College of Nursing and Rehabilitation, North China University of Science and Technology, Tangshan, Hebei, China.
College of Nursing and Rehabilitation, North China University of Science and Technology, Tangshan, Hebei, China.
Int J Nurs Stud. 2017 Sep;74:34-43. doi: 10.1016/j.ijnurstu.2017.04.004. Epub 2017 Apr 14.
Coronary artery disease is a major cause of morbidity and mortality among adults worldwide, including China. After a hospital stay, transitional care could help to ensure improved patient care and outcomes, and reduce Medicare costs. Nevertheless, the results of the existing transitional care are not always satisfactory and our knowledge of how to perform effective transitional care for patients with coronary artery disease is limited in mainland China.
To examine the effectiveness of a nurse-led transitional care program on clinical outcomes, health-related knowledge, and physical and mental health status among Chinese patients with coronary artery disease.
Randomized controlled trial.
The Omaha system and Pender's health promoting model were employed in planning and implementing this nurse-led transitional care program. The sample was comprised of 199 Chinese patients with coronary artery disease. The experimental group (n=100) received nurse-led transitional care intervention in addition to routine care. The nurse-led transitional care intervention included a structured assessment and health education, followed by 7 months of individual teaching and coaching (home visits, telephone follow-up and group activity). The control group (n=99) received a comparable length routine care and follow-up contacts. Evaluations were conducted at baseline and completion of the interventions using the perceived knowledge scale for coronary heart disease, the medical outcomes study 36-item short-form health survey and clinical measures (blood pressure, blood glucose, lipids, body mass index). Data were collected between March and October 2014.
Compared with the control group, participants in the experimental group showed significant better clinical outcomes (systolic blood pressure, t=5.762, P=0.000; diastolic blood pressure, t=4.250, P=0.000; fasting blood glucose, t=2.249, P=0.027; total cholesterol, t=4.362, P=0.000; triglyceride, t=3.147, P=0.002; low density lipoprotein cholesterol, t=2.399, P=0.018; and body mass index, t=3.166, P=0.002), higher knowledge scores for coronary artery disease (total knowledge score, t=-7.099, P=0.000), better physical health status (t=-2.503, P=0.014) and mental health status (t=-2.950, P=0.004).
This study provides evidence for the value of a nurse-led transitional care program using both the Omaha system and Pender's health promoting model as its theoretical framework. The structured interventions in this nurse-led transitional care program facilitate the use of this program in other settings.
冠心病是全世界成年人发病率和死亡率的主要原因，包括中国。住院后，过渡护理可以帮助确保改善患者的护理和结局，并降低医疗保险的费用。然而，现有的过渡护理结果并不总是令人满意，我们对如何为中国大陆的冠心病患者提供有效的过渡护理知之甚少。
研究护士主导的过渡护理方案对中国冠心病患者的临床结局、健康相关知识以及身心健康状况的影响。
随机对照试验。
奥马哈系统和彭德健康促进模式被用于规划和实施这个护士主导的过渡护理方案。该样本由 199 名中国冠心病患者组成。实验组（n=100）在接受常规护理的基础上，还接受了护士主导的过渡护理干预。护士主导的过渡护理干预包括结构化评估和健康教育，然后是 7 个月的个体教学和辅导（家访、电话随访和小组活动）。对照组（n=99）接受了可比长度的常规护理和随访。在基线和干预完成时使用冠心病感知知识量表、医疗结局研究 36 项简短健康调查和临床指标（血压、血糖、血脂、体重指数）进行评估。数据收集于 2014 年 3 月至 10 月之间。
与对照组相比，实验组患者的临床结局明显更好（收缩压，t=5.762，P=0.000；舒张压，t=4.250，P=0.000；空腹血糖，t=2.249，P=0.027；总胆固醇，t=4.362，P=0.000；甘油三酯，t=3.147，P=0.002；低密度脂蛋白胆固醇，t=2.399，P=0.018；体重指数，t=3.166，P=0.002），冠心病知识得分更高（总分，t=-7.099，P=0.000），身体健康状况更好（t=-2.503，P=0.014），心理健康状况更好（t=-2.950，P=0.004）。
本研究为以奥马哈系统和彭德健康促进模式为理论框架的护士主导的过渡护理方案的价值提供了证据。该护士主导的过渡护理方案中的结构化干预措施有助于在其他环境中使用该方案。
