| Objective:A cross-sectional investigation was conducted to understand the current situation of clinical nurses’ rehabilitation management of patients with neurogenic dysphagia in Shanxi Province,and to master the relevant knowledge and behaviors of medical staff on rehabilitation management of neurogenic dysphagia,so as to provide reference for further improvement of rehabilitation nursing program.On the basis of the results of the previous cross-sectional investigation,the literature on the management of neurogenic dysphagia at home and abroad was systematically searched,and the corresponding rehabilitation and nursing program was formulated in combination with the International Classification of Functioning,Disability,and Health theory,and the preliminary empirical study was conducted,which was applied to the patients with neurogenic dysphagia.The scale was used to evaluate the changes of the program on patients with neurogenic dysphagia,such as depression water test,eating questionnaire evaluation tool,improvement of daily living ability scale,swallowing quality of life questionnaire,hemoglobin,serum total protein,albumin and prealbumin,in order to verify the scientific,normative and sustainable nature of the program and improve the quality of rehabilitation and medical treatment effect of patients.Methods:Part I: Through objective sampling,clinical nurses meeting the exclusion standard in hospitals at all levels of Shanxi Province from January 2022 to March2022 were selected as the research objects.The main departments included: neurology,neurosurgery,rehabilitation medicine,geriatrics,mental health,etc.The self-prepared questionnaire was used to understand the current situation of rehabilitation nursing management of clinical nurses for patients with neurogenic dysphagia,and to explore how to better serve patients with neurogenic dysphagia and develop more comprehensive rehabilitation programs.Part II: A total of 80 patients who were hospitalized in the Department of Rehabilitation Medicine of a Grade-III hospital in Taiyuan,Shanxi Province from April 2022 to October 2022 and which met the inclusion and exclusion criteria were selected by convenient sampling.The control group received conventional rehabilitation nursing,and The experimental group was treated rehabilitation nursing based on International Classification of Functioning,Disability,and Health theory.The intervention time of this study was 4 weeks.Before and one month after the intervention,the changes of the patients were assessed using the Kubota Water Swallowing Test,eating assessment tool-10,Mordified Barthel Index,the Swallowing-Quality of life,hemoglobin,serum total protein,albumin,and prealbumin.SPSS 26.0 software was used to process and analyze the data.The measurement data conforming to the normal distribution were expressed as mean and standard deviation( ±s),and the counting data were expressed as frequency(n)and percentage(%).Paired sample t test,independent sample t test and chi-square test were used,and the test level α=0.05.P<0.05 indicated that the difference was statistically significant.Results:Part I:the self-evaluation scores of nurses’ understanding of neurogenic dysphagia and nursing knowledge related to intermittent tube feeding were not high;For the complications and risk management of neurogenic dysphagia,the scores of nurses’ answers were low;As for the feeding style of patients with neurogenic dysphagia,65.22% of hospitals or departments still use indwelling gastric tube,and only 17.39%use intermittent tube feeding;Only 12.32% of nurses believed that doctors had taken positive measures to deal with patients with neurogenic dysphagia;Most nurses are willing to help patients manage swallowing disorders and share and learn swallowing related knowledge.Part II:At the end of the intervention,all 80 patients had completed the whole rehabilitation training cycle.There were 40 cases in the experimental group and 40 cases in the control group.After comparison,there were no significant differences in various questionnaire scores and indicators between the two groups(P>0.05),indicating that the two groups of patients were comparable.One month after intervention,the degree of dysphagia in the experimental group(Kubota Water Swallowing Test)from I to IV degree were 9,17,8,4and 2 cases,while in the control group were 5,11,13,7and 4 cases,the difference was significant(Z=-2.124,P < 0.05).One month after intervention,the eating assessment tool-10 in the experimental group was(14.08±2.83)points,which was significantly lower than that in the control group [(17.23±4.42)points].One month after intervention,the Modified Barthel Index in experimental group was(79.18±8.26)points,which was significantly higher than that in the control group[(74.80±6.29)points].One month after intervention,the Swallowing-Quality of life in the experimental group was(148.93±14.72)points,which was significantly higher than that in the control group [(133.05±12.45)points].There were no statistically significant differences in hemoglobin,serum totarotein,albumin and prealbumin before intervention in all(P>0.05).The hemoglobin,serum totarotein,albumin and prealbumin of the experimental group were(135.15±15.3)g/L,(69.40±6.73)g/L,(42.48±5.14)g/L,(262.99±43.77)g/L,which were significantly higher than those in the control group(121.05±16.5)g/L,(66.11±4.60)g/L,(40.03±4.74)g/L,(208.75±50.40)g/L,the differences was statistically significant(t values were 2.218～5.139,all P < 0.05).Conclusion:Through literature search,integration of the results of cross-sectional investigation,through expert meeting method and research group discussion,continuous improvement and modification of the formulated program,formed the rehabilitation nursing management program based on the International Classification of Functioning,Disability,and Health theory,and conducted targeted training for nurses,optimize clinical practice,and improve standardized management.A simple randomized controlled trial was conducted to verify the feasibility and effect of the rehabilitation nursing program based on the International Classification of Functioning,Disability,and Health theory.Compared with the control group,the experimental group significantly improved the swallowing function status of patients with neurogenic dysphagia,enhanced the ability of daily living,improved the quality of life of patients and improved nutritional status and other indicators.These results indicate that this research scheme can improve the quality of medical treatment for patients with neurogenic dysphagia and lay a foundation for clinical workers to carry out relevant rehabilitation intervention measures. |
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