| Objective(s):To ensure the discharge safety of patients with Rheumatoid arthritis(RA)and improve the rehabilitation effect.From the perspective of patients’ own experience and nurses’ professionalism,this study explores the discharge readiness of RA patients by questionnaire survey and qualitative interview,understands the influencing factors,and explores the nursing strategy to improve the level of discharge readiness of RA patients were discussed.Methods:Part One:245 RA patients from 3 third-class hospitals in Yunnan Province were selected by convenience sampling method,and use general information questionnaire,Readiness for Hospital Discharge Scale,Quality of Discharge Teaching Scale,Social Support Rating Scale and Medical Coping Modes Questionnaire to investigate the patients.The recovered data is checked by double entry using EpiData 3.1 to ensure the accuracy of data entry.SPSS 25.0 software was used for statistical analysis.The general data of patients were described by frequency and constituent ratio,and the scores of discharge readiness,discharge guidance quality,social support and coping style were described by mean and standard deviation.Monofactor analysis was used to compare the differences of discharge readiness of RA patients with different demographic characteristics.Pearson correlation analysis was used to analyze the relationship among discharge guidance quality,social support,medical coping and discharge readiness.Multiple stepwise regression was used to analyze the influencing factors of discharge readiness of RA patients.Part two:Draw up the outline of semi-structured interview for nurses,and conduct semi-structured interview for 14 nurses in Rheumatology and Immunology Department of the above-mentioned three third-class hospitals,and analyze the interview data with Nvivo11.0,so as to understand the situation of nurses’ discharge preparation service for RA patients.Based on the results of interviews and questionnaires,this paper discusses the nursing strategy to improve the level of discharge readiness of RA patients,so as to provide scientific basis for more reasonable and effective discharge readiness services for RA patients.Results:1.The discharge readiness of RA patients is in the middle level with a total score of(93.31±14.11)and an average score of(7.78±1.18).Monofactor analysis shows that work status,current residence,per capita monthly income of family,type of complications,degree of disease awareness,convenience of seeking medical treatment and taking medicine after discharge,pain or not have significant influence on the discharge preparation of RA patients(P<0.05);Pearson correlation analysis shows that the discharge readiness of RA patients is positively correlated with the quality of discharge teaching,the dimension of actually obtained content,guidance skills and effect.It is positively correlated with social support and its subjective and objective support dimensions;It is positively correlated with the facing dimension in medical coping style and negatively correlated with the yielding dimension.Multiple stepwise regression analysis shows that the main influencing factors of the discharge readiness of RA patients are actually obtained content,teaching skills and effects,yielding coping style,whether it is convenient to seek medical treatment and take medicine after discharge,types of complications,whether there is pain or not(P<0.05),which explains 44.1%of the total variation of the discharge readiness of RA patients.2.By analyzing the semi-structured interview content of nursing staff,three topics were extracted,namely,inadequacies and deficiencies,influencing factors and suggestions for improvement.Among them,the inadequacies and deficiencies include five sub-themes:lack of continuity of discharge preparation,single form of out-of-hospital follow-up,lack of continuity and pertinence of out-of-hospital follow-up,lack of attention to caregiver guidance,and psychological care to be strengthened;The influencing factors include two sub-themes:the factors influencing the guidance effect of nurses and the factors influencing the implementation of patients.Suggestions for improvement include four sub-themes:diversified guidance methods,individualized discharge preparation,ensuring the accessibility of knowledge acquisition and strengthening out-of-hospital follow-up.Based on the results of interviews and questionnaires,this study explored the intervention measures to improve the discharge preparation of RA patients:providing personalized discharge preparation services for patients;Optimize the discharge preparation service process and formulate a perfect discharge guidance strategy;Strengthen psychological care;Strengthen out-of-hospital follow-up to ensure the continuity and effectiveness of discharge preparation services;Pay attention to the caregivers’ discharge guidance;Fully mobilize the favorable factors around patients and improve the social support level of patients.Conclusion(s):1.The discharge readiness of RA patients is at a medium level.The main influencing factors of discharge readiness of RA patients are the amount of guidance content actually obtained by patients,the guidance skills and effects of nurses,the coping style of yielding,whether it is convenient to seek medical treatment and take medicine after discharge,the types of complications and whether there is pain or not.2.Nursing staffs discharge preparation service for RA patients is deficient and influenced by many factors,which suggests that nursing staff should fully consider various influencing factors,and continuously improve deficiencies to improve discharge preparation services. |
