The analysis of the discharge preparation and influencing factors after replantation of severed fingers
-
摘要:
目的 本研究旨在深入探讨断指再植术后患者的出院准备现状及其影响因素，以此为基础为患者提供更高效的康复方案，同时为护理人员提供指导以制定更为科学的出院策略。 方法 采用横断面调查法，于2021年1月—2023年5月对无锡市第九人民医院行断指再植术的102例患者进行问卷调查，调查内容包括对入选患者一般信息、疾病相关信息以及出院准备度和出院指导质量等。采用单变量和多元线性回归分析，进一步分析出院准备情况相关因素，以及出院准备情况与出院指导质量的相关性。 结果 102例断指再植术患者数据均被有效回收。多因素分析显示，断指再植术后患者的出院准备度与年龄、居住地、学历、婚姻状况、合并症、住院时间、出院指导质量等均有相关性。102例患者的出院准备度得分为(170.43±15.70)分，出院指导质量得分为(140.61±12.25)分。患者的出院准备度总分与出院指导质量总分之间呈正相关关系(r=0.736，P＜0.001)。 结论 断指再植患者出院准备度受年龄、居住地、学历、婚姻状况、合并症、住院时间、出院指导质量的多重影响，患者出院准备度与出院指导质量呈正相关关系，且出院准备度与讲授技巧之间也呈正相关关系，此结果对临床护理的管理与实践具有指导意义。 Abstract:Objective To explore the discharge preparation of patients after replantation of severed fingers and its influencing factors, so as to provide more efficient rehabilitation programs for patients and provide guidance for the nursing team to formulate more scientific discharge strategies. Methods From January 2021 to May 2023, a cross-sectional survey was conducted on 102 patients who underwent replantation of severed fingers in Wuxi Ninth People' s Hospital. The questionnaire survey included the collection of general information, disease-related information, discharge readiness, and discharge guidance quality of the selected patients. Univariate and multivariate linear regression analyses were used to further analyze the related factors of discharge readiness and the correlation between discharge readiness and discharge instruction quality. Results The data of 102 patients with replantation of severed fingers were effectively recovered. Multivariate analysis showed that the readiness for hospital discharge of patients after replantation of severed fingers was related to age, residence, education, marital status, complications, length of hospital stay, and quality of discharge guidance. Among them, in this study, the average score of discharge readiness of 102 patients was 170.43±15.70, and the average score of discharge instruction quality was 140.61±12.25. There was a positive correlation between the total score of discharge readiness and the total score of discharge teaching quality (r=0.736, P < 0.001). Conclusion This study reveals that the readiness for hospital discharge of patients with replantation of severed fingers is affected by age, residence, education, marital status, complications, length of hospital stay, and the quality of discharge instruction. It also points out that there is a positive correlation between readiness for hospital discharge and the quality of discharge instruction, and there is a positive correlation between readiness for hospital discharge and teaching skills. The results have guiding significance for the management and practice of clinical nursing. -
表 1 102位断指再植术后患者的基本资料
Table 1. Basic data of 102 patients after replantation of severed fingers
项目 例数(%) RHDS总分(x±s，分) 统计量 P值 性别 -0.270a 0.788 男性 78(76.47) 169.68±13.62 女性 24(23.53) 170.46±7.56 年龄 64.367b ＜0.001 ≤40岁 26(25.49) 188.18±11.12 40~60岁 70(68.63) 167.89±7.62 ＞60岁 6(5.88) 154.87±8.88 居住地 30.177b ＜0.001 农村 45(44.12) 161.29±12.10 城镇 12(11.76) 169.99±11.44 市区 45(44.12) 179.66±10.19 学历 39.545b ＜0.001 小学及以下 10(9.8) 157.65±11.44 中学 52(50.98) 160.09±8.02 专科 33(32.35) 177.58±9.11 本科及以上 7(6.86) 185.03±9.88 职业 1.900b 0.155 农民和工人 26(25.49) 169.67±4.99 退休 25(24.51) 168.73±8.25 其他 51(50.00) 166.14±9.28 住院次数 1.091a 0.278 首次 86(84.31) 173.92±10.61 2次及以上 16(15.69) 170.85±8.52 婚姻状况 -6.450a ＜0.001 未婚 7(6.86) 162.36±13.99 已婚 95(93.14) 189.78±10.62 费用支付方式 0.088a 0.930 自费 98(96.08) 169.65±11.35 医保 4(3.92) 169.15±8.23 主要照顾者 1.753b 0.179 独居 22(21.57) 167.81±9.84 亲属 31(30.39) 173.16±11.89 其他 49(48.04) 168.40±13.54 合并症 30.942b ＜0.001 0~1种 44(43.14) 183.92±11.41 2~3种 48(47.06) 169.33±10.17 4种及以上 10(9.8) 160.07±11.35 住院天数 60.792b ＜0.001 ≤14天 54(52.94) 186.71±12.66 14~21天 37(36.27) 163.46±7.57 ＞21天 11(10.79) 161.73±10.13 注：a为t值，b为F值。 
下载: 导出CSV
表 2 102位断指再植术后患者的出院准备度情况(x±s，分)
Table 2. Discharge readiness of 102 patients after replantation of severed fingers(x±s, points)
项目 条目数 总分 条目均分 维度 自身状况 7 54.65±8.06 7.81±1.15 疾病知识 8 56.63±8.34 7.08±1.04 出院后应对能力 3 21.72±7.62 7.24±2.54 可获得的社会支持 4 34.93±5.54 8.73±1.39 RHDS总分 22 170.43±15.70 7.75±0.71
下载: 导出CSV
表 3 断指再植术后患者的出院指导质量情况(x±s，分)
Table 3. Quality of discharge guidance for patients after replantation of severed fingers(x±s, points)
项目 条目数 总分 条目均分 维度 需要的内容 6 46.21±7.03 7.70±1.17 获得的内容 6 41.89±6.59 6.98±1.10 讲授技巧 12 100.76±7.82 8.40±0.65 QDTS总分 24 140.61±12.25 5.86±0.51
下载: 导出CSV
表 4 断指再植术后患者出院准备情况影响的多元线性回归分析
Table 4. Multiple linear regression analysis of the influence of patient discharge readiness after replantation of severed fingers
项目 B SE β t值 P值 年龄 2.521 1.957 0.161 3.352 0.001 居住地 2.988 2.210 0.198 6.182 ＜0.001 学历 2.760 1.258 0.130 5.334 ＜0.001 婚姻状况 -3.268 1.449 -0.157 -2.256 0.026 合并症 -8.154 1.763 -1.940 -6.757 ＜0.001 住院天数 -4.157 2.194 -0.610 -2.616 0.009 出院指导质量 13.255 3.188 4.657 6.731 ＜0.001 注：各变量赋值如下，出院准备度、出院指导质量以实际值赋值；性别，男性=1，女性=2；居住地，农村=(1, 0, 0)，城镇=(0, 1, 0)，市区=(0, 0, 1)；学历，小学及以下=1，中学=2，专科=3，本科及以上=4；婚姻状况，未婚=1，已婚=2；合并症，0~1种=1，2~3种=2, 4种及以上=3；住院时间，≤14 d=1，14~21 d=2，＞21 d=3。
下载: 导出CSV
表 5 患者出院准备度与出院指导质量的相关性分析
Table 5. Correlation analysis between readiness for hospital discharge and quality of discharge instruction of patients
项目 出院准备度总分 自身状况 疾病知识 出院后应对能力 可获得的社会支持 r值 P值 r值 P值 r值 P值 r值 P值 r值 P值 出院指导总分 0.736 ＜0.001 0.177 0.076 -0.003 0.973 0.046 0.647 -0.012 0.902 需要的内容 0.069 0.493 0.892 ＜0.001 0.362 ＜0.001 0.225 0.023 0.324 0.001 获得的内容 -0.139 0.160 0.336 0.001 0.894 ＜0.001 0.122 0.221 0.316 0.001 讲授技巧 0.558 ＜0.001 0.173 0.082 -0.004 0.970 -0.016 0.874 0.024 0.809
下载: 导出CSV
-
[1] REID D B C, SHAH K N, ELTORAI A E M, et al. Epidemiology of finger amputations in the United States from 1997 to 2016[J]. JHS GO, 2019, 1(2): 45-51. [2] 俞乾, 于涌, 钟君, 等. 基于激光散斑成像的断指再植术后血液微循环监测评估系统[C]//第十七届全国光学测试学术交流会摘要集. 2018.YU Q, YU Y, ZHONG J, et al. Blood microcirculation monitoring and evaluation system after replantation of severed finger based on laser speckle imaging[C]//Proc 17th Natl Symp Opt Test. 2018. [3] 华祖广, 魏鹏, 吴屹冰, 等. 断指再植术后那屈肝素钙局部注射的疗效及对凝血功能的影响[J]. 中华全科医学, 2019, 17(10): 1678-1680, 1784.HUA Z G, JOHNNY, WU Y B, et al. Efficacy of local injection of nadroparin calcium after replantation of severed fingers and its effect on coagulation function[J]. Chinese Journal of General Practice, 2019, 17(10): 1678-1680, 1784. [4] KAWAIAH A, THAKUR M, GARG S, et al. Fingertip injuries and amputations: a review of the literature[J]. Cureus, 2020, 12(5): e8291. DOI: 10.7759/cureus.8291. [5] PATIL S, CORNETT E M, JESUNATHADAS J, et al. Implementing enhanced recovery pathways to improve surgical outcomes[J]. J Clin Anesth, 2019, 35(Suppl 1): S24-S28. [6] 蒲丛珊, 夏家爱, 王义婷, 等. 妊娠期高血压疾病产妇出院准备度现状及影响因素研究[J]. 中国护理管理, 2022, 22(6): 923-928.PU C S, XIA J A, WANG Y T, et al. Status and influencing factors of readiness for hospital discharge in women with hypertensive disorders complicating pregnancy[J]. Chin Nurs Manag, 2022, 22(6): 923-928. [7] MABIRE C, BACHNICK S, AUSSERHOFER D, et al. Patient readiness for hospital discharge and its relationship to discharge preparation and structural factors: a cross-sectional study[J]. Int J Nurs Stud, 2019, 90: 13-20. doi: 10.1016/j.ijnurstu.2018.09.016 [8] YANG M, LIANG W, ZHAO H, et al. Quality analysis of discharge instruction among 602 hospitalized patients in China: a multicenter, cross-sectional study[J]. BMC Health Serv Res, 2020, 20(1): 647. doi: 10.1186/s12913-020-05518-6 [9] RODWIN B A, BILAN V P, GUNDERSON C G, et al. Improving the quality of inpatient dscharge instructions: an evaluation and implementation of best practices[J]. South Med J, 2021, 114(8): 445-449. doi: 10.14423/SMJ.0000000000001284 [10] 王芬, 张竑, 张媛媛, 等. 基于出院准备度联合智能"云随访"对早产儿延续护理的效果[J]. 中国临床研究, 2020, 33(5): 706-709.WANG F, ZHANG H, ZHANG Y Y, et al. Effect of discharge readiness combined with intelligent "cloud follow-up" on transitional care of premature infants[J]. Chinese Journal of Clinical Research, 2020, 33(5): 706-709. [11] HUANG L, PENG S. Status Quo and influencing factors of discharge readiness of patients with bilateral ureteral stoma after radical cystectomy[J]. Front Surg, 2022, 9: 860162. DOI: 10.3389/fsurg.2022.860162. [12] 罗秀艳, 罗朝晖, 何美玲, 等. 断指再植术后再植指总体活动度恢复状况及其影响因素分析[J]. 护理实践与研究, 2021, 18(9): 1269-1273. doi: 10.3969/j.issn.1672-9676.2021.09.002LUO X Y, LUO Z H, He M L, et al. Recovery of finger mobility and its influencing factors after replantation of severed fingers[J]. Nursing Practice and Research, 2021, 18(9): 1269-1273. doi: 10.3969/j.issn.1672-9676.2021.09.002 [13] 李本, 姜莉莉, 安璐, 等. 哺乳期乳腺炎患者出院准备度量表的构建及信效度检验[J]. 现代医药卫生, 2023, 39(6): 924-928.LI B, JIANG L L, AN L, et al. Construction and reliability and validity test of readiness for hospital discharge Scale for patients with lactation mastitis[J]. Journal of Modern Medicine and Health, 2023, 39(6): 924-928. [14] 何欢, 李莉, 何翠环, 等. 临床决策支持系统在膝关节镜下半月板成形术患者出院准备度中的应用[J]. 安徽医学, 2022, 43(9): 1092-1095.HE H, Li L, HE C H, et al. Application of clinical decision support system in discharge readiness of patients undergoing knee arthroscopic meniscplasty[J]. Anhui Med, 2022, 43(9): 1092-1095. [15] WU D L, LUO C L, DU X, et al. Current status and influencing factors of readiness for discharge of elderly patients with chronic obstructive pulmonary disease[J]. Patient Prefer Adher, 2023, 17: 1323-1333. DOI: 10.2147/PPA.S410725. [16] QIAN J, QIAN M, REN Y, et al. Readiness for hospital discharge and influencing factors: a cross-sectional study on patients discharged with tubes from the department of hepatobiliary surgery[J]. BMC SURG, 2021, 21(1): 121. doi: 10.1186/s12893-021-01119-0 [17] LUBBE A L, VAN RIJN M, GROEN W G, et al. The quality of geriatric rehabilitation from the patients ' perspective: a scoping review[J]. Age Ageing, 2023, 52(3): afad032. DOI: 10.1093/ageing/afad032. [18] TIJSEN L M, DERKSEN E W, ACHTERBERG W P, et al. Challenging rehabilitation environment for older patients[J]. Clin Interv Aging, 2019, 14: 1451-1460. DOI: 10.2147/CIA.S207863. [19] KONDA S R, GONZALEZ L J, JOHNSON J R, et al. Marriage status predicts hospital outcomes following orthopedic trauma[J]. Geriatr Orthop Surg, 2020, 11: 2151459319898648. DOI: 10.1177/2151459319898648. [20] LUTHER B, WILSON R D, KRANZ C, et al. Discharge processes: what evidence tells us is most effective[J]. Orthop Nurs, 2019, 38(5): 328-333. doi: 10.1097/NOR.0000000000000601 [21] GUAN M, FENG X. Correlation between quality of discharge teaching, readiness for hospital discharge and health outcomes of hysterectomy patients: a structural equation model analysis[J/OL]. Nurs Open, 2023, 10(6): 3817-3827. [22] SCHULTZ B E, CORBETT C F, HUGHES R G, et al. Scoping review: social support impacts hospital readmission rates[J]. J Clin Nurs, 2022, 31(19-20): 2691-2705. doi: 10.1111/jocn.16143 [23] OSCALICES M I L, OKUNO M F P, LOPES M C B T, et al. Discharge guidance and telephone follow-up in the therapeutic adherence of heart failure: randomized clinical trial[J]. Rev Lat Am Enfermagem, 2019, 27: e3159. DOI: 10.1590/1518-8345.2484.3159. [24] KANG E, TOBIANO G A, CHABOYER W, et al. Nurses ' role in delivering discharge education to general surgical patients: a qualitative study[J]. J Adv Nurs, 2020, 76(7): 1698-1707. doi: 10.1111/jan.14379 -
点击查看大图
表(5)
计量
- 文章访问数: 21
- HTML全文浏览量: 15
- PDF下载量: 2
- 被引次数: 0
