Analysis Of High Risk Factors In Patients With Severe Stroke And Study Of Cluster Intervention Strategies

Objective:Discussion on risk factors of aspiration in severe stroke patients with and effects of cluster nursing intervention strategies, to provide evidence for scientific and clinical guideline of enteral nutrition nursing specification in critical patients of neurology department.Methods:According to clinical observation on patients with severe stroke, clinical experiences of nursing experts, and literature review, we summarized risk factors of aspiration for severe stroke patients. In view of the risk factors of aspiration in severe stroke patients, access to domestic literature, combined with expert advice, reasonable and scientific cluster intervention strategies for preventing aspiration were formulated, which will be suitable for domestic medical situation. In this study, 114 patients with severe stroke were selected,who were treated with enteral nutrition in Neurological Intensive Care Unit of Jilin University First Hospital from August 2015 to 2016 March.Patients were divided into cluster intervention trial group(56 cases)who were treated from August to October 2015,and control group(58 cases) providing routine nursing interventions who were treated from January to March 2016.Data and information of patients in both groups were recorded in < table of clinical research and case report >. Positive results of the sputum pepsin testing was regarded as diagnostic criteria of aspiration, then sputum was collected for14 consecutive days. Sixty registered nurses were selected, who are involved in the experimental data collected in this study, they provided routine nursing interventions and cluster intervention on two groups of patients respectively.Aspiration incidence of two groups and implementation rate of standardized nursing procedures for preventing aspiration in nurses were compared. All data was analysed and presented by SPSS software and Excel, t-test for measurement data, x2 test for count data. P<0.05 standed for differences have statistical significance.Results:1. The incidence rate of aspiration in the experimental group was 7.1%,which was significantly lower than that in the control group(25.9%).(P=0.007)2. Compare implementation rate of standardized nursing operation between Two groups of nurses.(1) “If the bed was lowered for clinical needs, feeding should be stopped for 30 min~60min”, this implementation rate increased from 15.5% to 92.9%(P<0.001, it was significant difference);(2) In patients with gastric motility disorder or long-term enteral nutrition(>4w), the rate of choosing H.pylori feeding was increased from 32.8% to67.9%(P<0.001, with significant difference);(3) The implementation rate of aspiration screening for severe stroke patients in 24 h after being accepted was increased from 0% to 100%(P<0.001,with significant difference);(4) "Oral care with 0.12% chlorhexidine, at least 3 times per day or according to need; the secretions of nasal and oral cavity and retentate of airbag were cleared up in time",this implementation rate increased from 8.6% to100%(P< 0.001, there are significant differences).Conclusion:1. Focusing on risk factors,implementation of cluster intervention strategies can reduce the incidence of aspiration in severe stroke patients.2. Both in the implementation of routine nursing intervention and cluster intervention strategies, Nurses’ implementation of the norms care has been in good condition.3. Grasping the high risk factors of aspiration and implementing cluster intervention strategy, Nurses highlighted the safety of enteral nutrition and improved the standard of nursing operation.4. Implementation of cluster intervention strategies to prevent aspiration helped guarantee the safety of enteral nutrition in severe stroke patients and improve the quality of nursing care.5. The cluster intervention strategy for preventing aspiration received good results, in compliance with the clinical nursing operation guide and the actual situation, which can be regarded as standard implementation in clinical operation, to achieve the purpose of nutritional support.