| ObjectiveBased on the third edition of the Classification of Nursing Outcomes,based on the clinical nursing diagnosis of TKA patients during the perioperative period,this study screens out the core nursing outcomes that can reflect the essence of specialized nursing practice,and revises them to provide a standardized basis for nursing staff to implement precise nursing measures,which can scientifically and effectively guide the clinic.To explore the clinical application of interventions based on the perioperative core nursing outcomes of patients with TKA,it also provides a direction for key measures to improve clinical nursing work and further improve nursing work efficiency.MethodsPart Ⅰ Screening of core nursing outcomes in TKA patients during the perioperative period: The core nursing outcomes were further screened by reviewing 255 inpatient electronic medical records of patients undergoing unilateral artificial total knee arthroplasty in a tertiary hospital in Inner Mongolia from September to December 2020(joint surgery,rehabilitation,and sports medicine),and the common nursing diagnosis was linked to the relevant nursing outcomes.Part Ⅱ Revision of perioperative core nursing outcomes for TKA patients: The research team completed the revision of core nursing outcomes by compiling an expert questionnaire and conducting two rounds of Delphi expert correspondence to reach reliable expert agreement among clinically experienced orthopedic expert members.Part Ⅲ Application of interventions based on perioperative core care outcome indicators in patients with TKA: Patients from the Department of Joint Surgery of a top three hospital in Inner Mongolia who underwent unilateral TKA for the first time from July to October 2021 were selected,and the control group implemented routine nursing measures,and the intervention group implemented routine nursing and interventions based on the perioperative core care outcome index of TKA patients.The scores of knee range of motion,knee HSS function and Barthel index on the day of admission,7 days after surgery and 1 month after surgery were compared;the scores of the visual simulation scale of pain on the day of admission,24 hours after surgery,48 hours after surgery and 72 hours after surgery were compared between the two groups;the number of days of hospital stay,the time of first postoperative bedtime,and complications of the two groups were compared.Results1.The final screening revision of perioperative core nursing outcomes for patients with TKA was completed in a total of 7 items,namely: "pain level","activity","self-care: activities of daily living","tissue integrity: skin and mucous membranes","prevention of fall behavior","knowledge: disease and care",and "anxiety self-control".2.Patients in the intervention group were subjected to an intervention based on the perioperative core care outcome index of patients with TKA,and there were statistical differences in knee range of motion,knee HSS function and Barthel index scores at 7 days postoperative and 1 month after surgery(P<0.05),no statistical difference in postoperative 24h(P>0.05),there were statistical differences in the visual simulation scores of pain 48 h and 72 h after surgery(P<0.05),statistical difference in the number of days in hospital stay and time of first postoperative bedtime activity(P<0.05),and statistical differences in postoperative complications nausea,vomiting and constipation(P <0.05),there were no statistical differences in surgical incision bleeding,deep vein thrombosis,and surgical incision infection(P>0.05).Conclusion1.Based on the "Classification of Nursing Outcomes",combined with electronic case review,literature review and questionnaire survey,this study initially screened the core nursing outcomes of TKA patients in the perioperative period,and finally formed a revised version of the perioperative core nursing outcomes of TKA patients by Delphi experts,and the screening revision methods and processes were true and scientific,which could effectively evaluate orthopedic TKA patients.2.Nursing interventions based on core nursing outcomes can effectively improve the level of perioperative health behavior in patients with TKA,effectively improve postoperative knee function,and provide a practical method for caregivers to implement perioperative care in patients with TKA in clinical practice,and can be further tried to promote application in patients with orthopedic TKA. |
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