| Objective:This study analyzes the current situation and influencing factors of clinical nursing difficulty for elderly people with cognitive impairment(aged 80 and above),and understands the main factors that affect the difficulty of clinical nursing for elderly people with cognitive impairment.It provides a reference basis for the effective implementation of clinical precision nursing services,rational allocation of nursing human resources,and scientific nursing management work.Methods:This study adopts a mixed research method.1.Quantitative research: Using cross-sectional survey method for research.Convenient sampling and questionnaire survey were conducted on elderly patients with cognitive impairment and clinical nursing staff responsible for daily care of the elderly in tertiary and first-class comprehensive hospitals in Liaoning Province.Using a general information survey questionnaire,a patient nursing difficulty assessment form,a simple mental state examination scale,and a concise neuropsychological scale as evaluation tools,the current status of clinical nursing difficulty in elderly patients with cognitive impairment was investigated and influencing factors were analyzed.SPSS26.0 and EXCEL software were used for statistical analysis of questionnaire data.The basic information of elderly people with cognitive impairment was analyzed through sample frequency analysis.The clinical nursing difficulty of elderly people with cognitive impairment was analyzed through descriptive statistics.The influencing factors of clinical nursing difficulty of elderly people with cognitive impairment were further analyzed through independent sample t-test,univariate analysis,Pearson correlation analysis,and multiple linear regression analysis.2.Qualitative research: Using descriptive research methods to conduct research.On the basis of reviewing the research results and visiting expert opinions in the early stage,the researchers designed their own interview outline.After the pre investigation,the outline content was improved.Using destination sampling method,the nursing staff responsible for clinical nursing work for elderly patients with cognitive impairment were selected as the research subjects.Finally,a total of 15 clinical nursing staff were included.By conducting semi-structured interviews and using content analysis to analyze transcripts to determine the theme,we aim to gain a deeper understanding of the current nursing difficulties and influencing factors faced by clinical nursing staff in the care process for elderly patients with cognitive impairment.Results:1.The results of this study show that the clinical nursing difficulty score of the elderly with cognitive impairment is(34.16 ± 5.48),which is at a high nursing difficulty level.2.The results of univariate analysis and correlation analysis showed that age,education level,marital status,residential status,nature of previous work,income,payment method of medical expenses,duration of dementia,nursing level,number of chronic diseases,and types of medication taken during hospitalization were related to differences in nursing difficulty levels among elderly people with cognitive impairment,and the differences were statistically significant(p<0.05);There is a negative correlation between the difficulty of clinical nursing for elderly patients with cognitive impairment and their cognitive ability level,a positive correlation with the severity of their mental and behavioral symptoms,and a positive correlation with the pain level of their mental and behavioral symptom nursing.The lower the patient’s cognitive function score,the higher the difficulty level of clinical nursing;The higher the severity of patients’ mental and behavioral symptoms,the greater the difficulty of nursing care and the more severe the pain caused by clinical nursing staff.3.The results of multiple linear regression analysis showed that seven variables,including age,marital status,residential status,nursing level,cognitive ability,total severity of mental and behavioral symptoms,and total pain of mental and behavioral symptoms,entered the clinical nursing difficulty regression equation for elderly patients with cognitive impairment,and the differences were statistically significant(p<0.05).4.The qualitative research results extracted five themes and 14 sub themes: theme 1: patient’s own factors(demography factors,the impact of cognitive function changes,the impact of mental behavioral symptoms);Topic 2: Nursing level factors(clinical nursing work,comprehensive abilities of nursing staff,nursing safety risks,and response methods to reduce nursing difficulty);Topic 3: Factors of nurse patient communication;Topic 4: Social support factors(caregiver’s ability to assist in nursing,attitudes of children and family towards the elderly);Theme 5: Nursing environmental factors(ward environment layout,instrument and equipment configuration,hospital policy support,medical team cooperation,and multidisciplinary team collaboration).Conclusion:1.The difficulty of clinical nursing for elderly people with cognitive impairment is at a high level.The main factors that affect the difficulty of clinical nursing for elderly patients with cognitive impairment are age,marital status,nursing level,residential status,cognitive function level of patients,and psychological and behavioral symptoms of patients.2.The five main thematic factors that affect the difficulty of clinical nursing for elderly patients with cognitive impairment are patient factors,nursing level factors,communication between nurses and patients,social support,and nursing environment factors.Among them,chronic disease prevalence,nursing level factors,communication between nurses and patients,social support,and nursing environment factors among their own factors supplement the quantitative research results.3.Regarding the relevant factors that affect the difficulty of nursing care for elderly people with cognitive impairment,explore the main measures to reduce the difficulty of clinical nursing care for elderly people with cognitive impairment from multiple perspectives such as patients,clinical nursing work,nurse patient communication,social support,and environment,and improve the quality of clinical nursing. |
