Department of Nursing, Chinese Academy of Medical Sciences, Peking Union Medical College, Peking Union Medical College Hospital, Beijing, China.
China Center for Health Development Studies, Peking University, Beijing, China.
Eur J Cardiovasc Nurs. 2019 Dec;18(8):753-763. doi: 10.1177/1474515119872850. Epub 2019 Sep 4.
Immobility complications, including pressure injuries (PIs), deep vein thrombosis (DVT), pneumonia, and urinary tract infections (UTIs), affect the clinical outcomes of stroke patients. A standardized nursing intervention model (SNIM) was constructed and implemented to improve the quality of care and clinical outcomes among immobile patients with stroke.
To assess the benefit of SNIM for immobility complication rates, including PIs, DVT, pneumonia, and UTIs, and mortalities in immobile patients with stroke.
A before and after study design was used. Patients were divided into a pre- and post-SNIM training original cohort and matched for socioeconomic, demographic, and disease characteristics using propensity score. We fitted logistic regression models to examine the effect of SNIM, and whether the benefit differed between tertiary and non-tertiary hospitals.
In the original cohort, the rate of pneumonia, UTIs, and mortality was lower after SNIM training. Furthermore, in the matched cohort, the difference in PI rates was significant. Logistic regression analysis revealed that the probability of PIs, pneumonia, UTIs, and mortality were significantly reduced after SNIM training in the original cohort and this estimated value changed little in the matched cohort. Our results show that the decreased rates of pneumonia, UTIs, and mortality were mainly among non-tertiary hospitals.
A structured and systematic SNIM benefited immobile stroke patients' clinical outcomes, but mainly in non-tertiary hospitals in China. Standardized nursing training is needed in non-tertiary hospitals.
包括压疮（PI）、深静脉血栓形成（DVT）、肺炎和尿路感染（UTI）在内的活动受限并发症会影响中风患者的临床结局。构建并实施了标准化护理干预模型（SNIM），以提高中风活动受限患者的护理质量和临床结局。
评估 SNIM 对中风活动受限患者的 PI、DVT、肺炎和 UTI 发生率及死亡率的影响。
采用前后研究设计。患者被分为 SNIM 培训前和培训后的原始队列，并使用倾向评分进行社会经济、人口统计学和疾病特征的匹配。我们拟合了逻辑回归模型来检验 SNIM 的效果，以及 SNIM 的效果是否在三级和非三级医院之间存在差异。
在原始队列中，SNIM 培训后肺炎、UTI 和死亡率的发生率较低。此外，在匹配队列中，PI 发生率的差异具有统计学意义。逻辑回归分析显示，在原始队列中，SNIM 培训后 PI、肺炎、UTI 和死亡率的概率显著降低，而在匹配队列中，这一估计值变化不大。结果表明，肺炎、UTI 和死亡率的降低率主要发生在非三级医院。
结构化和系统性的 SNIM 有益于中风活动受限患者的临床结局，但主要在我国的非三级医院。非三级医院需要标准化的护理培训。
