| Objective: Based on the evidence-based nursing theory and the Australian JBI health care model,the high-level research evidence is included in the research content,and its scientific and safety is verified by the expert meeting method and small sample clinical application,and finally early mobilization program in postoperative patients of hepatic corrihosis combined with hepaocellular carcinoma(HCC)is established.And clinically confirmed the practicality and effect of this program,which provide clinical and effective early postoperative measures for clinical nursing staff to promote rapid recovery postoperative patients of hepatic corrihosis combined with hepaocellular carcinoma MethodsThe first section : Construction of early mobilization program in postoperative patients of hepatic corrihosis combined with hepatocellular carcinoma: 1.Establish a team of early mobilization program in postoperative patients of hepatic corrihosis combined with hepatocellular carcinoma.2.Evidence-based evidence retrieval and literature quality evaluation 3.Experts discussed and demonstrate that the content and structure of early mobilization program in postoperative patients of hepatic corrihosis combined with hepatocellular carcinoma.4.Organize expert opinions,modify,supplement and improve and form an early mobilization program in postoperative patients of hepatic corrihosis combined with hepatocellular carcinoma finally.5.Application of this early mobilization program for clinical small sample.The second section: Clinical application of early mobilization program in postoperative patients of hepatic corrihosis combined with hepatocellular carcinoma: The 46 HCC patients hospitalized in the Department of Hepatobiliary Surgery of the First Affiliated Hospital of Guangxi Medical University from December 2017 to February 2018 were selected as the control group,the 46 HCC patients hospitalized from July 2018 to October 2018 were selected as the intervention group.The control group was treated according to the nursing routine of hepatobiliary surgery,the intervention group was treated with the e early mobilization program in postoperative patients of hepatic corrihosis combined with hepatocellular carcinoma.The two groups of patients were compared those index(1)the clinical effect of postoperative patients with early mobilization;(2)the implementation of early mobilization measures of nurses in the intervention group;(3)Auxiliary efficacy index: Liver function indicators,complication rate and grade evaluation;postoperative hospital stay time;(4)emotional state changes in patients before and after intervention;(5)the satisfaction of discharged patients.All data were statistically analyzed using SPSS19.0 statistical software.The measurement data were described by mean ± standard deviation(`c±s).The two groups were compared by t test.The count data were compared by chi-square test.P<0.05 was considered as difference.It is statistically significant.Result1.Through the evidence-based nursing practice,a draft plan for early mobilization program in postoperative patients of hepatic corrihosis combined with hepatocellular carcinoma was constructed.After the revision and supplement of the draft structure,project and content by experts,the official text of the early mobilization program in postoperative patients of hepatic corrihosis combined with hepatocellular carcinoma was finally formed.Including preoperative assessment,preoperative and postoperative health education,postoperative early mobilization initiation criteria,early mobilization suspension criteria,safety and quality assurance of postoperative early mobilization,postoperative early mobilization scores for patients,postoperative early mobilization schedules,postoperative rehabilitation training table and the early activity process quality control table in this program.The application of this program in a small clinical samples,observed that the patient’s willingness to move were strong,excellent performance in early mobilization,no adverse events such as bleeding,wound splitting,falls,etc.This program can be applied clinically.2.Acceptance of early activity: Patients in the intervention group were unwilling to move,the general willingness of activities was lower than that of the control group,and the number of active strong was significantly higher than that of the control group,the difference was statistically significant(P<0.05);The patient’s the early mobilization satisfaction table showed that the nurse’s knowledge level,satisfaction for the nurse’s early mobile zation guilinded,the nurse’s health education,postoperative physical recovery and quality of life improvement,and the nurse’s concern and problem-solving and discharge counseling of the six items of table was higher than that of the control group,and the difference was statistically significant(P<0.05).The nurses’ knowledge level,satisfaction for nurses’ early mobilization guilinded,nurses’ health education,surgery The satisfaction evaluation of the body and the quality of life improvement the four items were significantly higher than that of the control group,and the difference was statistically significant(P<0.01).3.Comparison of safety indicators of early activities: no adverse events such as wound bleeding,tube loss and falls occurred during the activities of the two groups of patients.There was a statistically significant difference in the total number of complications and the incidence of postoperative grade I complications between the intervention group and the control group(P<0.05).The incidence of complications of grade II,III and IV in the intervention group was lower than that of the control group,but the difference was not statistically significant(P>0.05).The incidence of postoperative nausea and vomiting in the intervention group was lower than that in the control group,the difference was statistically significant(P<0.05).4.The effect of early mobilization in patients: the first exhaust time of the intervention group and the control group was 59.21±10.20 h and 72.11±20.95 h,and the first defecation time of the intervention group and the control grouas were 90.68±10.21 h and 99.39±19.60 h,the first feeding time of the intervention group and the control group was 43.73±15.50 h and 58.08±21.33 h.There was no significant difference in the abdominal distension score between the two groups(P>0.05),but the bloating scores of the intervention group was 1-3d after operation.were lower than those in the control group.The bloating scores of the intervention group were 0.64±0.58 and 0.48±0.89 at 4 days and 5 days after operation,which was significantly lower than the control group 4 days and 5 days after surgery were 1.07±0.60 points and 0.88±0.59 points,the recovery time of gastrointestinal function in the intervention group was shorter than that in the control group,the difference was statistically significant(P<0.05).In the intervention group,2 patients had pulmonary infection after operation,4 patients had ineffective sputum,5 patients had pleural effusion,8 patients had pulmonary infection after operation,in control group 11 patients had ineffective sputum,and 13 patients had pleural effusion,the difference between the two groups was statistically significant(P<0.05).The recovery time of lung function in the intervention group was shorter than that of the control group.The first time to get out of bed in the intervention group and the control group were 53.99±14.00 h and 65.07±20.57 h,the difference between the two groups was statistically significant(P<0.05).The activity distance and number of steps of the intervention group from 2 days to 5 days after operation was significantly higher than that of the control group,and the difference was statistically significant(P<0.05).The recovery time of the intervention group was earlier than that of the control group.The postoperative hospital stay was 8.31±1.68 days in the intervention group,which was significantly shorter than that in the control group(10.00±2.70 days).The difference was statistically significant(P<0.01).Changes in emotional status before and after intervention in the two groups: There was no significant difference between score for each dimension and the total score of BPOMS(45.45±6.87 VS 45.88±4.67)between the two groups before and after intervention(P>0.05),so the scores of the two groups of data were comparable on preoperation 1 day.The two groups had higher scores in the three dimensions of stress-anxiety,fatigue-slowness,confusion-puzzle,indicating that patients of hepatic corrihosis combined with hepatocellular carcinoma had negative emotions such as more stress,anxiety,fatigue,retardation,confused,chaotic before surgery,but also depression.From the results of discharge day,the intervention group had cores in stress-anxiety,depression-frustration,anger-hostility,fatigue-slowness,confusion-disorder were significantly lower than the control group,but the energy-activity dimension score was higher than the control group.The difference between the two groups was statistically significant(P<0.05).Conclusion 1.The "Early mobilization Program for HCC with Hepatitis B cirrhosis" based on evidence-based evidence has scientific and clinical application safety.2." Early mobilization Program for HCC with Hepatitis B cirrhosis " can improve the patient’s willingness to move and improve the compliance of early mobilization.3."Early mobilization Program for HCC with Hepatitis B cirrhosis " can effectively promote postoperative rehabilitation and reduce postoperative complications,which is worthy of clinical application.4.The construction and application of " Early mobilization Program for HCC with Hepatitis B cirrhosis " can guide nurses to scientifically carry out early activity care and promote the development of clinical specialty nursing. |
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