Study On Traditional Chinese Medicine Clinical Nursing Pathway Construction And Application Of Chronic Heart Failure

Background:Chronic heart failure（CHF）is a dominant disease of Traditional Chinese Medicine.Based on the existing quality nursing experience,we should give full play to the advantages of traditional Chinese medicine nursing and carry out inheritance and innovation.At present,China’s medical institutions are also continuing to promote the application and popularization of clinical pathway and traditional Chinese medicine technology.On the basis of deepening the implementation of traditional Chinese medicine nursing routine and technical norms,we should promote the optimization of traditional Chinese medicine nursing mode and innovation of traditional Chinese medicine nursing technology.The Clinical Nursing Pathway（CNP）,as a new patient-centered Nursing management model,enables nurses to quickly and efficiently complete various Nursing tasks according to the established model and provide high-quality Nursing services for patients.Therefore,it is necessary to develop TCM CNP suitable for CHF to standardize and guide nursing staff to carry out TCM nursing work and improve the quality and service ability of TCM nursing.Methods:1.By searching China National Knowledge Infrastructure（CNKI）,Chinese Biomedical literature Database,Wanfang Data Knowledge Service Platform,Pub Med,Cochrane Library and EMbase;Refer to the website of Chinese Medical Association,Yimai Tong and Dingxiang Garden;Refer to related books on internal medicine and nursing of TCM;According to CHF TCM Diagnosis and treatment Plan（2017 edition）and CHF TCM Nursing Plan（2013 edition）.Under the guidance of holistic nursing theory,syndrome differentiation nursing theory,evidence-based nursing theory and PDCA theory,and with reference to the path construction method,the items to be reported,basic information of the path and indicators at all levels of the path were preliminarily determined through the subject group discussion to complete the initial construction of CHF TCM CNP.2.According to The Delphi principle,compile the correspondence questionnaire,establish the indicator screening criteria,determine the correspondence experts,conduct two rounds of Delphi correspondence consultation on the preliminarily constructed path,and use Excel2016 for data entry and sorting.SPSS 25.0 was used to analysis of the statistics the expert enthusiasm coefficient,expert authority coefficient,expert opinion concentration degree and expert opinion coordination degree of indicators at all levels,and revise the indicators at all levels of the path;and the indicators at all levels of the path were revised.Finally,the expert on-site discussion meeting will be held to discuss various contents and reach consensus,so as to form the final text of the path.3.Sixty CHF patients were selected by purpose sampling method,with 30 in each group,for clinical quasi-experimental study.The control group was treated with conventional TCM nursing,and the pathway group was treated with TCM CNP model.TCM syndrome score and effective rate were compared between the two groups.Clinical efficacy indexes included blood pressure（SBP/DBP）,heart rate（HR）,blood oxygen saturation（Sa O₂）,left ventricular ejected fraction（LVEF）,N-terminal brain natriuretic peptide precursor（NT-pro BNP）and 6-minute walking test（6MWT）.Economic indexes:They included length of stay and cost,Minnesota Quality of Life Score（MLHFQ）,inpatient care job satisfaction and pathway variability.SPSS 25.0Software was used for statistical analysis of various data.Results:1)literature research results:through literature study and group discussion to determine the path to report items include:the title of the path,the scope,targets,policymakers,and evidence collection,preliminary test results,the renewal plan,benefit and risk,standard operating procedure of paths,clinical diagnosis and treatment standardization files and manage files.The basic information of the pathway includes:target population,pathway standard,function of TCM nursing and intervention link,standard hospital stay,diagnosis standard of symptoms,TCM syndrome curative effect integral and judgment standard,analysis of variation and cause,and discharge standard.Indexes at all levels of the path text include 5first-level indexes,32 second-level indexes and 252 third-level indexes.2)Delphi letter consultation results:16 experts participated in two rounds of expert letter consultation;（1）Results of the letter consultation on indicators at all levels:The first-level indicators were not modified in the two rounds of letter consultation;Second-level indicators:5 were deleted and 4 were modified in the first round of letter consultation,and no changes were made in the second round.Level 3 indicators:13were added,22 were deleted and 36 were modified in the first round;In the second round,8 were added,5 were modified,and 4 were deleted;Finally,CHF TCM CNP with 5 first-level indicators,27 second-level indicators and 242 third-level indicators was formed.（2）Results of consultation for each coefficient:positive coefficient of experts（E1=80%,E2=100%）,expert authority coefficient（0.92）,coordination coefficient of indicators at all levels:first-level indicator（0.63）,second-level indicator（0.124）,third-level indicator（0.181）,all P<0.05.3)Results of path application:This study included 60 patients with CHF that met the criteria,including path group（n=30）,control group（n=30）,and 2 cases of path group shedding.There was no significant difference in the general situation between the two groups（P>0.05）.（1）The TCM syndrome score of pathway group（14.87±5.41 vs 19.53±3.99,P=0.019）was lower than that of control group;The effective rate of path group was higher than that of control group（72.81±3.13 vs 65.69±4.06,P=0.035）.（2）The comparison of SBP,DBP,HR and Sa O₂between the two groups showed that Sa O₂（96.8±0.89 vs95.43±3.61,P=0.049）in the path group was higher than that in the control group after intervention,while other indexes had no significant changes.（3）The comparison of6MWT,NT-pro BNP and LVEF between the two groups showed that 6MWT（321.40±13.40 vs 313.37±19.70,P=0.025）in the path group was higher than that in the control group.Nt-pro BNP and LVEF had no significant change.（4）comparison of hospitalization days and hospitalization costs between the two groups showed that the hospitalization costs in the pathway group were lower than those in the control group（8226（6192.75,12238.75）vs 9540（5709,10075.25）,P=0.003）,and the hospitalization days in the pathway group（10（7,13）vs 13（8,18）,P=0.012）was lower than that of the control group.（5）The comparison of MLHFQ score and patient satisfaction between the two groups showed that the MLHFQ of the pathway group was lower than that of the control group（47.4±3.81 vs 50.27±6.37,P=0.025）.The satisfaction of patients in the pathway group was（78（76,80）vs 75.5（74,77.25）,P=0.000）,higher than that in the control group.（6）Path variation:there were 19 mutations in the path group,including16 positive mutations（84.21%）and 3 negative mutations（15.79%）.Conclusion:CHF TCM CNP has strong scientific,feasible and effective,and its clinical application is beneficial to improve the symptoms and hypoxia of CHF patients,enhance their exercise endurance,reduce hospitalization costs and hospital stay,improve the quality of life of patients and enhance patient satisfaction.