Study On The Construction And Effect Of Nursing Practice Model In Case Management Of Stroke

Objection:1.To understand the current situation of the management of stroke patients in China and explore a new mode of chronic disease management.2.Based on China’s medical and health background,combined with the current situation of the management of stroke patients,and drawing lessons from the experience of foreign stroke case management practice,the admission criteria and work responsibilities of stroke case managers in line with China’s national conditions are constructed.3.In view of the insufficiency of the current situation of the management of stroke patients,the practical scheme of stroke case management is constructed on the basis of the admission criteria and work responsibilities of stroke case managers.4.The preliminary design trial study evaluates the effectiveness of the case management practice program for stroke.Method:(1)A cross-sectional survey was conducted to investigate the current situation of medical and nursing skills of stroke patients during hospitalization,based on the reference of relevant literature and consultation with relevant nursing experts and managers,using the work content of foreign stroke case managers as the framework.(2)Adopts Delphi expert consultation method.On the basis of the investigation results of the current situation of the management of stroke population,a draft of the job responsibilities of case managers was preliminarily constructed.Based on the basic roles and responsibilities of case managers,the qualifications of case managers were explored and the draft of the post admission criteria for case managers was formulated.Consult experts’ opinions from stroke departments,revise them repeatedly,and preliminarily form the admission criteria and draft work responsibilities for stroke case managers.Delphi expert consultation was implemented to clarify the admission criteria and responsibilities of stroke case managers.(3).the action research method was used to construct the practical process plan of stroke case management.(4)The fourth stage is the design of experimental study to evaluate the effect of the practical scheme of stroke case management.Results:(1)A survey of 643 doctors,nurses and convalescents in 42 second and thirdclass general hospitals in China found that the risk factors,complications,rehabilitation,discharge preparation plan and communication management between doctors and patients of stroke patients were unsatisfactory.(2)A set of admission criteria for stroke case managers including three first-level indicators,seven second-level indicators and 17 third-level indicators was constructed,including four first-level indicators,17 second-level indicators and 80 thirdlevel indicators.The results of experts’ positive coefficient and authority coefficient show that the scheme is reliable and scientific.(3)Based on the established responsibility of stroke case management,the practical scheme of stroke case management and related research tools were constructed.(4)Case management can effectively improve patients’ awareness of risk factors,reduce their bad behavior after discharge,enhance the muscle strength of affected limbs,and improve neurological function recovery and self-care ability.Conclusion:(1)The present situation of risk factors,complications,rehabilitation management,discharge preparation plan and doctor-patient communication management of stroke patients in China is not ideal.Most medical and nursing technicians have the need of multi-disciplinary cooperation and specialist management.(2)A set of admission criteria for stroke case managers including three first-level indicators,seven second-level indicators and 17 third-level indicators was constructed,including four first-level indicators,17 second-level indicators and 80 third-level indicators.(3)A model of stroke case management has been formed,with risk factors,complications,rehabilitation management,compliance and doctor-patient communication as the core,and discharge preparation plan as the path through the whole process.(4)The practice model of case management nursing for stroke patients formed in this study can effectively promote the self-management of risk factors and the recovery of neurological function,and improve the ability of self-care in life.