The Construction And Application Of Discharge Preparation Service For Patients With First Coronary Artery Stent Implantation

Objective Constructed the discharge preparation service model of patients with first coronary stent implantation by delphi method.The purpose is to provide a scientific,reasonable and feasible new nursing service scheme for patients with first-time coronary artery stent implantation,and to apply it to clinical practice to verify its application effect.Methods1.The Construction of discharge preparation service programme for patients with first coronary artery stent implantation: Firstly,the literature review method was used to analyze the development status and trend of coronary interventional surgery and discharge preparation services in China.Through the specific analysis,comparison and synthesis of the data,the framework of discharge preparation service mode for patients with the first coronary stent implantation was preliminarily proposed.Secondly,two rounds of expert consultation were conducted using the Delphi method to construct the service model of discharge preparation for patients with the first coronary artery stent implantation,and the reliability and representativeness of expert consultation were measured by the evaluation indexes of expert activeness coefficient,authority coefficient,coordination degree and concentration degree.2.Empirical study: A total of 120 patients who underwent the first coronary stent implantation in three wards of the department of cardiology of a third-grade a hospital in Inner Mongolia from April 2019 to June 2019 were collected as subjects.Those who met the inclusion and exclusion criteria were randomly divided into the control group and the intervention group according to the admission sequence in a random number table.The control group adopted the routine nursing mode of the department of cardiology,and the intervention group implemented the discharge preparation service mode of the patients with the first coronary artery stent implantation on the basis of the routine nursing mode.Intervention timeis from patients admitted to hospital on the same day to the hospital for six months,compared two groups of patients at discharge readiness,physiological indexes,the incidence of major adverse cardiovascular events(MACE),hospitalization rates again,self-management ability differences in the aspects of the difference,then analysis in patients with coronary artery stenting for the first time out of the hospital preparation and application effect of service mode.Results1.The construction of mode: After two rounds of expert consultation,this study completed the establishment of the discharge readiness service model for patients with the first coronary artery stent implantation,including 5 first-level indicators,21 second-level indicators,and 49third-level indicators.Through the statistical analysis of the results of the letter consultation,it is concluded that the positive coefficient of the two rounds of experts is 100%.The authority coefficients of the two rounds of experts were 0.84 and 0.86,respectively.The coordination coefficients of the two rounds of experts were 0.168 and 0.227.The variation coefficients of the two rounds of questionnaires were 0.07 ~ 0.27 and 0.05 ~ 0.14.The full mark ratio of the items in the two rounds of the questionnaire was 0.00 ~ 0.87 and 0.27 ~ 0.93.2.Empirical study:(1)The total score of discharge readiness of the patients in the intervention group was higher than that of the control group,and the scores of the patients in the intervention group were higher than those of the control group in terms of personal status,adaptability and expected support,with statistically significant differences(P<0.05).(2)The physiological indexes of BMI,systolic blood pressure,diastolic blood pressure,LDL and hba1 c in the intervention group were all lower than those in the control group,and the differences were statistically significant(P<0.05).(3)After 6 months of intervention,the total incidence of major cardiovascular adverse events(MACE events)in the intervention group was lower than that in the control group,and the difference was statistically significant(P<0.01).(4)After 6 months of intervention,the rehospitalization rate of patients in the intervention group was lower than that in the control group,and the difference was statistically significant(P<0.01).(5)intervention in the intervention group patients after total score of self management ability is higher than the control group,and the intervention group in bad habits,symptom management,emotional cognitive management emergency management,disease,knowledge management,general life and treatment compliance management seven dimensions scores are higher than the control group,the differences were statistically significant(P<0.01).Conclusion In this study,the method of constructing the discharge preparation service model of patients with first coronary artery stent implantation by Delphi method was scientific,reasonable structure and reliable results,which is suitable for clinical practice.Application of this model can effectively improve the patients' discharge readiness,improve disease physiological indexes and self-management ability,reduce the incidence of major adverse cardiovascular events(MACE)and hospitalization rates again,the patient to provide a full range of protection ring,implements the patients from the hospital environment to families/smooth transition of the basic medical institution environment,and for clinical nursing of patients with coronary artery stenting to provide theoretical basis and practical guidance.