| Objective:To construct a cluster nutrition nursing strategy for elderly stroke patients with dysphagia on the basis of evidence,and evaluate its intervention effect.Methods:1.Stage of cluster strategy construction: Relevant literature on nutritional nursing intervention for elderly stroke patients with dysphagia was retrieved,and then evaluated.The first draft of cluster nutrition nursing strategy was formulated through evidence extraction,and then Delphi expert letter consultation was conducted.After two rounds of expert letter consultation,items were revised and improved after group discussion according to expert scores and opinions,and the final cluster nutrition nursing strategy was formed.2.Stage of implementation of cluster strategy: A total of 70 patients in the geriatrics department of a grade-THREE Grade A hospital who met the admission criteria were selected.The patients were divided into two groups according to different ward areas,with ward 1 as the control group(n=35)and ward 2 as the intervention group(n=35).The above 70 patients began nutritional nursing intervention from hospitalization.The control group was given routine nursing,the intervention group was given cluster nutrition nursing strategy,intervention time was 2 weeks.The general baseline data of patients were compared before intervention,and the incidence of aspiration,nutritional biochemical indicators(hemoglobin,total serum protein,albumin,prealbumin,total cholesterol),grip strength,and quality of life score of swallowing disorders were collected in the two groups before and after intervention to evaluate the intervention effect.Results:1.Formation of clustering strategy: according to inclusion and exclusion criteria,a total of 8 articles were included,including 1 guide,3 expert consensus,2 systematic evaluation,1 randomized controlled trial,and 1 class experimental study.The first draft of the cluster nutritional care strategy including 6 primary indicators,13 secondary indicators and 18 tertiary indicators was formed through evidence extraction.In the two rounds of expert letter consultation,the positive coefficients of experts were 86.66% and80%,the authority coefficients of experts were 0.875 and 0.825,and the Kendall harmony coefficients of importance of each item were 0.165 and 0.453,respectively,with statistically significant differences(P<0.001).Expert opinion: add 5 new indicators(2 two-level indicators,3 three-level indicators);modify 2 three-level indicators.The final cluster nutrition care strategy includes six primary indicators,including "swallowing screening","nutrition screening","swallowing disorder risk assessment","nutrition intervention","oral hygiene" and "health education",and 15 secondary indicators "and 21 tertiary indicators".2.Evaluation of cluster strategy implementation effect:2.1 There was no significant difference between the two groups in gender,age,education,type of chronic diseases,depression field drinking water test grade,which were comparable(P>0.05)2.2.There was no significant difference in nutritional indicators(hemoglobin,total protein,prealbumin,albumin,and cholesterol),grip strength,and quality of life scores between the two groups before the intervention(P>0.05)2.3.After intervention:2.3.1 Dominance aspiration rate decreased significantly,with significant differences between the two groups(P<0.05);Occult aspiration rate was not significant between the two groups(P>0.05)2.3.2 Nutritional indicators: hemoglobin,total protein,prealbumin,albumin and cholesterol were statistically different(P<0.05)2.3.3 There was no significant difference in the handgrip strength between the two groups(P>0.05)2.3.4 The SWAL-QOL total score was significant(P <0.05),eight dimensions were different in psychological burden,eating time,eating desire,symptom frequency,food selection,fear,mental health,and fatigue(P <0.05),there were no significant differences in language communication,social communication and sleep(P> 0.05).Conclusion:1.The cluster nutrition care strategy of this study was constructed on the basis of evidence and reviewed by experienced experts in relevant fields,which ensured its scientificity and feasibility and could provide reference for clinical practice.2.The application of cluster nutritional care strategy in elderly patients with stroke dysphagia reduced the incidence of dominant aspiration,improved their nutritional status,enhance their quality of life,and proved the effectiveness of this strategy. |
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