老年慢性心力衰竭患者医疗照护方案的构建及应用研究

doi:10.3761/j.issn.0254-1769.2024.24.001

摘要/Abstract

摘要：

目的基于改善老年人医疗照护框架（4Ms理论）构建老年慢性心力衰竭患者医疗照护方案，并验证其临床应用效果。方法在文献回顾的基础上，结合专家函询，构建基于4Ms理论的老年慢性心力衰竭患者医疗照护方案。采用便利抽样法，选取2022年8月—2023年6月入住浙江省某三级甲等综合医院的慢性心力衰竭患者160例作为研究对象。其中2023年1月—6月的80例作为试验组，2022年8月—12月的80例作为对照组。试验组实施基于4Ms理论的老年慢性心力衰竭患者医疗照护方案，对照组实施常规护理。比较两组住院期间老年相关并发症发生率、住院天数、住院总费用和满意度，以及出院后3个月的再入院次数、服药不当评分和运动能力的差异。结果干预期间，共脱落3例，最终试验组纳入78例，对照组纳入79例。干预后，试验组住院满意度高于对照组，住院天数和住院总费用低于对照组（均P<0.01）。出院后3个月，试验组的再入院次数、服药不当评分低于对照组，运动能力高于对照组（均P<0.05）。结论构建的基于4Ms理论的老年慢性心力衰竭患者医疗照护方案具有较好的科学性、实用性，能够有效提升患者满意度、改善患者的服药不当及运动能力、降低住院天数和再入院次数，具有一定的参考意义。

关键词: 心力衰竭, 老年照护, 老年护理学, 4Ms理论

Abstract:

Objective To develop a geriatric-friendly care plan for elderly patients with chronic heart failure based on the 4Ms theoretical model and to validate its clinical effectiveness. Methods Based on literature review and patient interviews，a 4Ms geriatric-friendly care plan for elderly patients with heart failure was developed. The convenience sampling method was used to select A total of 160 patients admitted to a tertiary hospital in Zhejiang Province from August 2022 to June 2023 were selected as the study subjects. Among them，80 patients from January to June 2023 were assigned to an experimental group，and 80 patients from August to December 2022 were assigned to a control group. The experimental group received the 4Ms geriatric-friendly care plan developed in this study，while the control group received routine care. The differences in elderly-related complications during hospitalization，length of hospital stay，total hospitalization costs，satisfaction，and post-discharge outcomes（including readmission rates，improper medication and exercise capacity） were compared between the 2 groups. Results A total of 3 cases were lost，resulting in 78 cases in the experimental group and 79 cases in the control group. The experimental group had higher hospital satisfaction，lower hospitalization days，and lower total hospitalization costs compared to the control group（all P<0.01）. Within 3 months post-discharge，the experimental group had lower readmission and inappropriate medication score，with better exercise capacity compared to the control group （all P<0.05）. Conclusion The 4Ms geriatric-friendly care plan developed in this study demonstrates scientific and practical value. It effectively improves patient satisfaction，medication compliance，and exercise capacity，while reducing hospitalization days and readmission rates. This plan has significant references.

Key words: Heart Failure, Elderly Care, Geriatric Nursing, 4Ms Framework

祝海香, 韩小雪, 冯燕, 李艳, 钱楼青, 庄一渝. 老年慢性心力衰竭患者医疗照护方案的构建及应用研究[J]. 中华护理杂志, 2024, 59(24): 2949-2956.

ZHU Haixiang, HAN Xiaoxue, FENG Yan, LI Yan, QIAN Louqing, ZHUANG Yiyu. Construction and application of a geriatric-friendly care plan for elderly patients with chronic heart failure[J]. Chinese Journal of Nursing, 2024, 59(24): 2949-2956.

图/表 4

表1 老年慢性心力衰竭患者医疗照护方案

Table 1 CHF elderly patients care plan

表2 两组一般资料的比较

Table 2 Comparison of general data between the 2 groups

表3 出院时两组评价指标的比较

Table 3 Comparison of outcome indicators at discharge between the 2 groups

表4 两组干预前后服药不当评分、简易体能评估量表评分的比较

Table 4 Comparison of medication misuse scores and Short Physical Performance Battery scores before and after the intervention between the 2 groups

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