| Objectives1.Based on the Framework of Omaha system and the support of case management mode,a case management program for postoperative rehabilitation of Percutaneous Coronary Intervention(PCI)patients was constructed based on Omaha system.2.Verify the effect of case management program based on Omaha system applied to postoperative rehabilitation of PCI patients.Methods1.Construction of postoperative rehabilitation case management scheme for PCI patients based on Omaha SystemA research group was established.Based on the holistic nursing theory,Maslow’s hierarchy of human Basic Needs and knowing-belief theory,combined with the physiological and psychological characteristics of PCI patients after surgery,a case management program for postoperative rehabilitation of PCI patients was constructed based on Omaha system,including,Evaluation scheme of postoperative rehabilitation nursing problems of PCI patients based on Omaha system,intervention scheme of postoperative rehabilitation case management of PCI patients based on Omaha system,evaluation scheme of postoperative rehabilitation case management effect of PCI patients based on Omaha system;Through the Delphi method,To evaluate nursing problems of Omaha system based on PCI in patients with postoperative rehabilitation nursing assessment,case management intervention of Omaha system based on PCI in patients with postoperative rehabilitation case management interventions table,effect evaluation of the Omaha system based on PCI in patients with postoperative rehabilitation case management effect evaluation of two rounds of expert enquiry,Finally,the postoperative rehabilitation case management program of PCI patients based on Omaha system was determined.2.An empirical study of postoperative rehabilitation case management program for PCI patients based on Omaha SystemUsing the convenience sampling method,the selection from July to September,2021,2021 in Shenzhen city,Guangdong province,a Grade III Level A hospital cardiovascular internal medicine in the hospital and the patients with PCI 110 patients included in the standard as the research object,using the method of random Numbers table patients were randomly divided into control group(n = 55)(1st unit)and observation group(n =55)(2nd unit).From the 1st day after surgery to the 12 th week after discharge,routine nursing and telephone routine follow-up were carried out in the control group.On the basis of the control group,case management intervention program for postoperative rehabilitation of PCI patients based on Omaha system was implemented in the observation group.On the 1st day after surgery,1 day before discharge,5 weeks after discharge,and 12 weeks after discharge,the existing nursing problems of patients with PCI were evaluated by using the Omaha-based evaluation table of postoperative rehabilitation nursing problems of PCI patients,and by using the Omaha-based evaluation table of postoperative rehabilitation case management effect of PCI patients.Cognition(K)-behavior(B)-condition(S)score of patient care problems;The quality of life after coronary intervention(CROQ-PTCA-Post)scores were performed at 1postoperative day and 12 weeks after discharge.Results1.A case management scheme for postoperative rehabilitation of PCI patients was constructed based on Omaha system: the evaluation table for postoperative rehabilitation nursing problems of PCI patients based on Omaha system included 4 first-level indicators(fields),21 second-level indicators(nursing problems)and 130 third-level indicators(specific symptoms/signs);The intervention table of postoperative rehabilitation case management for PCI patients based on Omaha system includes 4first-level indicators(fields),21 second-level indicators(nursing problems)and 172 third-level indicators(interventions).The evaluation table of postoperative rehabilitation case management effect for PCI patients based on Omaha system includes 4 first-level indicators(fields),21 second-level indicators(nursing problems),and 315 third-level indicators(cognition,behavior,and status score).2.In this study,104 patients completed the study,including 51 in the control group,with a loss to follow-up rate of 7.27%.There were 53 cases in the observation group,and the rate of loss to follow-up was 3.64%.(1)There were no statistically significant differences in baseline data between the two groups,such as gender,marital status,residence status,education level,working status,per capita monthly income of family,type of medical insurance,disease history,number of implanted stents(stents),puncture site and duration of surgery(P>0.05).(2)On the first day after surgery and 1 day before discharge,more than 20% of patients(≥11)in the observation group and the control group had 9 nursing problems,including pain,circulation,breathing,sleep and rest,substance abuse,nutrition,physical activity,personal care,and mental health.On the 1st day after surgery,there were no significant differences in cognition(K),behavior(B)and condition(S)scores of 9 nursing problems in the observation group and the control group(P > 0.05).One day before discharge,the scores of cognition(K),behavior(B)and condition(S)of 9nursing problems in the observation group and the control group were statistically significant(P < 0.05).(3)At week 5 and week 12 after discharge,more than 20% of patients(≥ 11)in the observation group and the control group had 10 nursing problems,including pain,circulation,digestation-hydration,sleep and rest,substance abuse,nutrition,physical activity,drug treatment program,health care supervision,and mental health.The scores of cognition(K),behavior(B)and condition(S)of the 10 nursing problems in the observation group and the control group were statistically significant(P <0.05).(4)On the 1st postoperative day,more than 20% of patients(≥11)in the observation group had 10 nursing problems,including pain,circulation,digesting-hydration,breathing,sleep and rest,substance abuse,nutrition,physical activity,personal care,and mental health.On the 1st day after surgery,1 day before discharge,5 weeks after discharge and 12 weeks after discharge,the cognition(K),behavior(B)and status(S)scores of common nursing problems in the observation group were statistically significant(P<0.05)by repeated measure variance analysis.(5)CROQ-PTCA-Post scores of patients in the observation group and the control group on the first day after coronary intervention showed no statistically significant difference(P>0.05).Routine nursing and telephone routine follow-up were performed in the control group.The scores of CROQ-PTCA-Post dimensions at the 12 th week after discharge were significantly higher than those at the 1st day after discharge(P<0.05).The observation group implemented the case management program of postoperative rehabilitation of PCI patients based on Omaha system,and the scores of CROQ-PTCA-Post in all dimensions were significantly increased(P<0.05).The scores of CROQ-PTCA-Post dimensions in the observation group at the 12 th week after discharge were significantly higher than those in the control group(P<0.05).Conclusions1.The evaluation form of postoperative rehabilitation nursing problems of PCI patients based on Omaha system can systematically and comprehensively evaluate the nursing problems of postoperative rehabilitation of PCI patients,which is convenient for case managers to evaluate the needs of patients as a whole,and provides direction for the formulation of targeted intervention measures;Intervention table of postoperative rehabilitation case management for PCI patients based on Omaha system comprehensively provides targeted intervention measures and intervention programs for case managers according to patient care problems;Dynamic evaluation and feedback of patients’ nursing problems were carried out through the evaluation table of postoperative rehabilitation case management effect of PCI patients based on Omaha system.The case management scheme of PCI patients’ postoperative rehabilitation based on Omaha system constructed in this study is scientific and practical.2.The implementation of the case management program for postoperative rehabilitation of PCI patients based on Omaha system can effectively improve the cognition(K),behavior(B),condition(S)and quality of life of PATIENTS with postoperative nursing problems related to PCI,which is worthy of clinical promotion. |
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