Effecting of Discharge Planning on the Prognosis of Stroke Patients
|School||Southern Medical University,|
|Keywords||Stroke Discharge planning Second stroke rate Daily living ability Quality of life Intervention|
Objective:Cerebral apoplexy is the fist killer of human health and with higher prevalence, higher case fatality rate and higher mutilation rate, which become a globe problem. In order to assist patients transferring from hospital to family safely, and enhance the patient’s self-care ability, reduce the rate of return to hospital again, Nursing scholars at home and abroad carried out the exploration of a variety of nursing intervention including hospital care and discharge care on stroke patient’s prognosis of the immediate and long-term outcome. In china, hospital care has formed a complete system of care. But the discharge care which means that patients discharged from hospital to their destinations including return to their families and access to community hospitals or old people’s home had not yet carried out a systematic study. In this study, we established stroke patient’s discharge planning care programs employed the randomized controlled method and explored such specific stroke care programs on the prognosis of the patients.Methods1:The effects of discharge planning on stroke patient’s prognosis120cases stroke patients who admitted to department of neurology for the first time come from two general hospital of third grade In strict accordance with the inclusion and exclusion criteria, the patients were divided into60cases of experiment group and60cases of control groups using the method of random number table. The experiment group consisted40cases of men and20cases females and with average age60.50±6.82years old. Of whom included50cases of cerebral infarction and10cases of cerebral hemorrhage. The control group had40men and28females suffered from cerebral infarction46cases and cerebral hemorrhage14cases with average age of58.63±6.08years old. Contents of Investigation include age, gender, education level, marriage, occupation, medical payment, type of diseases, complication and so on. The two groups of patients’gender, aged, types of disease were comparable. Assessment tools consisted of BI scale, quality of life scale, patients’compliance registration form and the stroke knowledge questionnaire and patients’satisfaction survey table. The control group was given regular nursing, experiment group given regular nursing plus discharge planning interfering. Discharge planning consisted following:(1) To establishment of a team including specialist nurse, doctors, rehabilitation therapist, community nurse, specialist nurse made discharge planning.(2) To develop individualized rehabilitation training process according to motor relearning program (MRP) and Burnnstom disease staging.(3) The stroke knowledge training to patients and caregiver.(4) Providing health booklets to patients and caregivers.(5) Developing the patients’compliance registration tables after discharge from hospital.(6) Convening community nurses presentation community resource.(7) Take door follow-up and telephone follow-up. Two groups of patients all were followed up for6months after discharge.The patients’ADL score and survival quality were evaluated both the experiment group and control group before intervention,3days before discharge,1month after discharge,3months after discharge respectively. Both groups of patients and their caregivers were given the stroke knowledge questionnaire survey before intervention and3days before discharge, and evaluated the patients’compliance and recurrence of stroke and satisfaction rate during follow-up.2:Surveying the demands of caregivers and training them60cases of experiment caregivers consisted of42patients’relatives and18employees with average age of46.12±7.50years old. The control group patients’ caregivers of60cases come from45relatives and15employees aged48.75±8.47years old. Contents of Investigation include age, gender, education level, and the relationship with the patients. The investigation was carried out on-the-spot and the questionnaires were distributed by3advanced practice nurses (APN) through the unified training. To sorting the questionnaires scores according to the demand scale, the experiment group taken a specific training according to the sorting results, control group with conventional nursing care education method. The difference between two groups’stroke knowledge was compared at admission and before discharge.3:Statistical analysisBuilding database with SPSS13.0and entering datum, making statistics and analysis. The measurement datum expressed in the x±s style. The comparison between two group patients’BI and the total QOL scores and each item of QOL score at admission,3days before discharge, the first month, the third month, the6th month after discharge with repeated measure analysis of variance. The independent-sample t test was employed comparing among different time points between two groups. The repeated measure analysis of variance was adopted comparing among different time points in each group and multiple comparisons with LSD method,Spherical hypothesis test took the Greenhouse regulated result. The t test was used to compare the Questionnaire score about stroke knowledge between two groups at admission and discharge. And the regulated results using admission questionnaire scores was given taken with the repeated measure analysis of variance. Significant level a is0.05. Results1:The experimental group and control group patients’daily living skills comparison after discharge planning intervention1.1The comparison of the daily living abilities between two groups.To compare the two groups’daily living abilities at each time point with repeated measure analysis of variance, the results suggested that the BI index in experiment group was higher than that in control group(F=30.487,.P=0.000). there was also significant difference between two groups at different follow-up time point (F=896.804, P=0.000). to compare the BI index between two groups at each time point, there was no significant difference in BI index at admission and3days before discharge(P=0.655, P=0.718), the BI index in the experiment group were higher than that of the control group after discharging from hospital at1,3,6month (P<0.005)1.2The characteristic of the BI scores change at different time point within each group.To compare the BI index at different time point within each group, the experiment group’result showed that the patients’BI index were increased progressively with the extension of intervention time. There was significant difference in BI index between the three time points (discharged from hospital at first, third,6th month) and the two time points (at admission and3days before discharge)(P<0.005). The experiment groups BI scores reached high level at first month after discharge, and then increased progressively and slowly and reached peak until test ended. The control groups’result suggested that BI scores enhance along with the extension of time, the difference of BI index reached significant at each time point besides the difference between third month and6th month after discharge.2:The comparison of the quality of life between the two groups2.1The comparison of QOL at different time point between the two groups To compare the total scores of QOL between two group at each time point with repeated measure analysis of variance, the results showed that there was significant difference in QOL total score between two group (F=150.994, P=0.000). And there was also significant difference in QOL among different time points (F=1044.881, P=0.000), and there was interaction (F=69.654, P=0.000).2.2The comparison of total QOL score at different time point in each groupTo compare the total QOL scores at different time point in each group, the results showed that the total QOL scores in the experiment group was increasing progressively with the extension of intervention time until it reached peak at6th month after discharge. And there were significant difference in total QOL scores comparing among different time point (P<0.05). The control groups results showed that the total QOL scores raised correspondingly with time extension, but the rate of climb was mild after discharge, and there was no significant difference between the first and third month after discharge (P=0.930)3:The influence of transitional care of discharge discharge planning on patients’ complianceTo compare the two groups of patients’compliance scores at6months after discharge with descriptive statistics test of x2test. The results suggested that the compliance of experiment group were higher than those of control’in5items such as taking medicine regularly (x2=20.809, P=0.000), Control of alcohol and tobacco (x2=25.724, P=0.000), self monitoring health condition (x2=40.377, P=0.000), rehabilitation training (x2=28.831, P=0.000), appointment on time (x1=36.777, P=0.000) besides the item of eating a healthy balanced diet(x2=3.028,P=0.082).4:The effects of transitional care of discharge discharge planning on the second stroke in patients with cerebral apoplexy There were3patients stroke recurred in the experimental group in six months of study period with recurred rate of5.45%(3/55).10cases relapsed in control group (17.86%,10/56). The experiment groups’recurred rate was lower than that of control at6months after discharge from hospital with x2test (x2=4.128, P=0.042)5:Two groups of patients’stroke knowledge questionnaire score on admission and3days before discharge.The results showed that there was no significant difference in mastering stroke knowledge between the two groups (P>0.05). The experiment groups’stroke knowledge questionnaire score were higher than those of control group through training at discharge(90.00±6.11vs80.17±5.96, t=8.942, P=0.000), the result was the same as adjusted with the score at admission (F=79.131, P=0.000)6. The patients’nursing satisfaction comparison of the two groups during six months period of follow-up after discharge.The results showed that the experiment groups’nursing satisfaction was higher than that of control, Nursing intervention can significantly improve the discharge care satisfaction in patients with cerebral apoplexy (83.82±20.14vs56.79±21.24, t=6.878, P=0.000), the result was the same as adjusted with the score at admission (F=46.234, P=0.000)7. Stroke caregivers demand survey results shown that (1) the total score of the main caregivers’ demand was48.62±2.38during patients being in hospital, the experiment groups’ score was48.40±2.20and the control’48.85±2.55(t=-1.033,P=0.304).(2) the total score of the main caregivers’ demand was50.00±2.80after discharge from hospital, the experiment groups’score was51.1±2.88and the control’48.9±2.52(t=4.661,p=0.000)8:The knowledge questionnaire survey of the stroke patients’caregivers suggested that there was insufficient or lack of stroke knowledge. There was a rapid improvement of knowledge score through the training, the experiment group’score was higher than that of control (90.83±6.71/64.83±8.33, t=18.820, P=0.000), the result was the same as adjusted with the score at admission (F=385.681, P=0.000)Conclusion3.1The transitional care of discharge planning could reduce second stroke rate in patients with cerebral apoplexy.3.2The transitional care of discharge planning could increase stroke patients’daily living skills after discharge. With the extension of time after discharge, the patients’daily living skills improve more than that of control.3.3The quality of life of experiment group’patients after discharge was significantly improve than the controls’including body function, vitality, social communication and mental health.3.4Due to better care and urged, the experiment group patients’compliance was better than those of control’, including taking medicine regularly, returning visit on time, controlling of alcohol and tobacco and rehabilitation training.3.5This study found that there was insufficient or lack of stroke knowledge among the caregivers, There was a rapid improvement of knowledge score through the training, the experiment group’score was higher than that of control, these may created near and long-term effects on the prognosis of the patients with cerebral apoplexy.In conclusion, The transitional care of discharge t planning can reduce second stroke rate and improve patients’daily life abilities and quality of life after discharge from hospital. And may creative a positive effect on the improvement of patients knowledge level, compliance and nursing satisfaction. Through the caregivers’knowledge training, the patients acquired more professional cares, functional training, taking medicine more regularly than control group, all of these could create a positive effect on the long-term prognosis in stroke patients.