| Objective:Questionnaire survey was used to investigate the status quo of knowledge,attitude and practice management of nurses in cardiovascular departments of 11 prefecture-level hospitals in Shanxi Province on secondary prevention of coronary heart disease,and its influencing factors were analyzed.To clarify the needs of secondary prevention and cardiac rehabilitation management in patients with coronary heart disease;On this basis,domestic and foreign clinical practice guidelines on cardiac rehabilitation and secondary prevention management of CHD were systematically searched,the best evidence of secondary prevention management of CHD was evaluated and summarized,and combined with expert meeting method,the nursing management plan of secondary prevention and cardiac rehabilitation of CHD patients was constructed.Methods:(1)questionnaire method: A questionnaire was made to investigate the knowledge,attitude and behavior of nurses in cardiovascular departments on secondary prevention and cardiac rehabilitation of patients with coronary heart disease.A total of 1087 nurses in 11prefecture-level cardiovascular departments in Shanxi Province were selected by convenience sampling method to investigate their knowledge,attitude and behavior on secondary prevention management of patients with coronary heart disease.(2)Semi-structured interview: According to the interview outline,18 patients with coronary heart disease were deeply interviewed and their needs for secondary prevention and cardiac rehabilitation management were understood.(3)Evidence summary: systematic retrieval of clinical practice guidelines for cardiac rehabilitation and secondary prevention management of CHD,screening and integrated analysis of guideline evidences.(4)Evidence evaluation: the above evidences were integrated and refined according to the "2014 JBI Evidence pre-score system and Evidence Recommended Level System",and the preliminary draft of the nursing management plan for secondary prevention of coronary heart disease and cardiac rehabilitation was formulated(5)Expert meeting method: Organize clinical,nursing and rehabilitation related experts to hold expert meetings,and revise and improve the first draft of the nursing plan in combination with domestic clinical practice,and finally form the "Secondary Prevention and Cardiac Rehabilitation Nursing Management Plan for Patients with Coronary Heart Disease".Results:(1)Questionnaire survey results: A total of 1120 questionnaires were collected,of which 1087 were effective,with effective recovery rate of 97.0%.The score of knowledge dimension of secondary prevention of coronary heart disease was(24.17±5.37),the score of attitude dimension was(53.85±7.97),and the score of behavior dimension was(51.23±10.07).Multiple linear regression analysis showed that different departments,whether to learn relevant guidelines or consensus,years of cardiovascular care,whether the hospital implements cardiac rehabilitation,hospital level and whether to participate in cardiac rehabilitation training were the influencing factors of the total score of nurses’ knowledge and practice of secondary prevention of coronary heart disease(P<0.05).(2)Qualitative study results: the needs of CHD patients for secondary prevention and cardiac rehabilitation mainly fall into five aspects: lack of knowledge related to CHD,needs for personalized and operational rehabilitation guidance,needs for continued rehabilitation guidance after discharge,needs for family and social care,and needs for hospital and community combined services.(3)evidence synthesis and evaluation of evidence: through the system retrieval at home and abroad to guide,participants included 17 article summarizes clinical practice guidelines for evidence,preliminary summary 13,150 piece of evidence,including cardiac rehabilitation,exercise therapy,dietary recommendations,emotional/psychological/sleep management,blood pressure,blood lipid,blood glucose,quit smoking,limit alcohol consumption,body weight and waist circumference management,vocational rehabilitation,health education and sex.(4)Results of the expert meeting: Based on the questionnaire survey,patient interview,the best evidence results,and the discussion opinions of the expert meeting,the preliminary draft of the plan was revised to form the final version of "Nursing Management Plan for Secondary Prevention of Coronary Heart Disease and Cardiac Rehabilitation".Conclusion:(1)The knowledge and behavior level of nurses in cardiovascular department on secondary prevention management of CHD need to be improved,while the nursing attitude is more active,and there is a big gap between nursing clinical practice management and guideline recommendations.Therefore,it is necessary to strengthen the training of nurses on secondary prevention and cardiac rehabilitation of CHD.(2)Different patients have different cardiac rehabilitation needs,and different health education and cardiac rehabilitation intervention strategies lead to different clinical outcomes of patients,suggesting that medical staff should evaluate individual needs and implement personalized management strategies for secondary prevention and cardiac rehabilitation management.(3)based on the comprehensive survey,interviews,evidence and expert meetings to build the management of coronary heart disease secondary prevention and cardiac rehabilitation care programme in clinical practice and meet the demand of patients,the scheme,a total of 13 aspects contents,for subsequent managers for cardiac rehabilitation nursing management training plan,to promote cardiac rehabilitation management refinement,standardization and scientific development. |
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