| ObjectiveBased on primary hypertension lead to cerebral hemorrhage,and a stable condition after the CT shows no significant cerebral hemorrhage quantity increase overall disease patient characteristics,and the patient’s individual situation,study the personalized continuity of care in improving hypertension cerebral hemorrhage plateau,and the side body movement and life of patients with hemiplegia self-care ability,anxiety,depression and other aspects of practical application,and objective data to evaluate the effect.MethodsBased on the continuous care practice within the framework of Omaha System as the theoretical basis,the researcher carried out the study according to the following steps in combination with the treatment in the department of our hospital,the overall characteristics of clinical patients and different individual characteristics:1.The continuity of care for patients with hypertension cerebral hemorrhage hemiparalysis families service demand questionnaire "formulation: investigation and study,first of all,according to the disease of hypertension cerebral hemorrhage hemiparalysis characteristics,such as doctors,nurses,rehabilitation group of experts to discuss,guidance,to design the continuity of care for patients with hypertension cerebral hemorrhage hemiparalysis families service demand questionnaire",and to investigate patients with hypertension cerebral hemorrhage after the illness stability demand for continuity of care.Thirty patients with hypertensive intracerebral hemorrhage(HICH)at stable stage and accompanied by physical movement disorders were randomly selected for pre-investigation,and the questionnaire items were modified according to the feedback opinions,data access and expert group opinions;The final version was determined after the second investigation and reliability and validity test.2.Research on continuous care for patients with hemiplegia after hypertensive intracerebral hemorrhage: According to the disease characteristics of hypertensive intracerebral hemorrhage and the composition of patients’ needs,the following methods are proposed to be used to conduct the study.1)Establish a continuing care team.The team was led by the researcher and provided technical support by a neurosurgeon.The team consisted of two general neurosurgical nurses,one neurosurgical nurse with rehabilitation nursing qualification and one rehabilitation therapist.According to the characteristics of the disease and the individual needs of the patients,the team members jointly developed the follow-up continuity of care related content,including :(1)to discuss the research ideas,inclusion and exclusion criteria,and the basic principles of continuity of care;(2)The neurosurgeons and rehabilitation therapists conducted unified training,learning and assessment on the basic knowledge,rehabilitation training methods and measurement indicators that might be involved in the study,so as to ensure the uniformity of the scale scoring criteria,education and operation for patients and their families during the study;(3)The initial inclusion and exclusion criteria of this study were formulated based on the results of the questionnaire survey on the earlier needs.2)Pre-experiment: According to the initial inclusion and exclusion criteria,5patients with hypertensive intracerebral hemorrhage who met the criteria were randomly selected for the pre-experiment.The initial criteria were as follows:Inclusion criteria were:(1)patients with limb hemiplegia due to initial hypertensive intracerebral hemorrhage;(2)in the stable stage of the disease,conscious and able to communicate normally;(3)Volunteer to participate in this study.Exclusion criteria :(1)complicated with aneurysm,arteriovenous malformation and other cerebrovascular diseases;(2)Taking vasoactive drugs or anticoagulants;(3)The patient suffers from mental disorders,other serious systemic diseases,or other factors that result in limited physical activity;(4)People without regular care.3)According to the feedback of questionnaire and pre-experiment results,the inclusion and exclusion criteria were optimized,the division of labor of continuing care team members was clarified,and the health education program was optimized.The final inclusion criteria were :(1)the patient’s condition met the diagnostic criteria of cerebrovascular disease,and the patient was diagnosed with cerebral hemorrhage by CT or MRI;(2)Initial spontaneous intracerebral hemorrhage;(3)suffer from essential hypertension and have no other systemic diseases and dysfunction;(4)The GCS score was greater than 10 at discharge after the operation,and the muscle strength of the hemiplegia side was 2-4;(5)Clear consciousness,able to correctly understand the teaching content and cooperate with the training;(6)Patients who have lived in Wuhan;(7)patients and their caregivers voluntarily participate in the study and agree to cooperate with follow-up continuing care services and requirements;(8)After discharge,he received rehabilitation training at home according to instructions and did not seek help from other rehabilitation institutions.Exclusion criteria were :(1)aneurysm,cerebral arteriovenous malformation and other cerebrovascular diseases;(2)Unable to participate in the study with severe dysfunction of other systems,malignant tumors,paralysis,etc.;(3)previous psychiatric history and failure to follow the visitors;(4)Limitation of limb function caused by other diseases or factors;(5)Taking vasoactive drugs or anticoagulants;(6)Re-hospitalization due to other reasons during the observation period.The group analyzed and discussed the main risk factors that may be encountered in the course of continuing care for patients with stable hypertensive intracerebral hemorrhage.Home care measures and rehabilitation training programmes;How to improve patients’ compliance behavior and cultivate their good living habits through continuous care service;How to improve the limb movement ability,self-care ability,relieve the anxiety and depression of patients and improve the quality of life under the premise of disease control through continuous care services? After the discussion,the final continuity of care implementation plan,the evaluation index and inclusion and exclusion criteria of this study were determined.3.According to the preliminary questionnaire survey and preliminary experimental results,it is finally determined that the historical control method is adopted to conduct the experimental study.According to the final inclusion and exclusion criteria,40 patients with hemiplegia after hypertensive cerebral hemorrhage who received treatment in a Class A hospital in Wuhan from July 2018 to January2019 were retrospectively selected as the control group.A total of 35 patients with hemiplegia after hypertensive intracerebral hemorrhage who received treatment in a Grade A hospital in Wuhan from March 2019 to September 2019 were randomly selected as the experimental group.Nine people were lost to follow-up during the experiment,and 32 cases were eventually included in the control group and 34 cases in the experimental group.Continuing care measures:(I)Control group: retrospective analysis and data collection were performed on the patients in the control group.The continuous nursing measures of the control group were the basic return visit measures of the third grade A hospital,including:routine nursing during hospitalization,including admission education,disease knowledge introduction,medication guidance,lifestyle guidance,perioperative nursing,etc.Before discharge,routine discharge guidance was given,including dietary guidance,exercise guidance,timely review,etc.,and relevant information of patients was collected.One week after discharge,routine telephone return visit was conducted,and the main contents of return visit were: inquiring about the patient after discharge,trying to solve the existing problems of the patient,and reminding the time for review.CT reexamination after admission showed that there was no increase in cerebral hemorrhage,and the patient was in a stable period.When the baseline level of the patient was collected,three months after discharge and six months after reexamination,the researcher collected the patient data on the spot,recorded the patient’s situation,and asked the patient about the questions and experience of the continuing care service.(2)The experimental group: given the same as the control group during the period of hospitalization nursing measures,the hospital a week before the continuity during the nursing service,diversified group continuity of care for patients with nursing health education activities,the main contents are as follows: ○1 week prior to discharge,organized by the researchers explain the harm of the etiology of hypertension,high blood pressure,how to effectively control blood pressure,taking blood pressure medication precautions,cerebral hemorrhage,because the hair cause of disease,complications and related diet guidance and life guidance.Through the distribution of self-made health education handbook to explain the disease-related knowledge and rehabilitation related knowledge,cultivate patients’ good living habits,improve the self-care level and self-care awareness of patients and caregivers.Knowledge explanation to patients and caregivers to understand,illustrated,content to ensure simple and easy to understand,step by step.○2 Three days before discharge,patients were given discharge guidance and comprehensive nursing evaluation,patients’ caregivers were taught to measure blood pressure and patients and caregivers were encouraged to keep health diaries.The basic condition of the patients was evaluated,and targeted rehabilitation training guidance was made according to the problems of the patients.○3 Education on discharge: establish continuous nursing health records for patients,and the continuous nursing team will develop personalized rehabilitation nursing plan and home life guidance for them.The rehabilitation program is generally divided into four stages: early passive exercise,the healthy side of the limb to promote the movement of the affected side of the limb,carrying out life ability training,and strengthening the fine degree of limb movement.At discharge,individualized plans are made according to individual patient status,family activity space status,characteristics of main caregivers,etc.,and the rehabilitation plan process is adjusted according to the patient’s training process;Instruct patients to record their recovery on a weekly basis;Family members shoot videos of home rehabilitation training and daily activities every week to give feedback on patients’ rehabilitation and living conditions,so that their rehabilitation plan can be adjusted in time.○4 After the patient is discharged from hospital: Publish education content twice a week through We Chat platform,including disease knowledge guidance,medication guidance,life guidance,regularly shooting rehabilitation training videos to guide caregivers on how to train the patient at home;Through the special telephone for continuing care,the patients were called back every Sunday to inquire about the recovery of the patients and the health diary records,so as to solve the existing problems at the present stage.Patients’ caregivers were required to upload weekly videos of patients’ home rehabilitation training and daily activities;Patients discharged from hospital after the end of every month by the continuity of care team members with the patient to carry on the video attachment to see whether there is a hidden risk factors in patients with the living environment,found hidden dangers and points out that the patients by video link to check the daily training condition,to correct the problems of daily training,understanding and improve patients rehabilitation training schedule and answer questions;○5 During rehabilitation training after discharge,patients and their families were assessed two weeks after the start of each stage of training.The first stage mainly assessed the patient’s passive movement,and the continuing care team evaluated whether the caregiver grasped the correct method of helping the patient’s affected limb movement by shooting video.The second stage evaluates whether the patient grasps the correct method of moving the limb from the healthy side to the affected side.In the third stage,the caregivers filmed videos of patients eating,dressing,walking and body position change independently,and judged whether the patients could carry out living ability training on their own.The fourth stage assesses the fineness of limb movements of patients,and evaluates whether patients can complete fine movements such as grasping small objects and combing hair.Each stage is assessed to ensure that patients and caregivers have mastered the training methods for the stage,and after a certain period of time,the continuing care team will evaluate whether to proceed to the next stage of training.Continuing nursing team should ensure the continuous follow-up and real-time monitoring of the implementation of rehabilitation plan after discharge,timely intervene patients,evaluate and guide the rehabilitation training process of patients through telephone follow-up,video feedback and other methods;In patients admitted to hospital after the CT on the third day after the cerebral hemorrhage has no obvious earlier,in treatment of patients with plateau when collecting baseline,three months,six months after discharge the patient review,patient information collected by the continuity of care team site,record the clinical situation,ask the patient for continuity of care service and experience.The duration of observation and continuous care service for patients in both groups was 6 months.Data of two groups of patients were collected.(1)On the third day after the patient was admitted to the hospital and the CT showed no significant increase in cerebral hemorrhage compared with before,the patient was in the stable period,and the baseline level of the two groups of patients was collected to ensure that there was no statistically significant difference between the two groups.(2)Data were collected from patients in the control group and the experimental group three and six months after discharge.The main information includes: general information;Chinese version of Fugl-Meyer locomotor function assessment table was scored.During the review,researchers required patients to complete the prescribed movements and evaluate the use of their limbs in the daily environment.Daily living ability score(ADL),to evaluate the ability of patients to take care of themselves;The Anxiety and Depression Scale was used to evaluate patients’ anxiety and depression.Readmission rate due to hypertension or hypertensive cerebral hemorrhage;Satisfaction surveys.Among them,in order to avoid repeated use of the Fugl-Meyer locomotion function assessment form so that the control group could consciously train the scale evaluation content and thus affect the score,the Fugl-Meyer locomotion function assessment was only measured twice during the stable period and 6 months after discharge.SPSS25.0statistical software was used to analyze and process all data,frequency(percentage)was used to describe count data,and chi-square test was used for comparison between groups(Fisher’s exact test was used for some parts).The scores of motor function,self-care ability,anxiety and depression in the two groups during the same period were first tested for normality.Those meeting the normal distribution were described by mean ± standard deviation,and the independent sample t test was used for comparison between the two groups.Results1.The comparison of general information(age,gender,education,marital status,type of medical insurance,occupation,etc.)between the two groups showed P>0.05,which showed no statistical significance.Patients in the two groups were comparable.2.Comparison of Fugl-Meyer scores between the two groups during the same period: in the stable period,the scores of the experimental group(20.18±3.47)and the control group(20.47±3.24);6 months after discharge,the experimental group(78.41±3.96)and the control group(65.63±3.69).The t-test was used to compare the scores of patients in the same group at different times,and the difference was statistically significant(P<0.001),indicating that the patient’s limb function would also be improved without intervention.At the same time,the scores of two groups of patients were compared by t-test,and the differences were significant(P<0.001),indicating that continuous nursing can more significantly promote the recovery of motor function in patients with hemiplegia after hypertensive cerebral hemorrhage.3.Comparison of the daily living ability between the two groups during the same period: in the stable stage,the experimental group(19.94±3.15)and the control group(19.19±3.91);3 months after discharge,the experimental group(55.82±5.58)and the control group(35.19±3.39);6 months after discharge,the experimental group(88.18±5.64)and the control group(65.69±2.69).The t-test was used to compare the patients in the same group at different periods,and the difference was significant(P<0.001),indicating that the self-care ability of patients would be improved under the condition of no intervention.However,t test was used to compare the daily living ability of patients in the two groups.The self-care ability of patients in the experimental group was significantly higher than that in the control group,and the differences were significant(P<0.001),indicating that continuous nursing can more effectively promote the recovery of the daily living ability of patients with hemiplegia after hypertensive cerebral hemorrhage.4.Comparison of anxiety and depression in the two groups during the same period: the anxiety scores in the stable period of the experimental group(9.62±2.22)and the control group(9.50±2.09),the experimental group(6.38±2.13)and the control group(8.00±1.30)3 months after discharge,and the experimental group(5.41±1.10)and the control group(7.16±1.17)6 months after discharge;The scores of depression were 8.65±2.19 in the stable experimental group and 8.68±1.91 in the control group,6.36±1.34 in the experimental group 3 months after discharge and 7.79±1.55 in the control group,5.53±1.37 in the experimental group 6 months after discharge and6.74±1.48 in the control group.The patients in the same group were compared within the same group at different periods,and the anxiety and depression conditions of the patients were improved,with statistical significance(P<0.05).Two groups of patients were compared at the same time,the anxiety and depression of the experimental group in stable period,3 months and 6 months after discharge were significantly lower than that of the control group at the same period,the differences were significant(P<0.05),indicating that continuous nursing can significantly improve the anxiety and depression of patients with hypertensive cerebral hemorrhage hemiplegia.5.Within 6 months after discharge,the readmission times due to hypertension or hypertensive cerebral hemorrhage in the two groups were counted and the readmission rate was calculated.The readmission rate was 0.00% in the experimental group and 2.94% in the control group.It shows that continuous nursing can help patients with hypertensive cerebral hemorrhage develop good living habits to control blood pressure,reduce readmission rate,and reduce recurrence rate.6.Six months after discharge,the satisfaction of the two groups of patients was investigated.The average score of the experimental group(97.8±2.2)was significantly higher than the average score of the control group(92.4±2.6),indicating that continuous nursing can improve the nursing satisfaction of patients with hemiplegia after hypertensive cerebral hemorrhage.Conclusion1.Continuing nursing can improve the daily activity ability and limb movement function of hemiplegia patients after hypertensive intracerebral hemorrhage.2.Continuing nursing can improve the psychological state of patients with hemiplegia after intracerebral hemorrhage and improve patient satisfaction.3.Continuing care can enhance patients’ awareness of compliance,develop good living habits,and reduce the readmission rate. |
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