| Objective:Pulmonary rehabilitation is a well recognized and an important non-drug treatment strategy for chronic obstructive pulmonary disease.The lack of professionals is a critical reason for the low implementation rate of pulmonary rehabilitation.The purpose of this study is:(1)To investigate the implementation ability of pulmonary rehabilitation,the current situation and needs of pulmonary rehabilitation knowledge training of medical staff in county-level hospitals.(2)To construct a training mode and evaluation system for healthcare professions in county-level hospitals based on Taylor theory and Coriolis model.(3)To implement and assess the feasibility and scientificity of the training mode and evaluation system.Methods:1.Investigate the implementation ability,training status and demand of pulmonary rehabilitation :(1)Quantitative research : by random sampling,a cross-sectional study was conducted to describe the implementation ability,training status and demand of pulmonary rehabilitation among the medical staff in county-level hospitals;(2)Qualitative research: pulmonary rehabilitation experts and medical staff were interviewed to getthe suggestions and views on the training mode and evaluation system.2.Construct the training mode of healthcare professionals engaging in pulmonary rehabilitation in county-level hospital :(1)Combining with the previous research results,literature review,and Taylor theory,a consultation draft of the training modefrom the aspects of training objectives,training contents,training organization and training evaluation was constructed.(2)Indicators in the mode were screened through Delphi expert consultation;the index weight were got through analytic hierarchy process.Finally the implementation draft of the training mode of healthcare professionals engaging in pulmonary rehabilitation in county-level hospitals was formed.3.Implement and evaluate the training mode of healthcare professionals engaging in pulmonary rehabilitation in county-level hospitals: The training system is implemented through the selection of teachers,the construction of implementation plan and curriculum,the development of teaching resourcesand the recruitment of students.The effect was verified by Coriolis model.(1)Reaction layer: a survey was used to describe the trainees with training satisfaction and course evaluation form;the qualitative interview was used to understand the learning experience and suggestions of students.(2)Learning level :quantitative research was used to analyze the results of students’ formative assessment and completion assessment.(3)Behavioral level:quantitative research was used to analyze the implementation ability of pulmonary rehabilitation before,after and 6 months after training.(4)Results: quantitative research was used to compare the implementation and quality of pulmonary rehabilitation before and after training.Results:1.Investigate the implementation ability,training status and needs of pulmonary rehabilitation:(1)156 healthcare professionals participated in the survey,including 71 doctors,3 rehabilitation therapists and 82 nurses.The self-assessment of pulmonary rehabilitation implementation ability score(ranging from 37 to 185 points)was 71.23±11.3 points.The five items with lower score were: the ability to.use instruments completing functional tests such as cardiopulmonary exercise;b.the ability to make appropriate exercise prescription according to the exercise test results;c.the ability to conduct 6-minute walking test,muscle strength test and other tests;d.the ability to modify exercise plan properly;E.the ability to make personalized exercise prescription.(2)Only 21(13.5%)had received pulmonary rehabilitation education;13(8.3%)knew the effect of pulmonary rehabilitation.(3)The score of pulmonary rehabilitation knowledge training needs were 212.4±12.5 points(ranging from 45 to 225 points).The 5 items with high demand were:a.use of inhaled medication;b.lung function evaluation and analysis;c.dyspnea assessment and management;d.self-management of COPD patients;e.interpretation of blood gas analysis results.(4)Nine pulmonary rehabilitation experts were recruited to participate in the interview.Two themes are summarized:a.improving the training system,b.improving the support system.A total of 15 medical staff were recruited to participate in the interview,and two themes were summarized: a.insufficient cognition and knowledge of pulmonary rehabilitation;b.urgent need for professional training in-pulmonary rehabilitation.2.Construct the training mode of healthcare professionals engaging in pulmonary rehabilitation in county-level hospitals:(1)The consultation letter contains 4 primary indicators(training objective,training content,training organization and training evaluation),24 secondary indicators and 103 tertiary indicators.(2)17 experts participated in the inquiry,including 10 doctors,5 nurses and 2 rehabilitation therapists.The recovery rate of the two rounds of inquiry was 100%.(3)In the two rounds of correspondence,the Kendall’s w coefficient of each dimension ranges from 0.132 to 0.285,and the Kendall’s w coefficient of the total items are 0.173 and 0.201 respectivelywith p values less than 0.05.The consistency of expert opinions is high.(4)the selection rate of each item in the two rounds of correspondence with experts ranges from 56.25% to 100.00%,the full score rate of the index ranges from 17.65% to 100%,and the average is higher than 4.0.The coefficient of variation(CV)of three and four three-level indicators in the two rounds of consultation is higher than 0.25.(5)Analytic hierarchy process:the CR value of each item is less than 0.1,and the result is consistent.The weight(WI)of criterion layer I to target layer is: Culture target was0.1667;Cultured organization was 0.3333;Training content: 0.3333;Culture evaluation was 0.1667.(6)The top 6 weight(WI)of the target "training mode and evaluation system" at the scheme level is: a.case assessment was 0.0725;b.management system construction was 0.0505;c.pulmonary rehabilitation implementation rate before training was0.0347;d.pulmonary rehabilitation implementation rate after 6 months of training was 0.0347,e.theoretical knowledge assessmentwas 0.0268;f.skill assessment was 0.0268.(7)In finall,the implementation draft of the training mode of healthcare professionals engaging in pulmonary rehabilitation in county-level hospitals includes 4 primary indicators,26 secondary indicators and 117 tertiary indicators.3.Implement and evaluate the training mode of healthcare professionals engaging in pulmonary rehabilitation in county-level hospitals:(1)Implementation:127 people participated in the training,including 59 doctors,3 rehabilitationtherapists and 65 nurses.(2)Evaluation:(1)Reaction layer: the score of students’ satisfaction with teaching quality was 91.28±4.79;The satisfaction score of 26 theoretical courses was 4.87±0.13,and 12 skill courses was4.86±0.15.Twelve people participated in the interview and summed up four themes: positive training experience,suggestions for training,individual harvest and change,and thinking on developing pulmonary g rehabilitation.(2)Learning level : the average score of students was83.97±8.46,and the passing rate was 98.4%.(3)Behavior level: the pulmonary rehabilitation ability scores of students were 72.94±12.62,133.47±9.37 and 156.65±9.75 in pre-training,post-training and 6-month after training respectively.The top 5 riseing itemsare: I.the ability to formulate and adjust exercise and treatment plans suitable for different populations;Ⅱ.the ability to assess the risk factors of physiological and pathological lung diseases;Ⅲ.the ability to conduct 6-minute walking test,muscle strength and physical flexibility test;Ⅳ.the ability to assess quality of life and activity of daily living;Ⅴ.the ability to manage and treat dyspnea.(4)Results : I.rate of pulmonary rehabilitation implementation: 12.6% and 100%before and after training respectively;Ⅱ.Contents:more than 30% of pulmonary rehabilitation projects were carried out before trainingincluding home oxygen therapy,walking training,etc;After the training,upper limb function training,walking training,endurance training,resistance training,physical flexibility training,respiratory muscle training,home oxygen therapy,airway clearance training,etc were carried out in all the hospital.Ⅲ.quality of training: the prescription of pulmonary rehabilitation exercise before training is not comprehensive;.the coverage of exercise frequency,exercise time and exercise type in prescription after training is 100%,and the coverage of exercise intensity,exercise mode and exercise plan length is over 96.4%.Conclusion:1.The implementation ability of pulmonary rehabilitation of medical staff in county-level hospitals in Hunan Province is low,and the training demand of pulmonary rehabilitationis high.2.The constructed training and evaluation system of healthcare professionals engaging in pulmonary rehabilitation in county-level hospitals has high enthusiasm and authority of expertsas well ashigh consistency of content indicators.It is scientific and reliable,and has reasonable weight setting of each index.3.The trainees are highly satisfied with the training.After training,the qualified rate of students is high;pulmonary rehabilitation ability was improved.The training promotes the implementation rate and quality of pulmonary rehabilitation.The feasibility,scientificity and effectiveness of the training modeare verified.Figures: 6;Table: 67;Reference: 290... |
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