| Objectives:To set up and evaluate the effection of clinical nursing pathways (CNP) for thepatients with deep venous thrombosis (DVT) of the lower limbs in the treatment ofcatheter directed thrombolysis (CDT).Methods:1. We designed and generated the drafts of CNP and the flow path of implementwhich were based on literature review, chart review, nursing experience and theadvice and recommendations of clinical experts. Two rounds of expert consultationand twice pre-tests were taken to amend and verify the CNP (including the CNP fornurses and the CNP for patients).2. Prospective, randomized, comparative methods were used to examine theeffection of the CNP.80DVT of the lower limbs patients who were treated by CDTwere recruited via Fuzhou General Hospital of Nanjing Military Command fromMarch2012to January2013. All patients were confirmed of eligibility and informedconsent. All80subjects were randomized,40to receive the general nursing and40toreceive the nursing by CNP. The effection of the CNP was evaluated by therapeuticefficacy, the incidence of complications, length of hospital stay, hospital costs, thehealth education knowledge grasping rate and nursing satisfaction.3. Statistical approach: All statistical analyses were performed using SPSS13.0.Continuous data were showed as means and standard deviations (x±s), anddichotomous outcomes as frequency, percentage or constituent ratio. Differencesbetween groups were tested using the chi-square test, ridit test or Fisher method (forcategorical data), or Student’s unpaired t-test (for numerical data). P values less than0.05were considered significant. Results:1. The standard length of hospital stay of the CNP is13days (including1day forpreoperative preparation and12days for postoperative recovery). The CNP consistsof two parts: the nurse and the patient. There are6CNP forms in the nurse part:admission day, operation day, thrombolysis therapy, anticoagulant therapy, take filterday, discharge from hospital, which are in line with the doctor’s treatment plans. Thepatient part is composed by6forms as above, about patients’ inspection, treatment,activity, diet, and excretion. The forms are expressed as a “task-time” matrix formatand regulated nurses’ care project in strict time frame. The completed requirementsshould be mark as “√” and signed.2. No significant difference was found between two groups in gender, age,educational level, accompany disease or past history disease (P>0.05). There was nosignificant difference between two groups in cure rate (both100％, Hc=0.184, P＞0.05). and in the incidence of complications (10.00％versus5.00％, χ~2=0.180，P=0.671). For nursing satisfaction, statistically significant differences was foundbetween intervention groups receiving CNP over general nursing. The means andstandard deviations were92.85±7.10and85.70±8.45, respectively (t=4.097，P=0.000).Patients in the CNP group accepted the health knowledge better than that of controlgroup and showed a significant difference (t=5.103, P<0.05). The total hospital daysof CNP group was11.25±3.46which was significantly shorted than the generalnursing group (day,13.43±4.24). Similar result was found in the preoperativepreparation time (day,1.18±0.87versus2.25±0.98). However, a statisticallysignificant difference was not found for the postoperative hospitalization daysbetween two groups(t=1.405，P=0.164). Higher hospital costs was found in generalgroup than in CNP group (￥,55435.00±2890.23versus52782.00±3653.07) and itwas statistically significant (t=3.602，P=0.000).Conclusion:The clinical trial demonstrates that CNP for the patients with DVT of the lowerlimbs in the treatment of CDT is helpful to enhance the patients’ degree of satisfaction about nursing work, the awareness of health knowledge and reduce the duration ofhospital stays and hospital costs. At the same moment, it is beneficial to improve thequality of nursing. The drafts of CNP and the flow path of implement are scientific,practical and feasible. |
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