Parctitioners’ Management For Heart Failure Patients The Study And Practice Of Nurse

Research Objectives To explore the feasibility of nurse practitioner(NP) management mode and the influence of cardiac function, the quality of life, treatment adherence, mortality and hospitalization rates again, the influence of the medical expense and patients satisfaction in patients with heart failure.Methods Of Research 1.After randomized the 160 heart failure patients which were hospitalized in Dong’e People’s Hospital from January 2013 to June 2013. The NP management group had 80 patients(42 male patients,38 female patients,average age was 67.80±13.42) and the routine management group had 80 patients(58 male patients,22 female patients,average age was 66.49±12.81). 2.After the standardized solution treatment in patients with heart failure,we had 6-month follow-up.The NP group strengthened the outpatient follow-up for patients after discharge,gave them telephone calls or home visits on medication, diet and exercise guidance. 3.According to the results of follow-up, compared two groups of patients with NYHA heart function classification, cardiac function related parameters, plasma NT- pro BNP, quality of life score, athletic ability,treatment adherence,medical expense,the incidence of death and re-hospitalization and patients satisfaction. 4.Statistical analysis:Information was collected and typed into the EXCEL8.0,and was analyzed by using SPSS 17.0 software. Results Of Research 1.NYHA heart function classification: NP group was on average(2.29±0.69), compared with baseline(3.15±0.41),which improved significantly, with significant difference statistically significant(P < 0.01); Routine nursing group NYHA was on average(2.79±0.72),(3.29±0.41) at baseline, there was no statistically significant difference(P>0.05). 2.Cardiac function parameters: In the NP group,average number of FS, LVEDD, LVESD, LVEF were 27.31±6.32, 54.23±10.31, 46.89±12.68,compared with the baseline,26.29±7.16、62.26±11.63、50.82±12.56、42.83±10.32 with significant difference statistically significant(P<0.05). In routine nursing group,cardiac function related parameters LAD, FS, LVEDD, LVESD,LVEF compared with baseline had no significant difference(P>0.05). 3.Quality of life: Patients in the NP group had physical score of 13.26 ±4.35, compared with baseline 16.37±3.56 improved significantly(P< 0.05); Routine group had the score of 16.37 ±3. 56,compared with the baseline 16.37±3.56,had no significant statistical difference(P>0. 05). 4.Exercise capacity: 6 months after hospital discharge, NP group 6 MWT was 296.20±47.87 compared with 238.45±23.4, which had statistically significant differences(P<0.05). Routine nursing group 6 MWT was 262.95±38.76, compared with 241.82±23.45,the difference is statistically significant(P<0.05). 5.Treatment adherence: NP group management in blood pressure measurement, monitoring pulse, body weight, strict limits on water intake, strictly limiting sodium intake, self-examination edema,monitoring urine output and insist to take exercise were significantly higher than the proportion of the routine nursing group,which had significant difference(P<0.05). 6.Incidence of death and re-hospitalization: NP group 2(2.5%) patients re-hospitalization for many times, patients in routine nursing group of 11(15.7%), NP group and conventional group compared with patients with heart failure treatment of strengthening management can significantly reduce the percentage of death and re-hospitalization for heart failure increased again, the difference was statistically significant(P<0.05). 7.Medical expenses: comparing with routine nursing care physician group group total medical expenses than 12924.58(11413.09±13554.02 vs 12924.58±8105.37),which had no significant difference(P>0.05). 8.Patient satisfaction: NP group had the proportion of “very satisfied”(27.5%) was more than the proportion of the routine nursing group(8.75%),the percentage difference was statistically significant. Patients satisfaction of NP group was higher than routine nursing group(P<0.05).Conclusions 1.Compared with routine care,the NP management can improve cardiac function in patients with heart failure. 2.Compared with routine care,the NP management can improve the prognosis of patients with heart failure. 3.Compared with routine care,the NP management can improve the quality of life in patients with heart failure. 4.Compared with routine care,the NP management can reduce the incidence of death and re-hospitalization. 5.Compared with routine care,the NP management can reduce the medical expenses. 6.Compared with routine care,the NP management can increase the patient satisfaction. 7.The ability of NP can achieve the requirements of being the doctor assisstant.