| Objective:Based on clinical investigation and qualitative interview,this study constructed an evidence-based early comprehensive rehabilitation nursing scheme for patients undergoing degenerative lumbar surgery,aiming to reduce the pain and functional disability of patients undergoing degenerative lumbar surgery,improve the long-term quality of life,and provide evidence-based basis for health education of spinal surgery nurses.Methods:Patients undergoing initial surgical treatment for degenerative lumbar disease in a grade a hospital in nanjing from October 2018 to April 2019 were investigated and followed up.Three days before surgery,nurses used the general information questionnaire,Hamilton Anxiety Scale(HAMA)and Japanese lumbar JOA Scale to assess the risk factors affecting patients' cognition.Five days after surgery,patients used Fear Avoidance Beliefs Question(FABQ),Tampa Scale for Kinesiophobia(TSK),and general self-efficacy Scale(GSES)to evaluate their cognitive level of recovery.3 months after surgery,nurses applied visual anoalogue Scale.VAS,Oswestry disability index(ODI)and 12 simple health status questionnaires(sf-12).In order to understand the status quo and problems of patients' rehabilitation,13 patients3 months after surgery were selected for qualitative interviews,and Colaizzi seven-step analysis method was used for data processing and theme extraction.Will the quantitative study of statistically significant independent risk factors and qualitative research as the theme of the keywords,the Cochrane library,the guidenetwork computer retrieval(NGC),Canada Ontario registered nurses association(RNAO),Pub Med,EMBASE,Medline database,CNKI,Wanfang 8 Chinese English about promote the rehabilitation of patients with literature,collect relevant measures to improve the patients outcome,form the preliminary nursing strategy.Delphi expert letter consultation was used to evaluate the importance and clinical operability of each item.Develop a list of rehabilitation and nursing programs based on the results of the consultation.Results:Quantitative studies have shown that the cognitive level of Chinese patients undergoing degenerative lumbar spine surgery is low,and the patients' education level,smoking history,anxiety level and BMI are independent factors affecting the cognitive level.The cognitive level is significantly correlated with the late pain level,functional disability and quality of life.The qualitative study found that patients mainly faced four problems during the recovery period: difficulty in accepting physical limitations,lack of relevant knowledge of disease management,gaps in continuous rehabilitation nursing,and the need for social recognition and psychological support.Based on the evidence,104 literatures were retrieved and the evidence was summarized to finally form a set of rehabilitation strategies including 3primary indicators,11 secondary indicators and 36 tertiary indicators.The cognitive and behavioral interventions were given to the patients during pre-rehabilitation,post-surgery bed recovery and post-surgery rehabilitation.The positive coefficient of the two rounds of Delphi expert letter consultation was 100%,and the experts actively participated;The degree of expert authority is 0.89,which is good.P value of coordination coefficient of each item in the letter was < 0.05,indicating a good degree of coordination.The strategy has better scientific and clinical practicability.Finally,the rehabilitation nursing strategy after the consultation was integrated to form the final rehabilitation nursing plan.Conclusion:This study investigated the current status of cognition of patients undergoing lumbar degenerative surgery in China and its influencing factors.The effects of cognitive level on postoperative pain,functional disability and quality of life were analyzed.The establishment of a systematic rehabilitation strategy based on cognitive behavior intervention in the early postoperative period based on evidence,and theimplementation of Delphi expert letter consultation fully ensured the scientific,rigorous and practical nature of the strategy.Develop rehabilitation nursing program to provide evidence-based basis for health education for clinical nurses. |
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