Study On The Application Of Integrated Medical And Nursing Mode In Cardiac Rehabilitation Of Patients With Chronic Heart Failure

Objective:To explore the effect of integrated medical and nursing mode on cardiac rehabilitation,selfcare behavior and life quality in patients with chronic heart failure,so as to prevent their acute attack and reduce readmission rate to help them return to family and society as soon as possible.Methods:In this paper,those patients with chronic heart failure who were hospitalized in Cardiology Department of hospital in Changchun from January 1,2019 to May 1,2019 were selected.In this randomized controlled study,the patients coded p1-p85 were assigned to control group according to the admission time order of the subjects,and the patients coded p86-p170 were assigned to experimental group.All the patients received routine cardiac rehabilitation and nursing care for chronic heart failure?CHF?.In control group,the diagnosis,treatment and nursing care during hospitalization were intervened by doctors and nurses respectively.The patients in experimental group received clinical diagnosis,treatment and nursing care according to integrated medical and nursing mode.After admission,the medical records and general conditions of the patients with CHF were comprehensively evaluated by the specialists and responsible nurses of integrated medical and nursing group,and the existing and potential physiological,psychological and social problems of the patients were obtained for nursing diagnosis and medical diagnosis.The integrated medical and nursing group worked out the patient nursing plan and rehabilitation treatment plan through case discussion,joint medical and nursing rounds and filling in cardiac rehabilitation cases,and adjusted them in time according to the condition;taught the patients the related knowledge of CHF and home self-management;established Wechat communication group;followed up,evaluated and fed back the patients through monthly telephone follow-up and regular outpatient follow-up,and gave them continuous rehabilitation intervention.The data of the36-item short form health survey?SF-36?,Selfcare of Heart Failure Index?SCHFI?,N-terminal pro-brain natriuretic peptide?NT-proBNP?,left ventricular ejection fraction?LVEF?and readmission rate were compared before intervention,3 months after intervention and 6 months after intervention.Software IBM SPSS 24.0 was used for statistical analysis.T-test was used to compare the measurement data with normal distribution,rank sum test was used to disobey normal distribution,?² test was used to compare classified counting data,and repeated measurement analysis of variance was used for repeated measurement data.Results:1.Compared with smoking history,drinking history,whether the first diagnosis of heart failure,primary disease,course of disease,cardiac function grade and LVEF between the two groups before intervention,there were no significant difference with comparability?P>0.05?.Compared with baseline data between the two groups?including age,gender,family per capita monthly income,occupation,education,marital status,type of medical insurance and so on?,there were no significant difference with comparability?P>0.05?2.After 3 months of intervention,the scores of physiological function,physiological function,overall health,vitality,emotional function and mental health of experimental group were significantly higher than those of control group?t=2.292,P=0.023;t=2.573,P=0.011;t=2.687,P=0.008;t=2.088,P=0.038;t=3.070,P=0.003;t=2.333,P=0.021?.After 6 months of intervention,except for the dimension of social function,the scores of physiological function,physiological function,physical pain,overall health,vitality,emotional function and mental health in experimental group were significantly higher than those in control group?t=2.418,P=0.017;t=2.336,P=0.021;t=3.200,P=0.002;t=3.997,P<0.001;t=3.315,P=0.001;t=4.501,P<0.001;t=3.244,P=0.001?.3.The total scores of selfcare maintenance,selfcare management and scales in experimental group and control group increased with time,and the differences were statistically significant(F_time=225.466,P<0.001;F_time=828.355,P<0.001;F_time=832.818,P<0.001).Selfcare confidence when intervention for 3 months and 6 months was higher than that when hospitalization,but there was no significant difference between 3 months and 6months?P>0.05?.The scores of all dimensions and the total score of the scales in experimental group were higher than those in control group,and the differences were statistically significant(F_grouping=5.699,P=0.018;F_grouping=27.254,P<0.001;F_grouping=9.714,P<0.001;F_grouping=53.859,P<0.001).4.The NT-proBNP of the two groups decreased after intervention for 3 months and 6months,and the difference was statistically significant?F=218.371,P<0.001;F=68.669,P<0.001?.The NT-proBNP of experimental group was lower than that of control group,and the difference was statistically significant?t=2.030,P=0.044;t=3.556,P<0.001?.5.There was no significant difference in LVEF between when hospitalization and 3months after intervention?t=0.383,P=0.702;t=1.796,P=0.074?.After 6 months of intervention,the LVEF of experimental group was higher than that of control group,and the difference was statistically significant?t=2.854,P=0.005?.6.After intervention for 3 months and 6 months,the readmission rate of experimental group was lower than that of control group,and the difference was statistically significant??²=4.098,P=0.043;?²=4.827,P=0.028?.Conclusion:1.The integrated medical and nursing mode helps to improve NT-proBNP concentration and LVEF in patients with CHF,but the short-term effect of LVEF intervention is not ideal;2.The integrated medical and nursing mode is helpful to improve the life quality of patients with CHF,but the recovery of social function needs further research;3.The integrated medical and nursing mode can significantly improve the selfcare ability of patients with CHF;4.The integrated medical and nursing mode can reduce the readmission rate of patients with CHF.