Application Of Timing It Right In Patients With Total Knee Arthroplasty And Their Caregivers

Objective To understand the real experience of caregivers of total knee arthroplasty patients during the whole period of care,analyze the characteristics and content of their needs,and then develop targeted scientific interventions based on this theory.The effect and role of burden and functional recovery in total knee arthroplasty patients.Methods Phase 1: Formulation of TIR Nursing Intervention Program 1.Semi-structured interviews: The intentional sampling method was used to select 55 caregivers of total knee arthroplasty patients from October 2018 to December 2018 in the joint surgery of a top three hospital in Inner Mongolia who met the criteria of the platoon as interview subjects.According to the TIR,total knee arthroplasty was identified as five stages,respectively:(1)Diagnosis period: from patient admission to decision Before surgery;(2)Perioperative period: from the patient’s decision to surgery until the condition is stable;(3)Pre-discharge period: from the end of the patient’s related treatment to discharge;(4)Adjustment period: from the patient’s return to home to 3 months after surgery;(5)Adaptation Period(4-6 months after surgery),on the basis of this,semi-structured interviews were used to interview the caregivers of patients undergoing total knee arthroplasty surgery in various stages.Colaizzi phenomenological research was used to analyze the data and understand the care Caregiver needs at different stages of the disease and develop TIR nursing intervention programs.2.Expert group meeting method: 5 orthopedic nursing experts and 2 orthopedic clinical experts are invited to evaluate,discuss and modify the practicability and feasibility of the TIR nursing intervention plan prepared by semi-structured interview.Finally,determine the TIR nursing intervention plan and develop the " Health education manual for caregivers of total knee arthroplasty patients ".Phase 2: application and evaluation of TIR nursing intervention program Adopt a kind of experimental research,and use the convenience sampling method to select the caregivers of total knee arthroplasty patients who meet the stipulations in joint surgery in a top three hospital in Inner Mongolia from March 2019 to December 2019,To avoid contaminating the subjects in the same ward,the groups before and after joint surgery were randomly divided into the routine group and the intervention group by coin tossing.The routine group adopts routine care in the ward,and the responsible nurse gives the caregiver a corresponding health education program according to the patient’s condition,including how to assist the patient in rehabilitation exercises and how to use assistive devices;before the discharge,the importance of review and functional exercise is emphasized;Routine follow-up was given after discharge.The intervention group issued the "Health Care Handbook for Caregivers of Knee Replacement Patients" since the patients were admitted to the hospital,and began to implement TIR nursing interventions,including in-hospital interventions and out-of-hospital interventions.In-hospital interventions include the diagnosis period,perioperative period,and discharge preparation period.At the stage,face-to-face communication,guidance and demonstration are adopted;out-of-hospital intervention includes two stages: adjustment period and adaptation period,which mainly adopts regular telephone,We Chat,video,mutual aid groups,outpatient review and family visits.Family Care Giver Task Inventory,Zarit Caregiver Burden Interview and Hospital for Special Surgery were used to evaluate the effect before intervention,when discharged,and 3 months and 6 months after discharge.Use SPSS23.0 software for data entry and statistical analysis.Results Phase 1: Formulation of TIR Nursing Intervention Program 1.In the semi-structured interview,the needs of care at five different stages are summarized according to the timing it right: the diagnosis period:(1)mental and emotional support.(2)disease-related knowledge.(3)economic and care skills support;Perioperative period:(1)surgery-related information And Precautions.(2)Key points of postoperative care. (3)Symptom management.(4)Postoperative rehabilitation guidance.(5)Emotional support.(6)Financial assistance;Discharge preparation period:(1)Discharge procedures.(2)Out-of-hospital rehabilitation plan.(3)Follow-up treatment information.(4)Emotional support.(5)Patient role change;Adjustment period:(1)Provide home care knowledge.(2)Continuing nursing services.(3)Home environment debugging.(4)Emotional support.(5)Mutual assistance groups;Adaptation period:(1)Return to society guidance.(2)Provide disease prevention knowledge.(3)Emotional support.(4)Information of community medical institutions.2.In the expert group meeting method,a total of 7 experts evaluated,discussed,and revised the proposed TIR nursing intervention plan,and finally determined the TIR nursing intervention plan.The enthusiasm coefficient of the experts is 1,and the expert authority coefficient is 0.87.Phase 2: Application and evaluation of TIR nursing intervention program In this phase of the study,65 effective sample sizes were finally included,32 in the routine group and 33 in the intervention group.The results before the intervention showed that the baseline data of patients and caregivers in the two groups were not statistically different(P> 0.05).The results after the intervention showed that:(1)The total scores of Family Care Giver Task Inventory and scores of each dimension in the intervention group at each measurement point were lower than those in the routine group,the difference was statistically significant(P <0.001),and there were obvious Interaction(P <0.001).(2)The total score of Zarit Caregiver Burden Interview and personal burden score of the intervention group at each measurement point were lower than that of the routine group.After statistical testing,the difference was statistically significant(P <0.05);the responsibility burden score was statistically calculated at discharge,There was no statistically significant difference(P> 0.05),but the scores at 3 and 6 months were statistically tested and the difference was statistically significant(P <0.05),and there was a significant interaction between care burden scores(P <0.001).(3)The total score of Hospital for Special Surgery at each measurement point in the intervention group was higher than that of the routine group,the difference was statistically significant(P <0.05),and there was a significant interaction(P <0.001).Conclusion Through semi-structured interviews,we learned that the care needs of caregivers of knee replacement patients in different stages of the disease are dynamically changing,and draw up TIR nursing intervention program.After the expert group meeting method,a feasible and effective TIR nursing intervention plan was formulated more scientifically and applied The effect is significant,which helps to improve the caregiver’s ability to care,reduce the burden of care,and then promote the recovery of patients’ functions,speed up the rehabilitation process of patients,and provide theoretical and practical basis for the application of TIR in the caregivers of patients with total knee arthroplasty.