| Objective:Based on the concept of enhanced recovery after surgery,the perioperative clinical nursing pathway for elderly patients with hip fracture was constructed.And then verify its clinical application effect.Methods:1.To construct clinical nursing pathway of ERAS in perioperative period for elderly patients with hip fracture.Literature review method was used to extract ERAS items.Case review method was adopted to select general nursing items.Based on this,the preliminary draft of perioperative ERAS clinical nursing pathway for elderly hip fracture was constructed.Finally,the reliability and validity test of the draft path was carried out through the Delphi expert letter consultation,and the perioperative ERAS clinical nursing pathway of elderly hip fracture was finally formed.2.To verify the effect of ERAS clinical nursing pathway in perioperative period for elderly hip fracture.Using the quasi-experimental study method,76 eligible elderly patients with hip fracture from March 2021 to February 2022 in a grade A hospital of Xi’an were selected.Patients from March 2021 to July 2021 were included in the control group for routine nursing mode.Patients from August 2021 to February 2022were included in the intervention group,and were cared according to the newly constructed clinical ERAS nursing pathway.General information,pain score,Harris joint function score,incidence of complications,time to get out of bed for the first time,length of hospital stay and hospitalization cost were collected.Analyzed the data of the two groups.Two independent sample T test was used for inter-group comparison of measurement data subject to normal distribution,and non-parametric test was used for inter-group comparison of measurement data subject to non-normal distribution.χ~2test was used for comparison of enumeration data,and<0.05 was considered statistically significant.Results:1.Construct ERAS clinical nursing pathway.Through literature review,10guidelines and expert consensus were included,and 13 items of ERAS were extracted.Through case review,54 general nursing items were screened out.Based on this,the perioperative ERAS clinical nursing pathway for elderly patients with hip fracture was preliminarily constructed,including the basic structure of the path(5 first-level items,14 second-level items)and specific nursing path items(5 first-level items,19 second-level items,57 third-level items).Two rounds of expert letter consultation were also conducted.Results of expert letter consultation:(1)The positive coefficients of the two rounds of letter consultation were 100%;(2)Expert authority:Cr=0.95;(3)Degree of concentration of expert opinions:the first round(agreement rate)was 64.29%-100%;In the second round,the mean value of importance was 3.86-4.93.(4)The degree of coordination of expert opinions:the coefficient of variation of questionnaire items was between 0.05 and 0.15,and the harmony coefficient was 0.430,p<0.001;(5)Reliability of expert letter consultation table:there were 105 items in expert letter consultation table,Cronbach’s Alpha coefficient was 0.973.Finally,a path with 53items of ERAS and routine nursing contents was formed,which took the time axis before,during and after surgery as the frame.2.To verify the effect of ERAS clinical nursing pathway in perioperative period for aged hip fracture.There was no statistically significant difference in general data between the two groups,which was comparable.(1)there was no significant difference in 24h VAS score between the intervention group(3.16±0.84)and the control group(3.29±0.86);VAS score of patients in intervention group(1.87±0.61)was lower than that in control group(2.16±0.93)on discharge day,the difference was statistically significant(t=1.577,P=0.015).(2)the Harris score of patients in the intervention group(49.13±5.51;55.08±3.77)was lower than that in the control group(42.58±5.38;52.13±4.23),the difference was statistically significant(z=-4.240,p<0.001;z=-2.913,p=0.004);(3)the total incidence of postoperative complications in the intervention group(9.39%)was lower than that in the control group(36.67%),and the difference was statistically significant(χ~2=4.16,p<0.05).(4)the time of first postoperative movement out of bed in intervention group(1.63±0.78),length of stay(8.21±1.02)and hospitalization cost(45896.93±7756.86)were lower than those in control group(3.71±1.02;12.37±2.36;60766.49±9971.37).The difference was statistically significant(Z=-6.666,P<0.001;T=9.574,P=0.001;T=7.197,P=0.038).Conclusion:1.Based on the latest guidelines such as"2021 Chinese Clinical Practice Guidelines for Enhanced Recovery after Surgery",the perioperative ERAS clinical nursing pathway for elderly patients with hip fracture has good reliability,scientific and practical value,and is conducive to promoting the further application of ERAS.2.Perioperative ERAS clinical nursing pathway for elderly patients with hip fracture can reduce postoperative pain,improve hip function and reduce complications.It can also shorten the time of first postoperative ambulation and hospitalization,reduce hospitalization costs,and help patients accelerate recovery. |
