Application Of Hospital-home Transitional Nursing Model In Self-management Of Patients With Chronic Heart Failure

ObjectiveTo construct a hospital-home transitional care intervention program for patients with chronic heart failure and to explore the effectiveness of the program on self-management of patients with chronic heart failure,with the aim of providing some empirical studies on clinical interventions for the transitional care of patients with chronic heart failure.MethodsThis study consists of two parts:Part I: Development of the intervention program.(1)Domestic and international databases were searched for evidence related to nurse-led hospital-home transitional care for patients with chronic heart failure,the literature quality of the included guidelines and literatures was evaluated according to the evaluation criteria.The JBI evidence recommendation system was used to score each piece of evidence and give the recommendation level.(2)Experts in relevant academic fields were invited to conduct 2 rounds of expert correspondence to correspondence,revise and discuss the initial protocol,and finally determine the intervention protocol for the hospital-home transitional care model.Part II: Evaluation of the clinical application of the hospital-home transitional care intervention program for patients with chronic heart failure.(1)A convenience sampling method was used to select 60 patients with chronic heart failure who met the inclusion and exclusion criteria in a tertiary care hospital in Guangdong Province from February2022 to August 2022.Control group: conventional model of care was used.Research process: The control group was treated with conventional mode nursing,and the intervention group was treated with hospital-home transitional mode nursing intervention based on the control group.(2)Effectiveness evaluation: The investigators used the Chronic Heart Failure Self-Efficacy Scale,Chronic Heart Failure Self-Management Scale and Transitional Care Quality Evaluation Scale to assess patients’ self-care ability,self-efficacy level,transitional care quality and patient satisfaction at the time of admission,1 month and 3 months after discharge,respectively;assessment of objective indicators: left ventricular ejection fraction(LVEF)on cardiac ultrasound and plasma NT-pro BNP levels;assessment of readmission and emergency visits by obtaining patients’ emergency visits and readmissions through subjective statements from patients/family primary caregivers and the hospital HIS system.(3)Statistical methods: In this study,IBM SPSS 25.0 software was used to analyze the collected data and statistical methods such as statistical description,t test of two independent samples,Chi-square test and repeated measure analysis of variance were used to compare the differences among indicators.P <0.05 was statistically significant.Results1.An evidence-based intervention protocol for a hospital-family transition model was developed.The protocol was developed by reviewing national and international studies on nurse-led transitional care models from hospital to home,collecting best practices and experiences both at home and abroad,and developing guidelines on effective intervention strategies.The evidence was integrated,reviewed and adapted through expert correspondence in the light of actual clinical situations,resulting in a final intervention protocol for a model of hospital-to-home transitional care.2.After the implementation of the intervention plan of the hospital-home transitional nursing model,the effect of the intervention group and the control group was evaluated.(1)Self-efficacy: the two groups did not differ statistically significantly(P > 0.05)at enrolment;at 1 month and 3 months after the intervention,the intervention group had higher self-esteem than the control group(6.55±0.57>5.67±0.47、6.75±0.67>5.71±0.93)and the statistically significant differences(P < 0.05).(2)Self-management skills: at enrolment,there was no statistical difference between the two groups in the score(P>0.05);1 month and 3 months after the intervention,patients in the intervention group had higher self-efficacy scores than those in the control group(67.00±1.91>63.62±4.05、68.03±1.86>64.11±1.76),with statistically significant differences(P<0.05).(3)Ultrasound examination of the heart: at enrolment,the difference between the intervention and control groups was not statistically significant(P>0.05).Echocardiographic findings after 1 and 3months of intervention were statistically significantly(P<0.05)higher in the intervention group than in the control group(52.10±5.60>46.75±7.93、56.24±4.46>51.13±8.39).(4)Laboratory tests(NT-pro BNP): at enrolment,the differences between the intervention and control groups were not statistically significant(P > 0.05);at 1 month and 3 months after intervention,laboratory results were lower in the intervention group(1181.34±98.72<1253.71±85.08、1104.86±98.22<1291.53±84.76)than in the control group,and the differences were statistically significant(P < 0.05).(5)Readmission to hospital: 3 months after hospital discharge,There was no statistically significant advantage for rehospitalization between the both groups in readmission to hospital(> 0.05),but there was a statistically significant difference in the use of emergency care in the intervention group(< 0.05).(6)Quality of transitional care assessment: the quality of transitional care score was higher in the intervention group(76.51±1.74)than in the control group(65.53±2.09),with a statistically significant difference(<0.05).Conclusion1.Transitional nursing mode can improve the self-efficacy level and self-management ability of patients with chronic heart failure,improve left ejection fraction,plasma NT-pro BNP level,and reduce patients’ emergency visits.2.Transitional care model gains patient acceptance,effectively improving patient satisfaction,and has popularization value in the management of patients with chronic heart failure.