Development And Effectiveness Evaluation Of Continuous Nursing Mode In A Community Hospital After Knee Replacement

ObjectiveBased on literature review and Delphi expert consultation results,we establi shed a continuous nursing mode in a community hospital after total knee arthr oplasty（TKA）in order to evaluate the effect of this mode in improving knee joi nt function,quality of life,nutritional status and reducing the incidence of advers e events such as falls,lower extremity deep venous thrombosis,surgical incision infection and poor healing of surgical incision.MethodsThis study involved two parts.The first part:establishment of a continuing nursing mode in the community hospital after knee replacement.The first step was to establish a research group;the second step was to understand the research status of the team composition,intervention time,intervention method,process,content and effect evaluation index of continuing nursing after knee arthroplasty through literature retrieval and literature analysis,so as to construct the preliminary framework of the model;the third step is to establish the preliminary framework of the model through Delphi expert consultation.The reliability and validity of the frame were tested to form the final framework.The second part:This involved the implementation in a similar experimental study to verify the effectiveness of the community hospital continuing care model after knee arthroplasty.Methods:A convenient sampling method was used to select 60 patients who received TKA in the Department of osteoarthritis of a tertiary hospital from July to November 2020.They were randomly divided into the experimental group and the control group,receiving extended community hospital continuing nursing mode and conventional extended care mode separately for 3 months.The HSS knee function score,SF-36 quality of life scale,mini nutritional assessment（man）score,and the incidence of falls,lower extremity deep venous thrombosis and other adverse events were collected on the day of discharge,45 days and 3 months after operation.Spss v22 was used to conduct statistical analysis using methods which included:Chi square test,independent sample t test.Results1.From January 2010 to January 2019,there were 46 domestic and foreign intervention studies on postoperative continuous care of（knee）joint replacement（39 domestic literatures and 7 foreign literatures）,including 13 studies on knee replacement alone（9 domestic literatures and 4 foreign literatures）.2.In the two rounds of expert consultation,the effective questionnaire recovery rate was 100%,experts’Authority（CR）was>0.7,experts’coordination coefficient was 0.410～0.657,and P<0.01,and the coefficient of variation of each item was 0.000～0.184.As a result of the study,the community hospital continuing nursing mode after knee replacement was constructed,including 4 first level indicators,11 second level indicators and 29 third level indicators.3.There was no significant difference in HSS knee score,SF-36 quality of life score,mini nutritional assessment（man）score and total score between the two groups before intervention（P>0.05）;4.The HSS knee score,SF-36 quality of life score,mini nutritional assessment（man）score and total score of the experimental group were higher than those of the control group（P<0.05）;5.There was on significant difference in the incidence of adverse events between the two groups within 3 months after operation（P>0.05）.Conclusions1.The content and construction process of continuing nursing mode in community hospital after TKA is innovative.2.Compared with the continuous nursing mode currently in practice,the continuous nursing mode of community hospital after knee arthroplasty is more in line with the current situation of patients’demand for continuous nursing.3.Compared with the current continuous nursing mode,the community hospital continuous nursing mode after knee arthroplasty can improve the knee joint function,quality of life and nutritional status of patients.