| Objective Through the Omaha system theory and the concept of health management to construct the best overall health management plan for stroke patients with swallowing disorders in the hospital-community-family,in order to reduce the social,psychological,dietary safety and complications caused by the patients due to swallowing disorders,and improve swallowing The quality of life provides a basis for clinical nurses to care for patients with dysphagia.Methods 1.The first part is to construct the Omaha System Evaluation Form,with the core of the health management of patients with first stroke dysphagia,which is completed through a multidisciplinary team and Delphi expert correspondence.In the Delphi expert letter inquiries,the enthusiasm of the experts is expressed by the questionnaire recovery rate,the degree of authority is expressed by the authority degree coefficient,the degree of concentration is expressed by the average value of item importance assignment,and the degree of coordination is expressed by the coordination coefficient and the coefficient of variation.2.The second part is a randomized controlled experiment.From January to November 2020,115 patients with first stroke dysphagia in the neurology department of a tertiary hospital in Inner Mongolia were selected into this study.Among them,57 patients admitted to the West Department of Neurology were set as the control group.The patients were treated with routine care during their hospitalization,and routine medical programs and follow-ups by doctors and nurses were implemented after discharge.The 58 patients admitted to the East Ward of the Department of Neurology were set as the intervention group.During the patient’s hospitalization and discharge,the overall Omaha system health management intervention was implemented,that is,through the Omaha system assessment,analysis and solution of the patient care from admission to discharge problem.The improvement of swallowing function,the incidence of aspiration,and the scores of the swallowing quality of life questionnaire(SWAL-QOL)of the two groups were compared and analyzed.Statistical analysis was performed using SPSS 23.0 statistical analysis software.The test level is α =0.05,and the P <0.05 is considered to be statistically significant.The KBS score of the Omaha system conforms to the normal distribution and adopts single-factor repeated measurement variance analysis;SWAL-QOL quality of life difference between groups is compared,if it conforms to the normal distribution,use the two independent sample t test,otherwise it is the two independent sample rank sum test.The swallowing function and the incidence of aspiration were tested by χ~2 test.Results 1.(1)In the first part,constructing the Omaha system for the first stroke patients with dysphagia health management assessment form using Delphi expert consultation,the first time 16 questionnaires were distributed,15 were recovered,the effective recovery rate was 94%;the second round of distribution13 and 13 questionnaires were returned,and the effective recovery rate was100%.Experts are highly motivated;(2)Consulting experts’ understanding of specialist subjects and the expert’s judgment basis on the questionnaire infers that the expert coefficient is 0.82;(3)Adopting expert opinions,revising items,and finally feedback to experts for communication,expert opinions tend to be concentrated and the degree of coordination Good,basically between 0.3-0.4.The content validity is better.Completed the health management assessment form for patients with swallowing dysfunction in the first stroke of the Omaha system through Delphi expert consultation.2.(1)In the second part,116 patients were enrolled based on the application of Omaha system’s first stroke dysphagia health management model.One patient in the control group was transferred to general surgery.Actually115 patients were in the experimental group,58 were in the experimental group,and the control group.57 people.The basic data of the two groups of patients were balanced,and the difference was not statistically significant(P>0.05),which was comparable.(2)From admission to discharge,the incidence of aspiration in the intervention group was significantly lower than that in the control group,and the difference was statistically significant(P<0.05).(3)There was no statistically significant difference in the scores of 11 items in the SWAL-QOL scale between the two groups at the time of enrollment(P>0.05),and the baseline was consistent and comparable.After the intervention,the comparison of the SWAL-QOL scale scores between the two groups of patients showed that the total score of quality of life,swallowing burden,willingness to eat,eating time,language communication,and social function were higher in the intervention group than in the control group,and the difference was statistically significant.Academic significance(P<0.05).(4)Before the intervention,after the two groups of Watian drinking water trials were tested byχ~2,the results of the two groups of Watian drinking water test data were not statistically significant(P>0.05)and were comparable;after treatment,the data of the two groups of Watian drinking water trials The data result P>0.05,the difference is not statistically significant.(5)Analysis of the improvement effect of more than 30% of nursing problems that occurred during the patient’s hospitalization showed that in addition to the improvement of digestion and hydration,the cognition,behavior,and status of other nursing problems were statistically significant at different stages of hospitalization(P<0.05)Except for neuro-muscle-skeletal behavior,the cognition,behavior and status of other nursing problems were statistically significant at different stages of discharge(P<0.05).Conclusions The health management model based on the Omaha system theory can implement personalized and continuous health management for patients from admission to discharge,and analyze the main nursing problems of stroke patients with dysphagia during the entire process and the improvement effects of nursing measures.Clinical nurses provide nursing basis for patients with dysphagia,and the health care model using the Omaha system as the framework can reduce the incidence of aspiration in patients with dysphagia and improve the quality of life of patients with swallowing disorders. |
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