Application Study Of Cluster Nursing In Patients With Dysphagia After Severe Traumatic Brain Injury

Objective(s):Through evidence-based nursing,the cluster nursing plan was constructed.The cluster nursing scheme was applied to the patients with dysphagia after severe traumatic brain injury,and the clinical effect of the application of cluster nursing scheme was observed,so as to provide reference for the clinical nursing scheme of patients with dysphagia after severe traumatic brain injury.Methods:1.Evidence-based issues were identified and retrieval strategies were formul ated.Through literature query,relevant articles including Randomized Controlle d Trial(RCT)of patients with dysphagia after severe traumatic brain injury,sy stematic evaluation,Meta-analysis,clinical practice guidelines,and expert conse nsus were collected.After quality evaluation and evidence level recommendatio n of the included articles,and in combination with expert consultation in the ho spital,a clustering care plan was formulated.2.During the period from May 2020 to January 2021,patients with dysphagia after severe traumatic brain injury in Department of Rehabilitation Medicine were selected according to the inclusion exclusion criteria,and were divided into the control group and the experimental group according to the random number table,with 30 people in each group.The control group received routine nursing,while the experimental group received cluster nursing on the basis of routine nursing.Before intervention,three weeks after intervention,and six weeks after intervention,the swallowing function,oral condition,incidence of aspiration,and cognitive and consciousness functions of the two groups were compared.Results:1.Based on the 16 included articles,through group discussion and hospital expert consultation,and in combination with the actual situation of the hospital,a cluster nursing plan integrating swallowing function evaluation and monitoring,oral training,oral care,and dietary care was constructed.2.There was no significant difference in general information between the two groups(P>0.05).Swallowing function:After six weeks of intervention,the number of people in the experimental group who ate food with water character was increased compared with that in the control group.The score of the modified Mann Assessment of Swallowing Abilities(MMASA)in the experimental group was(80.23±11.04),while that of the control group was(73.47±12.67),and the difference was statistically significant(P<0.05).After six weeks of intervention,four subjects in the experimental group and nine subjects in the control group were fed by tube feeding.The number of oral feeders in the experimental group was larger than that in the control group.The incidence of aspiration in the oral cavity of patients in the experimental group was improved as compared with that in the control group,and the difference was statistically significant(P<0.05).Cognitive and consciousness function:After six weeks of intervention,the Glasgow coma scale(GCS)scores of the two groups were improved,and the RLA scores of the two groups were higher than or equal to Grade Ⅳ.The experimental group was significantly better than the control group with a statistically significant difference(P<0.05).Conclusion(s):The application of cluster nursing plan can improve the swallowing function and oral condition of patients with dysphagia after severe traumatic brain injury,reduce the incidence of aspiration,and improve the consciousness and cognitive level.The implementation of cluster nursing has great guiding significance for patients with severe traumatic brain injury.The scheme is more scientific and practical,which promotes the development of evidence-based nursing and provides the basis for clinical nursing scheme for patients with dysphagia after severe traumatic brain injury to recover as soon as possible.