| Stroke is a common disease causing disability, death and dependent living in mid-aged and elderly people. Most of stroke survivors experience a significant decline in quality of life 1 to 6 months after stroke. In the transitional period from hospital to home, patients will face some problems such as lack of stroke knowledge, low discharge compliance, and lack of home rehabilitation skills. Accordingly, nursing scholars have carried out a variety of care intervention to deal with patients’health problems occurring in the transition. But the domestic researches were still existed the following deficiencies:①lack of evidence-base for intervention programme;②lack of nursing theory or model for framework. This study will develop a transitional care programme for stroke patients guided by transiontal care model (TCM) and referred by evidence-based care recommendations. In addition, this study will evaluate the effects of the programme by a randomized controlled clinical trail.Part A: Developing a Transional Care Programme for Stroke Patients1. MethodsThe aim of this part was to develop a transitional care programme for stroke patients by literature reviewing and clinical trial. Main procedures are follows.1) Review literatures of evidence-based guidelines in stroke care intervention, and summarize some nursing evidence with high level recommendation.2) Review literatures of the progression in transional care model and stroke care, and establish a constructive framework of the programme.3) Develop the 4 sub-programmes:①health education programme in hospital,②discharge recommendation in patient compliance,③home rehabilitation guidance,④comprehensive nursing assessment.2. Results The transitional care programme for stroke patients was a 5-week series of 4 nursing activities containing 2 stages of hospital care and discharge care. The pre-discharge stage is the small-based health education, the discharge recommendation of patient diary and the comprehensive nursing assessment guided by Omaha problem classification system. The post-discharge stage is the telephone follow-up and the home visit in promoting patient compliance and guiding home rehabilitation. Besides provider-initiated events, the programme accommodated patient-initiated call if patients need immediate advice. The intervener was leaded by the trained nurse specialist, and assisted by the multi-disciplinary team including neurologist, nurses, rehabilitation therapists and psychological therapists.3. Conclusion1) The intervention model was guided by TCM as a theoretical framework. And the intervention programme reflected four features of comprehensiveness, continuity, coordination, and collaboration.2) The intervention activities were embedded in the best available nursing evidence. And the nursing activities included that health education improving knowledge level, discharge diary guidance in improving patient compliance, comprehensive nursing assessment in finding and dealing with health problems, upper limbs and fingers rehabilitation training in promoting hand function.Part B: Evaluating the Transitional Care Programme for Stroke PatientsThe aim of second part was to evaluate the effects of the developed programme by a randomized controlled clinical trial.1. MethodsSeventy-two patients on first confirmation of ischemic stroke in the acute stroke department from 2 large general hospitals were effectively enrolled and randomized to the intervention group (n=35) and the control group (n=37). The control group received conventional care, whereas the interventional group received the conventional care plus the transitional care. The outcome fell into 4 domains:①patient compliance with discharge recommendation;②Quality of Life (QOL): Barthel Index (BI) reflecting activities of daily living, Nine Hole Peg Test (NHPT)reflecting hand operation ability, and the self-reported subjective quality of life (SQOL);③health service utility: the number of hospital readmission, emergency visits, and outpatient visits;④patient satisfaction: patient satisfaction separately with hospital care and discharge care. The data were collected at two time-points, at 3 days pre-discharge and 12 weeks post-discharge. The analysis was conducted by SPSS13.0 software. The independent sample t test was used in comparison of quantitative data between the two groups, and chi-square test used in comparison of rates. The significance level was set at P<0.05.2. Results1) Patients Compliance: The total score of compliance with discharge recommendation (t= 6.011, P= 0.000<0.05) and the three single compliance items of rehabilitation training (t=5.255, P=0.000<0.05), lifestyle (t=5.156, P=0.000 <0.05), and referral follow-up (t=3.476, P=0.010<0.05) in the intervention group were significantly higher than in the control. But the two single items of balanced diet (t=0.967, P=0.337>0.05) and regular medication (t = 0.845, P = 0.401> 0.05) were no significant difference.2) Quality of Life: The increased range in subjective quality of life (t=2.716, P=0.008<0.05) and NHPT time (t=2.185, P=0.033<0.05) in the intervention group was significantly higher than in the control. The increased range of Barthel Index was no significant difference (t=0.823, P=0.414>0.05).3) Health Service Utility: The outpatient visits in the intervention group was higher than in the control (χ~2=9.053, P=0.029<0.05). The readmission hospital (χ~2=0.278, P=0.870>0.05) and the emergency visits (χ~2=1.036, P=0.596>0.05) were no significant difference.4) Patient Satisfaction: The patient satisfaction with hospital care (t=4.135, P= 0.000 <0.010) and discharge care (t=10.010, P=0.000 <0.01) in the intervention group were separately higher than in the control.3. Conclusion1) The stroke transitional care programme may significantly improve the patient compliance with discharge recommention.2) The stroke transitional care programme may significantly improve the patients’perception of quality of life.3) The stroke transitional care programme may significantly improve the hand ability. 4) The stroke transitional care programme may significantly improve the patient satisfaction with hospital care and discharge care.5) The stroke transitional care programme may significantly promote the visits to hospital clinic.6) The stroke transitional care programme may be non-effective in increasing Barthel Index and reducing hospital readmission and emergence visits.In summary, this study developed the stroke transitional care programme and evaluated the effects of it. The results presented that the developed programme showed the positive effects in stroke knowledge, discharge compliance, subjective quality of life, hand operation ability and nursing satisfaction. The conclusion showed that the developed programme was mostly consistent with the design purpose. This study is a preliminary exploration of the domestic transitional care for the stroke survivors. The results can be referred in promoting stroke hospital care and discharge care, and be presented some new interventional ideas in promoting the domestic stroke nursing practice. |
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