| Objective:Taking the concept of rapid rehabilitation surgery as the standard content,the concept of rapid rehabilitation surgery is preliminarily constructed to apply to the perioperative clinical nursing path of unilateral total hip arthroplasty.By changing the traditional concept of rehabilitation,we will actively explore the principle of taking the hospital as the main body and the patient as the core,rapid rehabilitation process aimed at disease,to improve the level of medical work,optimize the perioperative care program,make full use of and develop limited medical resources,minimize surgical stress response,reduce the incidence of postoperative complications and readmission rate.More over,reducing the hospitalization time of patients and reducing the hospitalization expenses of patients,improve the efficiency of medical work and the satisfaction of doctors and patients.The initial construction of this clinical route ultimately provides a favorable reference value and evidence-based basis for the continuous improvement and development of nursing work.Method:1.Through the retrieval of CNKI,Wanfang Medical Database,Pubmed,Embase,Web of Science,Meline and other databases,to read a large number of documents,refer to the perioperative clinical pathway of orthopedic hip replacement in the 2016 National Ministry of Health.Based on evidence-based medicine,accept the advises and used the experience of clinical senior medical workers to construct and apply a peri-operative fast-recovery clinical nursing route module for unilateral total hip arthroplasty.2.According to the working age,academic qualifications,work departments,and professional titles,etc.,a structured team of experts is sent to be consulted.Based on the relevant theories and evidence-based support,Delphi’s expert letter of inquiry(Delphi method)is used to solicit experts.Opinions on the access criteria,discharge criteria,variation,implementation evaluation indicators for clinical nursing pathways,implementation of nursing pathways,etc.,leading to consistent observations,and ultimately confirm the clinical nursing path perioperative the period of unilateral total hip arthroplasty based on the concept of rapid rehabilitation surgery.3.A simple randomization method was used to evaluate the clinical pathway and the patients who underwent unilateral total hip arthroplasty at the No.9 Hospital of the Chinese People’s Liberation Army from May 2017 to February 2018 were collected.From September to September 2017,it was the control group(traditional rehabilitation nursing route group).From October 2017 to February 2018,the hospitalized patients were the experimental group(rapid rehabilitation nursing route group).The basic conditions and extubation time of the two groups of patients,hospitalization time,length of hospital stay,hospitalization cost,time of bed removal,complications,Harris score(3d,10 d,postoperative 1 month,postoperative 3 months)were compared.SPSS 21.0 statistical software was used for analysis and processing of results.The descriptive analysis was used for the patient’s basic situation,and the T-test was used for the effect evaluation index.If the normal distribution was not followed,a non-parametric rank sum test was used.The X2 test was used for the ratio and composition ratio.The significance test for this study was 0.05.Result:1.An expert group was set up in the Department of the experimental unit to make constructive comments on the content of THA patients’ rapid rehabilitation nursing.The Fast Track Surgery of CNP in the perioperative period of THA patients was drafted.The nursing contents involved in this path were carefully screened and judged,and the initial rapid recovery CNP was formed.The result of expert inquiry:(1)Expert positive coefficient: the recovery rate of two rounds of experts’ correspondence is 94.74% and 100% respectively;(2)The authority degree of expert opinion Cr=0.965;(3)The first round of expert consultation results is expressed by expert approval rate,and the result shows that the agreement rate of each consultation item is between the 234 items of the three grade index entries.A total of more than90% items,accounting for 190 items,accounting for 81.1% of the total number ofitems,24 items of rapid rehabilitation nursing,100%,and 100% of the second rounds of experts’ correspondence questionnaire,the minimum value 2,the maximum value5,and the average 4.62 points;(4)The variation coefficient of the second rounds of expert inquiry questionnaire was between the 0~0.23 and the expert opinion The significant level of the coordination coefficient was P < 0.05;(5)In this study,the reliability of the two rounds of expert consultation table was analyzed by Cronbach ’s Alpha.The results of the first round were 234 items,the alpha coefficient was 0.769,the second rounds were 242 items,and the alpha coefficient was 0.817.2.clinical application results: there was no statistical difference between the two groups of general data and general surgical information,and the two groups were comparable.(1)there was a statistical difference between the two groups of drainage tube extubation time,out of bed activity time and hospitalization time(P < 0.001);(2)perioperative complications,the number of complications in the experimental group decreased significantly(P < 0.05);(3)Harris score: the two groups were all in postoperative 3D,postoperative 10 d,January after operation,and March after the operation.Harris scores were compared,the total evaluation was four times.The joint activity was estimated at about 50 points in the experimental group third days after the operation,and 90 points could be reached in March after the operation.The control group scored about 42 points in third days after the operation,80 in March after the operation,the joint grade was well evaluated,and P < 0.001;(4)Hospitalization expenses(except for examination fee and treatment fee)were significantly different(P < 0.001).3.the variation factors in the clinical pathway were analyzed in detail: the variation factors were mainly affected by the disease itself,the patient’s personal,family and social environmental factors,and the unexpected events(such as the cardiovascular disease),and the patients failed to follow the normal rehabilitation nursing process.Conclusion:In this study,through reading a large number of literature,by consulting related databases,using the relevant theory and evidence-based medical evidence as a support to initially establish a perioperative rapid rehabilitation CNP in unilateral THA patients,using Delphi method to conduct two rounds of expert letter inquiry,4in-hospital experts.15 out-of-hospital experts,excluding one letter of inquiries from non-effective experts,and finally enquiring about 18 experts,screened,judged,and further improved the content of the nursing route,and finally formed a clinical nursing procedure that was scientific,feasible,and practical.A simple randomization method was used to evaluate the nursing route.Finally,the extubation time was reduced by an average of 0.84 days,the average time to get out of bed was 2.28 days ahead of schedule,the hospitalization time was shortened by an average of 5.47 days,and the hospitalization cost was reduced by an average of 4418.92 yuan.The perioperative period of unilateral total hip arthroplasty rapid rehabilitation clinical nursing path was performed.The practice not only reduces the physical and psychological burden during the patient’s illness,but also greatly improves the quality of medical treatment and clinical results,and ultimately provides a favorable reference value and evidence-based basis for the continuous improvement and development of nursing work. |
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