| Objective: To explore the effects of continuous personalized nursing plan combined with continuous nursing mode on patients after hemostasis by endoscope for liver cirrhosis lead to esophageal and gastric varices bleeding and the influences on the patients’ prognosis.Methods:1.From July 1,2017 to December 31,2018,a total of 98 cases of cirrhotic patients with esophageal and gastric varices bleeding stopped by endoscopic hemostasis in 3 departments of gastroenterology of the first hospital of Qinhuangdao were selected.All the patients provided written informed consent were numbered 01-98 according to the order of hospitalization number and the patients were randomly allocated to the control group(49 cases)or the intervention group(49 cases)according to the sequence of admission Numbers.And the general data was collected.In the control group,the responsible nurses conducted systematic health education,discharge guidance and telephone follow-up during hospitalization.In the intervention group,the patients were given the routine care of digestive diseases,and builded health education management team to provide patients with the disease diagnosis and treatment,health education,follow-up appointments and follow-up after discharge and the mission of a series of services,including patients in hospital to establish the detailed electronic health records of patients in hospital,maked the care plan sheet from the patients before treatment to the patients back home,linked the electronic mission data to WeChat to make the patients and family members browse the education content many times a day: discharge on 12:00-14:00 and 18:00-20:00 answer all patient’s inquiries by WeChat,pushed the little common sense and related matters needing attention for patients in 7 days,1 month,2 months,3 months,6 months after hospital discharge.2.Through health education file content,hospitalized patients experience and satisfaction questionnaire,the form of self management scale in patients with cirrhosis were as folevaluation sheet of nursing health education effect in the middle period of hospitalizationlows: 1)The knowledge of disease-related health education was investigated by evaluating the effect of health education on patients 5 days after admission in the middle of hospitalization;2)when discharged there were the comparition for patients’ hospitalization expenses,length of hospital stay,the treatment effects,the incidence of complications,and the hospital experiences of patients and satisfaction survey in nursing;3)The rehospitalization of the patients within 30 days and 90 days in two groups was recorded;4)The effects of intervention was evaluated 6 months hospital discharge,and the self-management behavior of patients was compared.The self-management behavior scale for patients with liver cirrhosis developed by wang qian etal was used to evaluate with 24 items in 4 dimensions which named diet management,daily life management,medication management and condition monitoring management.5)At hospital discharge,1 month,3 months and 6 months after hospital discharge,the patients’ satisfaction with nursing work was compared;6)The compliance rate of patients at 1 month,3 months and 6 months after hospital discharge was compared.3.Data were collected and analyzed with SPSS20.0 software.The following statistical methods were used: chi-square test,descriptive analysis,two-sample independent t test and Logistic regression analysis.Results:1.General data of patients in the two groups was compared.In this study,general data of 90 patients in two groups was analyzed: There were 44 patients in the control group,including 27 males and 17 females,the average age was 47.3±7.35 years old;Thirty-eight were married and six were unmarried;Education level: 29 cases in primary school,9 cases in junior high school,6 cases in senior high school,0 cases in junior college or above;Family monthly income: ≤500 yuan 8 cases,500-1000 yuan 13 cases,1000-2000 yuan 14 cases,> 2000 yuan 9 cases;Medical payment methods: 13 cases of medical treatment insurance,cooperative medical 23 cases,8 cases at one’s own expenses;Having religious beliefs in 1 case;The caregivers were 39 children and 7 spouses.Degree of care of caregivers: 34 cases were good,11 cases were general,and 1 case was poor;There were 24 cases of alcohol consumption;Child-Pugh classification: A level 5 cases,17 were B,C level 22 cases.There were 46 cases in intervention group,including 28 males,18 females,e average age was 48.21±6.08 years old;Forty were married and six were unmarried;Education level: 28 cases in primary school,10 cases in junior high school,7 cases in senior high school,1 cases in junior college or above;Family income: 10 cases of 500 yuan per month or less,13 cases of 500-1000 yuan per month,15 cases of 1000-2000 yuan per month,8 cases of > 2000 yuan per month;Medical payment methods: 13 cases of medical treatment insurance,cooperative medical 24 cases,at 9 cases;Having religious beliefs in 1 case;The caregivers were 37 children and 7 spouses.Degree of care of caregivers: 29 cases were good,14 cases were general;There were 24 cases of alcohol consumption;Child-Pugh classification: A grade 5cases,class B 18 cases,23 cases of class C.There was no significant difference in general data between the two groups(P>0.05).2.Comparison of health education knowledge 5 days after hospitalized between the intervention group and the control group showed that: in the intervention group,42 cases were fully aware,7 cases were partially effective,and 0 cases were not,the awareness rate was 100%;in the control group,27 cases is fully aware,12 cases were partially effective,10 cases were not,the awareness rate was was 79.59%.Difference was statistically significant(P<0.05).3.Hospitalization time,hospitalization cost,treatment effect and incidence of complications were compared between the two groups after hospital discharge.The results show that in the intervention group hospitalization time was 14.4 ±7.3 days,hospitalization costs was 1.91±1.0 ten thousand yuan,treatment effective rate was 44.90% and 51.02%,invalid was 4.08%,total effective rate was 95.92%.There were 4 cases of cerebral hemorrhage,0 cases of hepatic encephalopathy,1 case of hepatorenal syndrome and 1 case of respiratory tract infection.The incidence of complications was 12.44%;In the control group hospitalization time was 18.59±11.41 days,hospitalization costs was 2.55 ± 1.51 ten thousand yuan,treatment effective rate was 28.57% and 40.82%,invalid was 30.61%,total effective rate was 69.39%,and there were 7 cases of cerebral hemorrhage,4 cases of hepatic encephalopathy,4 case of hepatorenal syndrome and 1 case of respiratory tract infection.The incidence of complications was 34.69%.The incidence of complications,the average length of hospital stay,average hospital costs in the intervention group were lower than that in the control group,while the treatment effects in the intervention group was better than that in the control group.There were significant differences(P < 0.05).5.The rehospitalization of the two groups within 30 days and 90 days was recorded.In the intervention group 0 cases was lost to follow-up and the readmission rate was 0.0% within 30 days;In the control group,2 cases were lost to follow-up and the readmission rate was 12.77% within 30 days.Within 90 days,in the intervention group 1 patient was lost to follow-up,0 died and the readmission rate was 6.25%;In the control group,4 patients were lost to follow-up,0 died and the readmission rate was 24.44%.During the two periods,The rehospitalization in the intervention group was significantly lower than that in the control group,and the difference was statistically significant(P<0.05).6.The self-management behavior scores after 6 months were compared.The scores of each dimension were as follows: the average scores of daily life management was 25.91 ±1.02 in the intervention group and 22.37 ±1.68 in the control group;the average scores of ietary management was 25.59±0.86 in the intervention group and 21.18±1.42 in the control group;the average score of condition monitoring management was 16.59 ±1.38 in the intervention group and 10.98±1.66 in the control group : the average scores of medication management was 18.29±3.04 in the intervention group and 10.30 ±2.69 in the control group.So there were significant differences in the four dimensions of daily life management,diet management,condition monitoring management and medication management(P<0.01).7.At each time point(at hospital discharge,1 month after hospital discharge,3 months after hospital discharge and 6 months after hospital discharge),to compare to patients’ satisfaction with nursing work,the results were as follows: at discharge,the rate of patients’ satisfaction with nursing work was 100% in the intervention group and 87.76% in the control group;at 1 month after hospital discharge,the rate of patients’ satisfaction with nursing work was 95.92% in the intervention group and 76.59% in the control group;at 3 months after hospital discharge,the rate of patients’ satisfaction with nursing work was 93.75% in the intervention group and 77.78% in the control group;at 6 months after hospital discharge,the rate of patients’ satisfaction with nursing work was 83.61% in the intervention group and 54.55% in the control group.It can be seen that patients’ satisfaction with nursing work decreased in both groups with the extension of hospital discharge time,but in the intervention group at each time node was significantly better than that in the control group,and the difference was statistically significant(P<0.05).8.For comparison of the compliances between the two groups were made at 1 month after hospital discharge,3 months after hospital discharge and 6 months after hospital discharge,the re-examination compliance rate was as follows: at 1 month after hospital discharge,it was 100% in the intervention group and 95.74% in the control group;At 3 months after hospital discharge,it was 93.75% in the intervention group and 77.78% in the control group;At 6 months after hospital discharge,it was 84.78% in the intervention group and 65.91% in the control group.Thus it can be seen that there was no significant difference within 1 month after hospital discharge(P>0.05),whereas the difference of the other months was statistically significant(P<0.05).9.Correlation analysis of the influence of patients’ quality of life in after endoscopic hemostatic treatment showed that according to the scores of self-behavior management scale for patients with liver cirrhosis,98 patients were divided into high group and low group with the median scores as the boundary.The Logistic regression analysis showed that those who have high education(junior,senior high school,junior college and above)and nice review compliances(whether review on time)have high self-behavior management ability.while the combination of personalized nursing plan and continuous nursing can improve the self-behavior management ability of patients who have the same level of education.The patients with the higher self behavior management ability have the higher quality of life after treatment.At the same time,personalized nursing plan combined with continuous nursing strengthen the communication with patients and guarantee the patient’s compliances review.Conclusion: Personalized nursing plan combined with continuous nursing can improve patients’ awareness of health education knowledge,satisfaction of nursing work,patients’ self-behavior management ability and patients’ compliances in review.To reduce the length of hospital stay,the hospitalization cost,the incidence of complications and the readmission rate;Improved the treatment effects,the quality of patients’ life.The use of WeChat in clinical practice is feasible and worthy of promotion. |
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