| 【Objectives】The purpose of this study is to explore the clinical application effect of HAPA model(Health Action Process Approach,HAPA)in the perioperative rehabilitation nursing of senile patients with artificial hip replacement.And to explore the effects of HAPA model rehabilitation nursing on hip function,daily living ability,pain,anxiety and dynamic balance function gait of elderly patients with hip replacement.The research explores effective measures to promote patients’ health behavior change and rehabilitation from the aspect of social cognitive behavior,in order to provide reference and basis for clinical promotion of better and faster rehabilitation of patients.【Methods】In this study,80 elderly patients who met the inclusion and exclusion criteria and underwent unilateral hip arthroplasty for the first time were selected from the orthopaedic department of a Grade III A hospital in Yunnan Province from December 2019 to November 2020.Using random number table method,they were randomly divided into control group and intervention group,with 40 cases in each group.The two groups of patients were respectively implemented different rehabilitation nursing intervention.The control group received routine nursing,mainly including preoperative(admission evaluation,psychological,life,pain and other nursing),operation day(pick-up,preparation and nursing)and postoperative(general nursing,specialized nursing,dietary guidance,discharge guidance).The intervention group received rehabilitation nursing guided by HAPA model combined with routine nursing.Intervention group in the control group,on the basis of the main the belief of preoperative rehabilitation intervention(risk perception,outcome expectations,self-efficacy enhancement)and rehabilitation nursing plan(functional exercise,life guidance plan)and postoperative rehabilitation program implementation,regulation and supervision(team operation,guiding by the bed,goal setting,performance contract,We Chat exchange group,Follow-up tracking).Research by Harris hip function scale,modified Barthel index(MBI),visual analog pain rating scale(VAS),Hamilton anxiety scale(HAMA),time to stand up-walk test(TUGT)research tools,before intervention for patients with baseline evaluation indicators,in the hospital,a month after the intervention respectively after the rehabilitation effect of evaluation.SPSS25.0 statistical software was used for data processing.【Results】1 A total of 80 patients were included in the study,of which 6 patients were abscission due to withdrawal and follow-up failure in the two groups,and the abscission rate was7.5%.Finally,74 effective samples were included,including 37 cases in the intervention group and 37 cases in the control group.2 Baseline data comparison: there was no statistically significant difference in demographic data between the two groups(P > 0.05).There were no statistically significant differences in disease related data(P > 0.05).3 Overall comparison of Harris hip function: There was no statistically significant difference in Harris scores between the two groups before intervention(P > 0.05).After rehabilitation nursing intervention,the Harris scores of the intervention group were higher than those of the control group after discharge and one month after operation,and the differences were statistically significant(P < 0.01).Pain,daily activity,gait,walker walking,distance,deformity,and range of motion were assessed in the Harris hip scale.There were no statistically significant differences between the two groups in each dimension before intervention(P > 0.05).After nursing intervention,the difference between the two groups at discharge was statistically significant(P < 0.05);There was no significant difference in pain dimensions between the two groups in one month after surgery(P > 0.05),and the differences in other dimensions were statistically significant(P < 0.05).4 Self-care ability in daily life: there was no statistically significant difference in MBI scores between the two groups before intervention(P > 0.05).After rehabilitation nursing intervention,the MBI scores of both groups were improved compared with those before discharge and one month after operation,and the intervention group was better than the control group,the differences were statistically significant(P < 0.01).5 Pain: There was no statistically significant difference in VAS scores between the two groups before intervention(P > 0.05).After rehabilitation nursing intervention,the degree of pain in both groups was reduced after discharge and one month after operation,and the VAS score in the intervention group was lower than that in the control group,the differences were statistically significant(P < 0.05).6 Anxiety: There was no statistically significant difference in HAMA scores between the two groups before intervention(P > 0.05).After rehabilitation nursing intervention,anxiety in both groups was relieved after discharge and one month after operation,and HAMA score in the intervention group was lower than that in the control group,the differences were statistically significant(P < 0.01).7 TUGT test: After rehabilitation nursing intervention,the TUGT test results of the two groups were compared after discharge and one month after operation,and the difference was statistically significant(P < 0.01).【Conclusions】1 The HAPA model is feasible and effective in the perioperative rehabilitation and nursing scheme of the elderly patients with artificial hip replacement.2 This rehabilitation nursing program has a positive effect on promoting hip joint function recovery and dynamic balance and stable gait of elderly patients with hip replacement,improving self-care ability in daily life,alleviating pain and anxiety of patients,and can effectively promote the rehabilitation of patients.This scheme is superior to simple routine nursing.The effect was particularly significant during hospitalization.3 Based on HAPA theory model to guide the rehabilitation nursing of patients with hip replacement,further confirmed the importance of following the principles of rehabilitation nursing and formulating rehabilitation nursing plan in clinical practice for the change of patients’ health behavior.4 From the perspective of social cognition and behavior,the application of HAPA model in rehabilitation nursing of elderly patients with artificial hip replacement can effectively promote the transformation of patients’ health behaviors.It has a positive effect on health recovery.This perspective is novel,applicable and beneficial to the rehabilitation of clinical patients.It has clinical application value and can be further explored and promoted in clinical practice. |
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