Effects of Online Home Nursing Care Model Application on Patients with Traumatic Spinal Cord Injury

Family-centred empowerment using telenursing on pressure injury incidence in post-discharge stroke patients

OBJECTIVE

The aim of this study was to evaluate the effect of a family-centred empowerment intervention on the incidence, stage and status of pressure injury (PI) in patients diagnosed with stroke during the post-discharge period with a telenursing approach.

METHOD

This randomised controlled clinical trial (RCT) was conducted with patients admitted to Ghaem Hospital in Mashhad and who were diagnosed with stroke. Patients were randomly assigned to one of two equal-sized groups: intervention and control. Family education and follow-up of the intervention group was performed using WhatsApp messenger for one month. Caregivers of patients in the control group received the routine training programme. The incidence, stage and status of PIs of both groups were measured at the beginning and at one month later using the Braden Scale, the EPUAP/NPUAP Classification System, and the Pressure Ulcer Scale for Healing (PUSH).

RESULTS

A total of 60 patients took part in the RCT (30 patients allocated to each group). The incidence of PI in the control group was significantly higher than in the intervention group (p<0.001). The results showed significantly lower stages of PI in the intervention group than in the control group (p<0.001 and p<0.05 for univariable and multivariable models, respectively). The results showed a significantly lower PUSH score in the intervention group than in the control group (p<0.001 and p<0.05 for univariable and multivariable models, respectively).

CONCLUSION

The findings of this RCT show that the empowerment and training of caregivers of patients diagnosed with stroke after discharge using telenursing can reduce the incidence and severity of PIs and improve their status in these patients.

Effects of comprehensive functional nursing on functional recovery and quality of life in patients with spinal cord injury

This study evaluated the effects of comprehensive functional nursing on functional recovery and quality of life in patients with spinal cord injuries (SCIs). A total of 214 patients with SCIs treated in our hospital from October 2019 to October 2021 were included in the retrospective analysis and divided into a general care group (n = 107) and a comprehensive care group (n = 107), based on the care that they received. Patients in the general care group received general functional nursing, whereas those in the comprehensive care group received a comprehensive functional nursing intervention. The Rivermead Mobility Index (RMI), Barthel Index (BI), and Berg Balance Score (BBS) were used to evaluate patient neurobehavioral ability before and after nursing. Changes in cardiopulmonary function indexes, left ventricular end-diastolic dimension (LVEDD), left ventricular end-systolic dimension (LVESD), vital capacity (VC), forced expiratory volume in 1 second (FEV1), FEV1/FVC, and maximal voluntary ventilation (MVV) were measured before and after nursing. The number of micturition, maximum micturition volume, bladder volume, residual urine volume, and lower urinary tract symptom (LUTS) score were recorded, and the improvement in bladder function were measured before and after nursing. The Hamilton Anxiety Scale (HAMA) and Beck Depression Inventory (BDI) scores were used to evaluate patients' emotional state. After nursing, the RMI, BI, BBS score, FEV1, FEV1/FVC, MVV, maximum micturition volume, bladder volume, and SF-36 scores of the comprehensive care group were significantly higher than those of the general care group, and the LVEDD, LVESD, micturition time, residual urine volume, and LUTS, HAMA, and BDI scores of the comprehensive care group were significantly lower than those of the general care group. In patients with SCIs, comprehensive functional nursing can promote the recovery of neurocognition, bladder function, and cardiorespiratory function, and improve their quality of life. Comprehensive functional nursing is worthy of clinical application.

Fracture liaison services combined with online home nursing care in fragility hip fracture: a comparative effectiveness pilot study

Fracture liaison service (FLS) is a management system for osteoporotic fractures, its difficulty lies in long-term management. Through this pilot single-center study, we found that FLS combined with an internet-based follow-up service (online home nursing care) can economically and conveniently monitor patients, reduce falls and refractures, and improve care and medication adherence.

INTRODUCTION

Among potential e-health platforms, mobile internet encompasses the largest user group of mobile instant messaging software in Asia and offers strong interaction, low cost, and fast speed. The online home nursing care model prevents unnecessary hospital admissions and readmissions. This study aims to explore the effects of a fracture liaison service (FLS) model combined with online home nursing care on patients with fragility hip fracture.

METHODS

Patients discharged after November 2020 received FLS care combined with online home nursing care. Patients discharged from May 2020 to November 2020 received only routine discharge guidance and were classified as the control group. The Parker Mobility Score (PMS), Medical Outcomes Study 36-item short-form health survey (MOS SF-36), general medication adherence scale (GMAS), complication rate, and fall/refracture rates were used to evaluate the efficacy of the FLS combined with online home nursing care during the 52-week follow-up period.

RESULTS

Eighty-nine patients with complete follow-up information were included in the analysis at the 52-week follow-up. The FLS combined with online home nursing care was associated with improved osteoporosis patient care, including increased medication adherence (64.58% in the control group and 90.24% in the observation group), improved mental quality of life, reduced fall/refracture rate (12.5% and 4.88%, respectively), and reduced rates of bedsores and joint stiffness; however, there was no effect on functional recovery within 1 year.

CONCLUSIONS

We recommend the combination of FLS with online home nursing care, considering the local environment, to economically and conveniently monitor patients, reduce falls and refractures, and improve care and medication adherence.

Construction of Internet +home Care Quality Supervision Indicators in China Based on the Delphi Method

Background

With the aging of China’s population, the incidence rate of chronic diseases is rising. At the same time, residents’ health awareness is also increasing. Implementing Internet +home care is an inevitable trend in adapting social development. Currently, Internet +home care is in the pilot stage in China, relevant institutional measures are neither standardized nor perfect, and there is no set of quality supervision indicators (QSIs).

Purpose

The construction of Internet +home care QSIs in China will provide a theoretical basis for Internet +home care quality supervision.

Materials and Methods

The Service-Quality model was used as the theoretical framework, and a literature review, semi-structured interviews, focus group discussions, and Delphi consultations determined the contents of the QSIs and the weight of each indicator.

Results

Internet +home care QSIs were constructed and included 5 first-level indicators, 17 secondary indicators, and 69 tertiary indicators. The effective recovery rates of the two rounds of Delphi expert consultation were 100% and 85%, the expert authority coefficients were 0.810 and 0.833, and the Kendall harmony coefficients were 0.189 and 0.125 (P<0.01). The final set of Internet +home care QSIs was as follows: tangibility (4 secondary and 16 tertiary indicators), reliability (4 secondary and 19 tertiary indicators), guarantee (5 secondary and 20 tertiary indicators), responsiveness (2 secondary and 8 tertiary indicators), and empathy (2 secondary and 6 tertiary indicators).

Conclusion

The construction of Internet +home care QSIs based on the SERVQUAL model is scientifically valid, and the indicators are reliable. They provide guidance and reference values for the continuous improvement and promotion of Internet +home care. This work also provides a theoretical basis for researching and developing an Internet +home care quality supervision platform.

Quality Care Alleviates Behavioral Cognitive Impairment and Reduces Complications in Elderly Patients with Cardiovascular and Cerebrovascular Diseases

Objective

Cardiovascular and cerebrovascular disease (CCVD) remains the most common factor of death around the world. Nursing care plays a key role in the recovery of patients with CCVD. This study was to explore the application of quality care in aged patients with CCVD.

Methods

Totally, 74 aged CCVD patients admitted from June 2018 to June 2019 in Dongying People's Hospital were randomly assigned in 2 groups with the same treatment. The control group was treated with routine care intervention, and the observation group was treated with quality care intervention for 12 weeks. Meanwhile, the frequency of agitation behaviors and cognitive ability were assessed, and complication was counted.

Results

The observation group showed decreased Cohen-Mansfield Agitation Inventory (CAMI) scores from 47.31 ± 8.27 to 38.73 ± 6.94, raised Mini-Mental State Examination (MMSE) scores from 15.01 ± 3.9 to 19.34 ± 3.15 and Montreal Cognitive Assessment (MoCA) scores from 16.92 ± 5.48 to 20.37 ± 4.16, and reduced complications after quality care intervention.

Conclusion

Quality care intervention exerted a better application effect on aged CCVD patients, along with reduction of agitation, improvement of mental condition and behavioral cognitive function, and reduced complications.

Telemedicine for Preventing and Treating Pressure Injury after Spinal Cord Injury: A Systematic Review and Meta-analysis (Preprint)

Background

Objective

Methods

Results

Conclusions

Influences and consequences resulting in addictions in general and to chronic alcoholism, especially for patients with spinal cord injury

Introduction: Spinal cord injury can be a cause of severe disability, with important consequences at the individual and social levels. Causes are often produced by falls or road accidents; and addictions (particularly chronic ethylism) also increase the risk of vertebral-medullary lesions. Materials and Methods: With with the approval of the TEHBA Ethics Commission (no.17464/14.06.2019), we used specific tests (DASS-21, MOS SF-36, SMAST, AUDIT, CAGE, AIS) and we questioned a group of patients admitted to the THEBA Neuro-Muscle Recovery Clinic after being treated in the Spinal Neurosurgery Service for acute and subacute vertebral medullary trauma. Results: We evaluated the link between addictions (especially ethanol), the risk of spinal cord injury, and the underlying subacute evolution of patients with this pathology. Conclusions: Substance abuse (especially ethanol) increases the risk of spinal cord injury and is a serious public health problem. Keywords: SCI, DASS-21, MOS SF-36, AUDIT, CAGE, SMAST, Neuromuscular Recovery