| Objective:The situation of chronic disease prevention and control in China is grim.The Long-term Plan for Chronic Disease Prevention and Control in China(2017-2025)points out that the whole process of health management should be carried out for patients with chronic diseases.However,at present,researches pay more attention to the safety of patients in hospital and less attention to the safety of patients discharged from hospital.In recent years,in order to alleviate the shortage of medical resources,shortening the average hospitalization days of patients has become a trend.However,the shortening of hospitalization days makes patients in the recovery stage at discharge time and increases the risk of unplanned readmission and other adverse events.How to help patients discharge smoothly and safely under such a big situation,improving patients’ discharge readiness is of great significance.This study takes liver cirrhosis as an example,takes the national policy as an opportunity,based on the theory of goal attainment,and based on the actual situation in our country,to explore the discharge preparation scheme for patients with chronic diseases,aiming at improving the discharge readiness,ensuring the safety of patients discharged from hospital,saving medical expenses,optimizing the allocation of medical resources,and improving economic and social benefits.Methods:A mixed research design was used.Through the present situation investigation to understand the liver cirrhosis patient discharge readiness and influencing factors,compare the differences between liver cirrhosis patients and their families in assessingdischarge readiness;Understood the perception of patients with liver cirrhosis on discharge preparation through qualitative research;Through literature research and expert consultation,a discharge preparation scheme for liver cirrhosis patients based on the theory of goal attainment was constructed;The effectiveness of the discharge preparation scheme was verified through empirical research.1.Current situation survey(1)To investigate the discharge readiness of liver cirrhosis patients and analyze the influencing factors: 185 patients with liver cirrhosis from a 3A hospital in Shanxi Province were selected as the research objects for convenient sampling,and the general data questionnaire,Readiness for Hospital Discharge Scale,Quality of Discharge Teaching Scale and Mishel Uncertainty in Illness Scale for Adults were used for investigation,and the single factor and multiple linear regression analysis of influencing factors of the discharge readiness were carried out.(2)To compare the differences between liver cirrhosis patients and their families in assessing discharge readiness and explore the influencing factors: 166 patients with liver cirrhosis and their families from a 3A hospital in Shanxi Province were selected as the research objects for convenient sampling,and the patient version and the family version of Readiness for Hospital Discharge Scale were used for investigation.The status quo of the discharge readiness of patients was investigated from the perspective of patients and their families respectively,and the differences in the evaluation results between the two were compared to explore the influencing factors.2.Qualitative researchObjective sampling method was used to conduct semi-structured interviews with 15 patients with liver cirrhosis from January to March 2019 in a 3A hospital in Shanxi province who met the admission criteria.Colaizzi method was used to analyze the data.3.Scheme constructionBased on the theory of "theory of goal attainment",combined with the previous investigation,qualitative research and literature research,the first draft of the intervention scheme was formed,and the final draft of the intervention scheme wasformed after two rounds of consultation by 15 experts and pre-experiment.4.Empirical research99 patients with liver cirrhosis from a 3A hospital in Shanxi Province were selected as the research object for convenient sampling.The control group(n=49)received routine nursing while the intervention group(n=50)implemented the discharge preparation scheme for liver cirrhosis patients based on the theory of goal attainment constructed by the research group in the early stage.The discharge readiness,discharge guidance quality,self-management behavior,disease uncertainty and unplanned readmission of the two groups were compared.Results:1.The results of the current survey(1)To investigate the discharge readiness of liver cirrhosis patients and analyze the influencing factors: The score of discharge readiness of patients with liver cirrhosis was(75.86±10.56),which was at a low level.Multiple linear regression analysis showed that education level,living condition,liver function Child-Pugh classification,discharge guidance quality and disease uncertainty were the influencing factors,which could explain 67.4% of the total variation of discharge readiness score.(2)To compare the differences between liver cirrhosis patients and their families in assessing discharge readiness and explore the influencing factors: The scores of discharge readiness of patients’ self-assessment was(76.17±10.81)and family members’ other assessment was(80.71 ±9.67),the differences between the two scores were statistically significant(P<0.001).Liver function Child-Pugh classification,hospitalization times,family members’ status and whether they live with patients were the influencing factors of the differences in the scores(P<0.05).2.Qualitative research resultsAfter summarizing and refining the 15 interview materials,four themes were finally revealed about the perception of patients with liver cirrhosis on discharge preparation:ambivalence at discharge,unknown state of discharge preparation,various challenges after discharge,and patients’ wish to participate in discharge discussions.3.Scheme Construction ResultsThe implementation scheme of discharge preparation intervention included interactive nursing evaluation,nurse-patient joint formulation of the goal of reaching the standard,implementation of interactive measures of reaching the standard(intervention time,intervention content,intervention form,intervention personnel)and effect evaluation.The specific contents of the discharge preparation intervention included overall assessment,the disease knowledge reserve,the self-management skill reserve,the caregiver guidance and the resources available after discharge.4.Empirical research results(1)The shedding of research objects: 53 patients were selected in the intervention group and 3 patients shed,of which 1 patient voluntarily requested to quit due to personal affairs and 2 patients were unwilling to continue participating in the study;In the control group,51 patients were selected and 2 patients fell off,of which 1 refused to follow up and 1 voluntarily requested to quit due to personal matters.Finally,99 subjects were included in the study,50 in the intervention group and 49 in the control group.(2)Before the intervention,the general data,the scores of self-management behavior and disease uncertainty of the two groups were tested in a balanced way,the results showed that the differences were not statistically significant(P>0.05)and were comparable.(3)After intervention,the total score of discharge readiness and scores of all dimensions in the intervention group were higher than those in the control group,the difference was statistically significant(P<0.001);The total score of discharge guidance quality and the score of acquired content in the intervention group were higher than those in the control group,the difference was statistically significant(P<0.001);The scores of self-management behaviors in the intervention group were higher than those in the control group on the day of discharge,1 month after discharge and 3 months after discharge,with statistically significant difference(P<0.001);The score of diseaseuncertainty in the intervention group was lower than that in the control group on the day of discharge,1 month after discharge and 3 months after discharge,and the difference was statistically significant(P<0.001);The unplanned readmission rate of patients in the intervention group within one month after discharge was 6.0%,which was lower than that in the control group(22.4%),and the difference was statistically significant(P=0.019);The unplanned readmission rate was 16.0% in the intervention group and34.7% in the control group within 3 months after discharge,the difference was statistically significant(P=0.032).Conclusion:The discharge preparation scheme for liver cirrhosis based on the theory of goal attainment can improve the discharge readiness and discharge guidance quality of patients,reduce the disease uncertainty and unplanned readmission rate of patients,and provide reference for chronic disease patients to prepare for discharge. |
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