Tu Jianxin, Zhou Jing, Li Xiumao, Zhang Qin, Luo Mingxian, Zhou Jiamei
Abdominal Oncology Department, The Second Affiliated Hospital of Zunyi Medical University, 563000 Zunyi, Guizhou, China.
Nursing School, Zunyi Medical University, 563002 Zunyi, Guizhou, China.
Rev Cardiovasc Med. 2024 Sep 24;25(9):347. doi: 10.31083/j.rcm2509347. eCollection 2024 Sep.
Thoracic aortic endovascular repair (TEVAR) is the primary treatment for Stanford type B aortic dissection (type B AD). However, patients often encounter significant difficulties post-TEVAR that endanger their safety when transitioning from hospital- to home-based care. Moreover, information on the ideal transitional care for patients with type B AD post-TEVAR is scarce in China. This single-masked randomized clinical trial aimed to assess the effectiveness of the Assess, Advise, Agree, Assist, and Arrange (5As) model-based transitional care in improving discharge preparation level and transitional care quality post-TEVAR among patients with type B AD in China.
This study was conducted at a hospital in China between January 2021 and October 2021. Patients with type B AD were randomly divided into intervention and control groups. Participants in the intervention group received the 5As model-based transitional nursing care. The 5As model is an evidence-based intervention strategy comprising: (1) Assess: assessing the preoperative cardiovascular risk behavior of patients with AD. (2) Advise: making suggestions according to the risk behaviors of the patients. (3) Agree: reaching a consensus on goals and action plans by making decisions with the patients and their families. (4) Assist: assisting patients in solving obstacles to implementing health plans. (5) Arrange: arranging follow-up visits according to the actual situation of the patients and guiding them in adhering to a schedule. The control group received the usual nursing care for the same duration and number of follow-up visits. A trained research nurse collected all the baseline data of the patients on admission, assessed discharge readiness level (using the Readiness for Hospital Discharge Scale) on the day of discharge, and collected transitional quality of care (by the Care Transition Measure-15) data on day 30 after discharge.
Overall, 72 patients with type B AD were recruited. Discharge readiness level and transitional care quality in the intervention group were significantly superior to those in the control group.
This study showed that the 5As model-based transitional care program can effectively promote discharge readiness and transitional care quality of patients with type B AD post-TEVAR.
The Chinese Clinical Trial Registry Center: ChiCTR2200060797 (https://www.chictr.org.cn/showproj.html?proj=167403).
胸主动脉腔内修复术（TEVAR）是斯坦福B型主动脉夹层（B型AD）的主要治疗方法。然而，患者在TEVAR术后从医院护理过渡到家庭护理时，往往会遇到严重困难，危及他们的安全。此外，在中国，关于B型AD患者TEVAR术后理想过渡护理的信息很少。这项单盲随机临床试验旨在评估基于评估、建议、同意、协助和安排（5A）模式的过渡护理对提高中国B型AD患者TEVAR术后出院准备水平和过渡护理质量的有效性。
本研究于2021年1月至2021年10月在中国一家医院进行。B型AD患者被随机分为干预组和对照组。干预组的参与者接受基于5A模式的过渡性护理。5A模式是一种基于证据的干预策略，包括：（1）评估：评估AD患者术前的心血管风险行为。（2）建议：根据患者的风险行为提出建议。（3）同意：与患者及其家属共同决策，就目标和行动计划达成共识。（4）协助：帮助患者解决实施健康计划的障碍。（5）安排：根据患者的实际情况安排随访，并指导他们遵守时间表。对照组在相同的持续时间和随访次数内接受常规护理。一名经过培训的研究护士收集了患者入院时的所有基线数据，在出院当天评估出院准备水平（使用出院准备量表），并在出院后30天收集过渡护理质量（通过护理过渡措施-15）数据。
总共招募了72例B型AD患者。干预组的出院准备水平和过渡护理质量显著优于对照组。
本研究表明，基于5A模式的过渡护理方案可以有效提高B型AD患者TEVAR术后的出院准备水平和过渡护理质量。
中国临床试验注册中心：ChiCTR2200060797（https://www.chictr.org.cn/showproj.html?proj=167403）。
