Research On The Construction Of Long-term Care Model Based On Evidence-based Medical Care Combined With Nursing Care For Patients With Stroke Disability

Objective:Through the investigation of the status quo of long-term care for stroke incapacitated patients in the combination of medical and nursing institutions,to provide a realistic basis for the construction of long-term care system;Based on evidence-based methods,relevant evidence of nursing evaluation,intervention and management of stroke patients in medical-care institutions were summarized,providing evidence-based basis for the development of long-term care indicator system.Based on patients’ needs and evidence integration results of guidelines,a scientific long-term care model for stroke incapacitated patients in a combination of medical and nursing institutions was preliminarily constructed after letter consultation and demonstration by Delphi experts,providing theoretical reference for the development of clinical long-term care.Methods:1.Objective sampling method was adopted to select 400 patients with stroke disability who had been admitted to 2 medical and nursing institutions in Nanning city from June to September 2021 and met the inclusion and exclusion criteria.Questionnaire survey was used to deeply understand and analyze the status of long-term care needs of stroke disability patients in medical and nursing institutions.Excel 2019 software was used to input the data and SPSS 25.0 software was used to analyze the data.Among them,mean ± standard deviation((?)±s)was used for measurement data,and frequency and percentage were used for statistical description of counting data.Independent sample T-test or one-way an OVA was used to compare the scores of long-term care needs in medical care institutions with different demographic characteristics.Multivariate linear regression analysis was used for multivariate analysis.P < 0.05 was considered as statistically significant difference.2.According to the "6S evidence model",domestic and foreign databases were searched from top to bottom systematically,clinical practice guidelines related to stroke disability nursing were searched and evaluated systematically,recommendations of high-quality guidelines were integrated,and recommended items suitable for clinical development were screened and formulated.AGREE ⅱ was used to evaluate the quality of guidelines,and expert consensus was evaluated by expert consensus evaluation Standard(2017)of JBI Evidence-based Health Care Center in Australia.The quality of other literatures was evaluated according to the original literature type,and the contents of literatures were summarized to form the best evidence.3.Based on the needs of patients and the results of evidence integration of guidelines,the draft of long-term care model for patients with stroke disability in medical-nursing institutions was constructed,and the draft of long-term care model was revised through two rounds of Delphi expert letter consultation method,and finally the long-term care model for patients with stroke disability in medical-nursing institutions was constructed.Results:1.Investigation on the current situation of long-term care needs of stroke disabled patients in medical-care institutions: a total of 400 questionnaires were issued to stroke disabled patients,and 385 were effectively received,with an effective recovery rate of 96.25%;The results of univariate analysis showed that there was statistically significant difference in the total demand for medical care combined with long-term care services among the stroke disabled elderly with different monthly income,main source of income,course of disease and degree of dysfunction(P < 0.05).The results of multiple linear regression analysis showed that the main source of income and the course of disease were the influencing factors of the demand for long-term care services for the elderly with stroke disability.2.Summary of the best evidence of long-term care for the elderly with stroke disability in medical-care institutions: a total of 10 articles were included in this study,including 5 guidelines and 5 expert consensus.The use of all evaluation tools shows that the quality is generally good,among which the AGREE Ⅱ quality evaluation results are as follows: 1 guide is recommended as A level,and 4 guidelines are recommended as B level.Through translation and classification,the same or similar items were integrated,and the evidence was summarized by experts,with a total of 55 recommendations,which were in line with China’s national conditions and the responsibility scope of the demand for long-term care services combining medical and nursing care.3.Construction of long-term care model for stroke incapacitated patients in medical and nursing institutions:(1)According to the content of best evidence,the index system of long-term care was determined including two dimensions of medical service and old-age care,9 first-level indicators and 55second-level indicators of medical treatment,medical care,medical rehabilitation,health management,hospice care,daily life care,psychological support,health guidance and environmental safety.Draft a long-term care model for stroke incapacitated patients in medical-care institutions.After two rounds of Delphi expert consultation,the initial draft was modified to form the theoretical framework of evidence-based long-term care model for stroke incapacity patients in medical and nursing institutions.(2)In the two rounds of Delphi expert letter consultation,the questionnaire recovery rate was70.37% and 100% respectively.In the first round of expert letter consultation,the coefficient of variation of "ⅱ-25,ⅱ-30,ⅱ-39" were all < 0.25,except for "ⅱ-25,ⅱ-30,ⅱ-39".The coefficient of variation of all indicators in the second round of letter consultation was < 0.25.The expert authority coefficients of the two rounds of correspondence consultation were 0.861 and0.924 respectively.Kendall’s W were 0.231 and 0.329,respectively(P <0.01).Expert opinions converge to form the final plan.Conclusion:1.Patients with stroke disability in medical-care institutions have higher long-term care needs,and patients with stroke disability are more willing to pursue diversified demand service forms,which are influenced by many factors such as main income sources and disease course.Therefore,service forms of medical-care institutions should be enriched to improve the quality of long-term care.2.The evidence-based long-term care model for stroke incapacitated patients in the combination of medical and nursing institutions has comprehensive and specific content,strong operability and strong clinical application value,but some items may have some differences with clinical practice.It is suggested that clinical nurses should fully consider the actual situation,combine the objective environment with social dynamic factors,narrow the gap between research and practice,and promote the implementation of the program.