| Objective:Stroke is the leading disability factor in the global population.It has the characteristics of high disability rate and high morbidity.Stroke has a long rehabilitation period.The rehabilitation effect is closely related to long-term care behavior.With the aging of our society,the incidence of stroke is gradually increasing.Long-term rehabilitation nursing for stroke has become an increasingly prominent social problem.Because of the change of family structure in our country,more and more stroke patients are living in old-age institutions.The service ability of old-age institutions for stroke patients will directly affect the rehabilitation effect.This study focused on the rehabilitation status of stroke patients in old-age institutions in Jingzhou and the rehabilitation ability of old-age institutions to investigate the rehabilitation status of stroke patients in old-age institutions in Jingzhou city.To find out a series of problems existing in the rehabilitation process of stroke patients in old-age institutions in Jingzhou,and to conduct in-depth analysis of the related causes.Finally,combined with the results of the pilot intervention,the corresponding solutions are put forward,hoping that through this study,the related service level of the old-age institutions in Jingzhou can be improved,and the stroke patients in the institutions can get better rehabilitation,improve their quality of life,and provide reference for the future construction of hospital-old-age institutions stroke rehabilitation cooperation mode in this area.Method1.Research object1.1 Old-age institutions: According to Cluster sampling survey,8 old-age institutions in Shashi District of Jingzhou City were surveyed by convenience sampling method.Inclusion criteria are:(1)registration in civil affairs departments;(2)possession of operating licenses for pension institutions;and(3)voluntary cooperation with the survey.1.2 Stroke patients in old-age institutions: 96 stroke patients were investigated by cluster sampling.Inclusion criteria:(1)Patients with previous stroke history;(2)Voluntary respondents of patients or their families.(3)Those who have lived in an old-age institution for two months or more.Exclusion criteria:(1)Those who had a history of psychosis in the past.(2)Patients with malignant tumors and other malignant diseases.(3)Those who have lived in an old-age institution for less than two months1.3 Nurses in old-age institutions: 53 nurses were surveyed by cluster sampling method.Inclusion criteria:(1)Voluntary cooperation with investigators;(2)Actual care work in pension institutions.Exclusion criteria:(1)unwilling to cooperate with the investigation.2.Research tools2.1.Rehabilitation ability survey of pension institutions,based on the "Basic Standards of Service Quality of Pension Institutions" issued by the General Administration of Quality Supervision and Inspection on December 12,2017,formulated a questionnaire on service quality of pension institutions to assess the nursing ability of pension institutions.2.2 Fugl-Meyer,Berg,ADL,MMSE,Watian Drinking Water Test were used to evaluate the self-care ability,limb movement disorder,cognitive impairment,balance ability and swallowing function of stroke patients.The scale is an international general scale.The reliability and validity of the scale have been proved by a large number of studies.2.3 Survey of rehabilitation skills of nurses,using stroke nursing knowledge test papers to investigate,the formulation of the test papers by team members through a large number of literature review,referring to the national training materials for nurses,as well as stroke rehabilitation specialist nurses textbooks.3.ResearchersThe nurses specializing in stroke rehabilitation in our hospital received unified professional training and assessment,and conducted a simulation survey before the investigation,with the investigation ability.4.Research methods4.1 Team cooperation was adopted by specialist nurses.4.2 The survey was divided into two parts.For the first time,the subjects were 8 institutions for the aged,96 stroke patients and 53 nurses.The second survey included 36 stroke patients and 26 nurses who received nursing intervention in the experimental group.The time of investigation was 3 months after intervention.5.Evaluation methods5.1 According to the scores of each scale,the rehabilitation status of stroke patients was evaluated from both individual and comprehensive scores.5.2 Evaluate the service ability of old-age institutions according to the survey of rehabilitation service ability,including three aspects: hardware condition,management and nursing skills of nurses.5.3 Through the rehabilitation data of stroke patients in the experimental group and the assessment data of nurses’ working ability,we evaluated the combined working mode of hospital-pension institutions and the role of rehabilitation nursing for stroke patients.6.Statistical analysis(1)All data and related information of this research process were analyzed by SPSS24.0 statistical software.(2)Determining the rehabilitation evaluation index of the stroke patient,the survey results of the service organization of the aged care institution,and the scores of the knowledge test results of the caregiver strokes are described by counting and measuring.The measurement data were measured by mean ± standard deviation,the count data was described by frequency and percentage;the non-parametric rank sum test was used for comparison between the data sets of grade counts;(3)the general data of the caregiver was consistent with the normal distribution and the variance The data were analyzed by one-way ANOVA or t-test to analyze the impact of general data on nursing ability.In the analysis of factors affecting the ability of nursing staff,the assessment of the ability of nursing staff was taken as the dependent variable,and the one-way analysis of variance was used.The relevant indicators in the meaningful analysis were analyzed by multivariate stepwise linear regression;(4)In the analysis of the intervention effect of the nursing staff training assessment results,the comparison of the nursing staff before and after the intervention,the normal distribution measurement data were analyzed by independent sample t test;(5)In the analysis of the rehabilitation effect of stroke patients before and after intervention,the independent measurement t-test was used for the normal distribution measurement data,and the non-parametric rank sum test was used for the grade data(ordered variables);(7)P<0.05 for the difference Statistical significance.Result1.First survey result1.1.Rehabilitation status of stroke patients: 20% of the total number of elderly patients admitted to the elderly in the old-age care institutions,including ischemic stroke accounted for 75%;the proportion of patients with 1-2 strokes was 94%.The proportion of patients with more than 2 years of disease was 49%;most patients with stroke had different degrees of dysfunction,89% of people with dyskinesia,86% of people with balance disorders,79% of people with mental impairment,swallowing Those with dysfunction accounted for 78%.1.2.Service capacity of the aged care institutions: The average occupancy rate of the old-age care institutions is 62%.100% of the institutional patients have missing or incomplete files,no rehabilitation facilities,and inadequate management mechanisms.1.3.Caregiver: The level of nursing staff’s education level is 83%,the average age is 53 years old,only 18% of the caregivers have obtained the nursing staff qualification certificate,the average monthly salary is 2048 yuan,and they have never participated in professional training.The proportion of personnel accounted for 66%,the proportion of daily work hours of 12 h or more accounted for 57%,the proportion of people who had a sense of power in the work was 96%,and the average score of stroke rehabilitation nursing knowledge was 45 points.Univariate analysis of the general data and nursing ability and multiple regression analysis showed that the influence of the nursing staff’s education level,age,monthly salary,family support,obtaining the certificate of practice,and the number of training sessions on the knowledge of the stroke nursing group was statistically significant.The degree,monthly salary and health care capacity are positively correlated.2.Second survey result2.1.Stroke patients: The three-month intervention period was carried out.After the interventional nursing,the changes in the scores of the indicators were evaluated and compared.The results were statistically significant(P<0.05)..2.2.Caregiver: Compared with before intervention,the degree of mastery of rehabilitation knowledge and technical operation ability were significantly improved,which was statistically significant(P<0.05).In conclusion1.Aged institutions: At present,only one of the Jingzhou old-age care institutions has obtained the qualification of medical care and has not really started their work.Most of the old-age care institutions have poor nursing ability and can only provide daily basic care.For patients with stroke,they are neglected to manage,and the rehabilitation of stroke patients cannot be met.2.Stroke patients in nursing institutions: Rehabilitation training is not available in the old-age care institutions.Most patients have dysfunction and the quality of life is not high.3.Caregivers in the old-age care institutions: the average age is too large,the education level is low,the professional training is poor,and the rehabilitation knowledge of stroke is lacking.4.Intervention effect: Under the background of medical care and combination,the team led by specialist nursing will provide nursing support for the old-age care institutions,and the training of stroke nursing skills for the elderly can effectively improve the nursing skills of the elderly in the old-age care institutions.The nursing intervention of the stroke patients in the nursing institution can improve the quality of life of stroke patients,and has a significant effect on improving dysfunction.The scores in balance ability and swallowing ability are statistically significant.5.Insufficiency and prospects: Due to limited project funds,the improvement of the hardware facilities of the old-age care institutions is not great,and the intervention cooperation is the unpaid behavior of the researchers using the rest time.Although the effect is remarkable,but the long-term mechanism has not been established,it is necessary to call for The administrative department attaches great importance to the establishment of a long-term working mechanism as soon as possible,so that stroke patients in nursing institutions can receive effective care during the recovery process and improve the quality of life of stroke patients. |
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