The Design,Application & Evaluation Of Perioperative Graphical Clinical Nursing Pathway For Acute Appendicitis

ObjectiveTo design a perioperative graphical clinical nursing pathway for acute appendicitis which included a clinical nursing pathway for nurses and a graphical clinical nursing pathway for patients with acute appendicitis undergoing appendectomy and to apply it for clinical purposes,and evaluated the hospital stays,hospitalization expenses,first time activity after surgery,first anal exhaust time,and changes in satisfaction towards the hospital services.To provide references and advise for the implementation and promotion for the clinical nursing pathway.Method1.In January 2018 to February 2018,according to the standard of developmental phases in clinical pathway study,the clinical pathway team took the PDCA theory as the instruction,based on the literature research,referred to the national standard clinical pathway for appendicitis,combined with the clinical pathway for appendicitis used in the hospital and the clinical nursing routines of appendicitis,then designed the perioperative graphical clinical nursing pathway draft by group focus interview and the panel meeting.At the end,the perioperative graphical clinical nursing pathway for acute appendicitis which included the clinical nursing pathway for nurses and the graphical clinical nursing pathway for patients with acute appendicitis undergoing appendectomy was designed through the pre-experiments and modifications.2.Patients with acute appendicitis as the first diagnosis after appendectomy and given with the brochure of clinical pathway were selected,dated from March 2018 to December2018.According to the different departments of the admission,37 patients admitted to the gastrointestinal surgery area 1 were used as the controlled group,and were carried along with currently used standard ‘graphical clinical nursing pathway for appendectomy’ for care and health education.At the same time,37 patients admitted to the gastrointestinal surgery area 2 were the experimental group,and standard ‘the perioperative graphical clinical nursing pathway for acute appendicitis’ was used for the surgery instruction along with our version of brochure were used for care and health education.3.In the end,we compared and evaluated the hospitalization days,hospitalization expenses,first activity time after surgery,the first postoperative anal exhaust time,the patient’s health education awareness rate,and the hospitalization service satisfaction rate in the controlled group and the experimental group.The excel database was used and all the collected data were statistically analyzed using SPSS21.0 statistical software.Quantitative data were expressed as mean ± standard deviation((?)±s),t test was used for comparison between the groups,and variance analysis was used among the groups;qualitative data were expressed by frequency and rate,and comparison between groups was performed by chi-square test;incomplete conditions were examined by rank sum test.α=0.05 is the inspection level.Results1.The clinical pathway team formed the perioperative graphical clinical nursing pathway for acute appendicitis which included the clinical nursing pathway for nurses and the graphical clinical nursing pathway for patients that supplemented the current clinical pathway for appendectomy used in the hospital.These tables included six parts:admission,preoperative,post-operative,post-operative rehabilitation,pre-discharge day and discharge day.The clinical nursing pathway for nurses was more detail and standardized than before,including nursing care and health education.The graphical clinical nursing pathway for patients consisted of easy-to-understand cartoon drawings and simple text descriptions.The contents included nursing-care plan,inspection,aspects of diet,wound care,activities and relaxation,meditations,and health education were arranged in the table.2.There was no significant difference in the academic qualifications,working years and professional titles of the nurses and doctors between the control group and the experimental group(P>0.05).There were no significant differences in gender,age,education level,marital status and medical insurance between the two groups(P>0.05).There was no significant difference in hospitalization days between the controlled group and the experimental group(P>0.05).The average hospitalization cost of patients in the experimental group(8142.49±856.83 RMB)was statistically significant compared with the controlled group(8753.99±876.09 RMB)(P<0.05).The first time out of bed in the experimental group(9.08±2.27h)were shorter than those in the controlled group(11.46±3.69h),the difference was statistically significant(P<0.05).The first anal exhaust in the experimental group(21.81±3.32h)were shorter than those in the controlled group(27.41±5.49h),the difference was statistically significant(P<0.05).In the health education awareness rate and hospitalization service satisfaction of the patients,the experimental group was higher than the controlled group,and the difference was statistically significant(P<0.05).ConclusionThe application of the perioperative graphical clinical nursing pathway for acute appendicitis effectively reduced the hospitalization cost for patients with appendectomy in acute appendicitis and improved the awareness of health education for patients.This enabled the patients to actively participate in the treatment and nursing,helping the patient’s early activities,promoted the recovery of gastrointestinal function,improved the satisfaction of the patient.The application of the perioperative graphical clinical nursing pathway for acute appendicitis was conducive to the standardized treatment and improved the clinical nursing quality,brought closer the patient and healthcare personnel.Therefore it was worth further research and promotion.