral service needs;Demand for rehabilitation equipment guidance and wheezing services.The second part:The effective recovery rate of the two rounds of expert consultation is 100%,the expert authority coefficients are 0.878 and 0.886,and the Kendall harmony coefficients are 0.267 and 0.230(P<0.001).Screening and revising the indicators based on the opinions of experts,and finally forming a discharge plan evaluation system that includes a discharge plan screening table and evaluation form for patients with ischemic stroke hemiplegia.The third part:1.Patient readiness for discharge:The discharge readiness of the intervention group at discharge was higher than that of the control group in terms of personal status,disease knowledge,coping ability,and expected support dimension scores(P<0.05);2.Caregiver readiness:There was no statistically significant difference in the scores of caregiver readiness between the two groups at admission(P?0.05).The caregiver readiness score of the intervention group at discharge was higher than that of the control group,and the difference was statistically significant(P?0.05).3.Activities of daily living:There was no statistically significant difference in BI index scores between the two groups at admission and discharge(P?0.05).The BI index scores of the intervention group were higher than those of the control group 1 month after discharge and 3 months after discharge Group,the difference was statistically significant(P?0.05);4.Hospitalization time and hospitalization cost:The average length of stay and hospitalization cost of the intervention group were lower than that of the control group,the difference was statistically significant(P?0.05);5.Readmission rate and complication rate:1 month after discharge,there was a statistically significant difference in the incidence of complications between the intervention group and the control group(P?0.05),and there was no significant difference in the re-admission rate(P?0.05);3 months after discharge,the rehospitalization rate and the incidence of complications in the intervention group were lower than those in the control group,the difference was statistically significant(P?0.05).Conclusions:1.Patients with ischemic stroke hemiplegia and their caregivers have many demands for discharge plan.The evaluation system of discharge plan for patients with ischemic stroke hemiplegia constructed on this basis has certain reliability and scientificity,which can provide a basis for clinical nurses to make discharge plan.2.The discharge plan based on the timing theory is conducive to shortening the hospitalization time,reducing hospitalization costs,readmission rate and complication rate of patients with ischemic stroke hemiplegia,improving the patients' daily life activities,discharge readiness and caregiver readiness,can maximize the patient's whole process,dynamic,multi-disciplinary,personalized management,and thereby improve the patient's rehabilitation outcome. |
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