College students nursing thesis excellent sample 1
Analysis of the impact of evidence-based nursing on the prognosis of hypertensive cerebral infarction
Abstract: Objective: To explore the impact of evidence-based nursing on the prognosis of patients with hypertensive cerebral infarction. Methods: 92 patients with hypertension complicating cerebral infarction were randomly divided into 46 cases each in the experimental group and the control group; the control group was given routine care for hypertensive cerebral infarction; the experimental group was given evidence-based care in terms of health education, dietary habits, medication adherence, psychology, and self-management, and was followed up by telephone or WeChat regularly at 3, 6, 12, and 24 months after discharge; the patients of the two groups were compared with the patients' prognosis after discharge from hospital. Differences in lifestyle, blood pressure, blood glucose, blood lipids, body weight, and cardiovascular and cerebrovascular disease accidents between the two groups in two years. Results The experimental group was better than the control group in the control of blood pressure, lifestyle, blood glucose, blood lipids, body weight, and cardiovascular and cerebrovascular disease accidents two years after discharge, and the differences were statistically significant upon comparison (P<0.05, P<0.01, or P<0.001). Conclusion Evidence-based nursing has an important impact on the prognosis of patients with hypertensive cerebral infarction, which can change the poor diet and lifestyle, standardize and correctly guide the patients to take medication and improve medication adherence, effectively control the patients' hypertension, and improve the patients' prognosis and quality of life, and regular follow-up can be the basis for the management of blood pressure, blood lipids, and glucose to meet the long-term standards after discharge, and to prevent and reduce the recurrence of stroke.
Keywords: evidence-based nursing; hypertension; cerebral infarction
The results of the third sample survey on the causes of death of China's residents, which was completed in 2008, showed that stroke has become the first cause of death of China's nationals, with a high morbidity rate, high mortality rate, high recurrence rate, high disability rate, and a heavy economic burden of the five characteristics, is a serious social development and public ****health problems in China. According to a survey, 71.4% of stroke patients suffered from hypertension before stroke [1]. For this reason, stroke prevention is the top priority for treating hypertension in China. The popularization of hypertension control knowledge and lifestyle can affect the treatment outcome of patients with hypertension complicated by cerebral infarction [2], and patients do not take medication in a standardized way, psychological factors, and self-management behaviors after discharge from the hospital, and these factors can affect the control of cerebral infarction. In this study, from the perspective of evidence-based nursing, we adopt evidence-based nursing intervention to address the above problems and achieve satisfactory results in improving the prognosis of hypertensive cerebral infarction.
1 Data and Methods
1.1 General Data
92 cases of hypertension complicated with cerebral infarction admitted to our hospital in July 2013?July 2014 were selected as the object of investigation, excluding communication and cognitive disorders, malignant hypertension, progressive aggravation of the condition, and patients with severe organ failure, which were all in line with the diagnostic criteria of hypertension, and were scanned by cranial CT scan or magnetic *** vibration imaging (MRI) confirmed the diagnosis of cerebral infarction, 51 cases of male, 41 cases of female, age 37-83 years old, randomly divided into experimental group and control group, each group of 46 cases. In the experimental group, there were 26 males, accounting for 56.52%; 20 females, accounting for 43.48%; ages ranged from 45 to 80 years old, with a mean age of (65.6?7.5) years, and the duration of the disease ranged from 1 to 27 years. In the control group, there were 25 cases of males, accounting for 54.35%; 21 cases of females, accounting for 45.65%; age 50-78 years old, mean age (66.3?6.2) years old, disease duration 3-25 years. The differences between the two groups in terms of age, gender, weight, literacy, type of primary disease and other baseline information were not statistically significant (P>0.05), and were comparable.
1.2 Nursing methods
1.2.1 The control group was cared for according to the routine care of hypertensive cerebral infarction, i.e., good observation of the condition, observation of the spirit, pupil, vital signs according to the doctor's orders, and correct implementation of various treatments and nursing care.1.2.2 The experimental group looked for the main problems affecting the poor control of the condition of patients with hypertension cerebral infarction in an evidence-based approach, including lack of knowledge of the disease, poor life style , poor medication compliance, psychological factors, poor self-management after discharge from the hospital in five major aspects, and start from these aspects to implement nursing interventions.
1.2.2.1 Health knowledge promotion Hypertension and all stages of cerebral infarction patients have a lack of health knowledge and health behavior is not ideal, the level of health knowledge and health behavior is proportional to the [3], the implementation of personalized health promotion, improve the level of health knowledge, so as to improve the unhealthy behaviors, can reduce the incidence of stroke [4]. During the patient's hospitalization, the nurse-in-charge investigated and collected the patient's positive examination results and stroke-related data, analyzed the existence of stroke risk factors in the patient [5], formulated the appropriate educational methods, distributed health promotion brochures in a targeted manner, and the nurse-in-charge implemented personalized health education. The main contents of health education included stroke risk factors, stroke aura, stroke management, medication guidance, healthy dietary habits, and the importance of blood pressure standardization. Responsible nurses carry out patient and repeated education, so that patients and their families understand and cooperate, actively participate in the treatment and care, and take the initiative to improve their lifestyles, which can effectively realize the goal of better blood pressure control. Before the patients were discharged from the hospital, the nurse in charge of the questionnaire according to the problems that still exist, to strengthen the mission, deepen the patients' knowledge of disease prevention and treatment, and strengthen the awareness of the prevention of the discharge of patients to adhere to the medication on time, patients can not be unauthorized to increase or decrease, stop the medication, and at the same time, to guide patients to correctly measure their blood pressure, self-monitoring of blood pressure, and to ask the patients to regular outpatient follow-up.
1.2.2.2 Healthy diet life guidance diet, lifestyle nursing intervention, help patients control blood pressure, improve the prognosis of patients [6]. The dietary life of hypertensive patients with stroke is based on the ? The four cornerstones of health? as a guide, i.e., reasonable diet, moderate exercise, smoking cessation and alcohol restriction, and psychological balance. People who usually eat more fruits and vegetables have relatively fewer chances of suffering from stroke, reduce dietary fat in the diet, salt intake?6g/d, eggs 3 to 4 per week [7], and control the total calories, reasonable diet with adherence to moderate exercise exercise can effectively control body weight and reduce obesity. Hypertension guidelines at home and abroad will exercise exercise as one of the non-pharmacological treatment measures, must be combined with exercise frequency, duration, intensity: at least three times a week, each exercise more than half an hour, intensity to the heart rate up to 170-age is appropriate. The intensity is appropriate, progressive, should not be fasting morning exercise and excessive exercise, the best for the afternoon 4 ~ 5 pm, to avoid the action and position is too large and too fierce, such as large body position rotation, bending back, excessively low, etc. [8], to reduce the occurrence of cardiovascular and cerebrovascular accidents.
1.2.2.3 Psychological care Post-stroke patients will be accompanied by different degrees of psychological disorders. Domestic and international literature reports that 50% of acute stroke patients have different degrees of depressive manifestations in the prognosis [9], and the peak of the occurrence of depressive symptoms is within 2 to 6 months after the disease, and attention to psychological care can effectively treat the disease and improve the therapeutic effect [10]. Therefore, good psychological care of patients is needed during hospitalization and post-discharge follow-up. First, to explain the development of the disease, prognosis, treatment effects and people's own psychological factors have a close relationship, health care workers and family members to give patients comfort, encouragement, understanding and other psychological support therapy, encourage patients to communicate with others, from which to find out the breakthroughs of the psychological barriers, the implementation of targeted psychological care, so that the patients from the shadow of the disease out of the acceptance of the occurrence of the disease and face up to the disease, to improve the state of their anxiety, and to promote patients to actively participate in rehabilitation training [11]. Actively participate in rehabilitation training [11], and even return to social work; Second, exercise therapy, early active and passive training of the affected limbs after stabilization of the condition, limb function permits the case of planned training of daily activities for patients; Third, drug therapy, excessive anxiety and depression in the doctor's guidance of the oral mood-improving drugs.
1.2.2.4 Instructing patients to take medication on time During hospitalization, patients are instructed to take medication correctly and on time to improve their medication adherence, and some studies have shown that poor medication adherence is a major factor in the readmission of stroke patients [12]. Methods to enhance medication taking on time include setting up an electronic alarm clock for medication taking by cell phone, establishing a list of oral medications to be distributed, and signing by both the nurse and the patient to prevent omission. Nurses bedside focused on teaching the three cornerstone drugs for secondary prevention of stroke are antithrombotic drugs, statins, and antihypertensive drugs. These three drugs, if there is no contraindication and adverse reactions, need to be taken for a long time under the guidance of a doctor, accompanied by high homocysteine hypertensive stroke patients, and at the same time to guide their long-term use of folic acid tablets, which can reduce the rate of recurrence of stroke, and do a good job of health education on adverse drug reactions, and emphasize the instructions in the discharge noted.
1.2.2.5 Nursing interventions for patients' self-management behaviors emphasize post-discharge follow-up, establish hypertensive stroke health records for patients, and carry out regular follow-up at 3 months, 6 months, 12 months, and 24 months after discharge, to understand whether patients are standardized medication, self-monitoring of blood pressure, poor lifestyle and other self-management capabilities, targeted health education, and to find abnormal blood pressure or stroke aura timely consultation. Patients with abnormal blood pressure or stroke aura should consult the doctor in time, and anxious patients should be counseled psychologically. Regular follow-up can effectively control patients' self-management behavior and develop a good lifestyle, which can effectively control the blood pressure of patients with hypertension complicated by cerebral infarction and improve their prognosis and quality of life [13]. Let have mobile WeChat patients and their families WeChat sweep code, join the stroke prevention and control WeChat group, in the circle of hypertensive cerebral infarction related health knowledge, to provide an information platform to communicate with each other, on the discharge of the ongoing missionary follow-up to provide the convenience of the patients and their families to get the patients and families of the affirmation, improve the degree of satisfaction.
1.3 Effectiveness evaluation
The experimental group carried out health questionnaires at the time of admission, before discharge, 1 year after discharge, and 2 years after discharge, which was self-designed, and the survey was carried out by trained specialists. The questionnaire ① was a stroke health knowledge questionnaire: including blood pressure value grading, stroke risk factors, stroke aura, stroke management 4 items 26 entries to ? Know, don't know? as the evaluation result. Questionnaire ② was about lifestyle and medication adherence: including low-salt and low-fat diet, vegetables, fruits, smoking, alcohol, exercise, and medication adherence, which were categorized as frequent (taking medication routinely), occasional, seldom, and none, and frequent or routine was considered excellent. Vegetables ?5 times per week were considered regular, fruits ?3 times per week were considered regular, and exercise ?3 times per week were considered regular. Lifestyles other than ? No smoking, drinking alcohol? were considered excellent, and the other lifestyle and medication adherence were judged as ? Regular were regarded as good. We completed ① and ② questionnaires at the time of admission, analyzed and evaluated the results of the two questionnaires during the hospitalization period, and personalized evidence-based nursing care such as health promotion and guidance was provided. Before discharge, patients were surveyed again with the questionnaire ①, and repeated guidance was given to patients with insufficient knowledge of health, and the records were established after discharge, and follow-up visits by telephone or WeChat were carried out at 3, 6, 12, and 24 months, and the patients were surveyed for whether they had any new-onset strokes or not, Transient ischemic attack, coronary heart disease, heart attack, acute coronary syndrome five cardiovascular and cerebrovascular disease accident, once a year to the stroke prevention clinic face-to-face follow-up, at least once a year to review the blood glucose and blood lipids, to understand the patients' self-management behaviors, the presence of patients with adverse behaviors, such as smoking, lack of physical activity, do not take or occasional use of stroke lowering secondary prevention medication, etc. timely intervention. The differences in blood pressure, lifestyle, medication adherence, blood glucose, lipids, body weight, and cardiovascular and cerebrovascular disease accidents between the two groups were compared 2 years after discharge from the hospital.
1.4 Statistical methods
SPSS13.0 statistical software package was used for statistical analysis. The count data were analyzed using the ?2 test, and the measurement data were analyzed using the t test, with P<0.05 as the difference being statistically significant.
2 Effect
2.1 Comparison of the excellent rate of lifestyle and medication adherence between the two groups of patients two years after discharge
The average excellent rate of lifestyle in the experimental group was 82.61% (152/184), which was higher than that of the control group, which was 50.54% (93/184), and the difference was statistically significant when comparing the two groups (?2=42.51, P<. 0.001); medication adherence was also better than the control group, and the difference was statistically significant (P<0.01).
3 Discussion
Hypertension is the most important risk factor for stroke [14], and some studies have shown that every 1.33kPa drop in systolic blood pressure or 0.665kPa drop in diastolic blood pressure can significantly reduce the risk of stroke by 41% [15], so actively lowering blood pressure is the key to preventing stroke. In this study, an evidence-based approach was used to find the five aspects of the problem that affect poor control of hypertensive cerebral infarction patients, and to choose the best personalized care and nursing decision-making [16], which can both improve satisfaction with care and achieve the patient's desire to prevent and treat the disease. Stroke prevention and treatment health education not only emphasizes antihypertensive, lipid-lowering, antithrombotic and other drug treatment, but also from the patient's underlying diseases such as hypertension, hyperlipidemia, diabetes and other related risk factors, poor living habits, diet and living well educated, whether the education is in place with the degree of knowledge of the nurses, sense of responsibility and other comprehensive qualities related to the stroke full-time follow-up personnel qualifications need to be higher level, by the stroke prevention and treatment of knowledge of the broader nurse as. Nurses with extensive knowledge of stroke prevention and treatment should be qualified. During the follow-up process, it was found that tobacco control was relatively poor, and some patients resumed smoking after quitting, and health education should also emphasize the harm of passive smoking; for hemiplegic patients, exercise should be moderate, and they should master the correct method of rehabilitation exercise and pay attention to safety to prevent falls and avoid joint ligament injuries due to inappropriate exercise. After the injury, patients resist rehabilitation exercise because of pain and fear of falling, which affects patients' prognosis and quality of life.
Poor health behaviors and medication adherence were found in elderly patients with poor economic conditions, low literacy, and age greater than 70 years old, whose family support was low, and how to improve the health behaviors of these groups needs to be studied. This study also found that health education and post-discharge follow-up management play an important role in preventing stroke recurrence. Through long-term follow-up management, repeated education on stroke prevention and treatment, improving patients' health literacy and awareness of early diagnosis and treatment, and recognizing the aura of stroke once it occurs, as well as going to hospitals with thrombolytic conditions in a timely manner, the disability and mortality rates of recurrent stroke can be reduced. The results of this study show that long-term follow-up is an important measure for stroke prevention and treatment. At present, the manpower of clinical specialist nurses is insufficient, and stroke patients receive less supportive nursing services after discharge [17], and the rehabilitation training of stroke patients after discharge is mainly managed by the community, which can improve the ability of daily life and the quality of life of stroke patients [18], but a long-term mechanism for the training of community healthcare workers on stroke prevention and treatment has not been established, and community nurses, as the primary prevention of stroke and the need for secondary prevention after discharge, have no knowledge about stroke prevention and treatment, and they are the main force for the prevention of stroke and treatment of stroke. The main force is detrimental to stroke prevention and treatment, and the institutionalization and routinization of follow-up management is the target task of stroke prevention and treatment. Comparison of the results of the experimental group and the control group showed that the five nursing programs in this evidence-based care can effectively control the main high-risk factors of stroke, so that patients with cerebral infarction of high blood glucose, high blood lipids, obesity, and poor lifestyle can be effectively controlled, thus reducing the recurrence rate of stroke and improving their prognosis and quality of life, which is worthy of clinical recommendation.
References:
[1] Wan Li-Hong, Zhang S-Pei, Hong H, et al. Research on health behaviors of stroke patients and their influencing factors[J]. Nursing Research: Early Edition, 2010, 24(1):1-4.
[2]VERBERKWJ, KROONAA, LENDERSJW, et al. Self- measurementofbloodpressureathomereducestheneedforantihypertensivedrugs:arandomized,controlledtrial[J].Hypertension,2007,50(6):1019 -1025.
[3] Deng Shifeng, Xiao Shan, Wan Lihong, et al. Current status and correlation between health knowledge and health behavior of patients with hypertension combined with stroke[J]. Modern Clinical Nursing, 2013, 12(11):1-5.
[4]Li Aidong, Huang Zongqing, Liu Hongtao, et al. A survey on the level of knowledge, attitude and behavior of stroke patients and their families related to stroke and rehabilitation[J]. China Rehabilitation Theory and Practice, 2009, 15(3):252-254.
[5]MITKAM.Lifestylechangeskeytocutstrokerisk:guidelinesplaceemergencyphysiciansonfrontline[J]. JAMA, 2011, 305(6):551-552.
[6]GONG Feng'an, LIU Hong. Research on the influence of nursing intervention on the lifestyle and treatment effect of hypertensive disease patients[J]. Contemporary Medicine, 2012, 18(11):122-123
[7]Cerebrovascular Disease Group of the Neurology Section of the Chinese Medical Association, ? Guidelines for primary prevention of stroke? Guidelines for Primary Prevention of Stroke. Guidelines for primary prevention of stroke in China (2010)[J]. Liuzhou Medicine, 2012, 25(3):151.
[8]Ye Li-Hua, Tang Jia-Min, Li Shu-Xia. Analysis of the correlation between health behavior self-efficacy and family functioning in elderly hypertensive combined stroke patients[J]. Qilu Nursing Journal, 2013, 19(8):3-5.
[9]CAEIROL, FERROJM, SANTOSCO, etal. Depressioninacutestroke[J].JPsychiatryNeurosci, 2006, 31(6):377-383.
[10] Li Li-Mei. Psychological care of depression after cerebrovascular disease[J]. Frontiers of Medicine, 2012, 2(4):224-225.
[11]Wei Yinghe, Huang Yongchun, Lan Xiaoyan, et al. Nursing? The effect of psychological intervention on the anxiety state of anxious patients with stroke[J]. Journal of Right River College of Ethnic Medicine, 2013, 35(3): 420-421.
Excellent Sample of College Students' Nursing Thesis Article 2
A Brief Introduction to Clinical Nursing Care of Perioperative Diabetes Mellitus Combined with Obstetrics and Gynecology Diseases
Abstract Objective To investigate the clinical nursing effect of perioperative diabetes mellitus combined with obstetrics and gynecology diseases. Methods Thirty-four patients with diabetes mellitus combined with obstetric and gynecologic diseases admitted to our hospital from March 2015 to March 2016 were selected as the subjects of this medical study. After admission, they were allowed to draw their own lots for grouping into observation group and control group, 17 cases each. The patients in the control group were cared for by conventional nursing methods, and the patients in the observation group were cared for by nursing interventions on the basis of conventional nursing. At the end of treatment, the hospitalization time, intraoperative bleeding and nursing satisfaction of the two groups were compared. The results of the observation group patients' hospitalization time and intraoperative bleeding were better than the control group, and the former's nursing satisfaction was significantly higher than the latter, the difference was statistically significant (P<0.05). Conclusion Obstetrics and gynecology diseases combined with diabetes mellitus patients in the perioperative period when the use of nursing interventions for nursing has a good effect, it is worthwhile to promote and learn from the clinical.
Keywords Obstetric and gynecological diseases combined with diabetes mellitus; perioperative period; clinical care
1 Data and Methods
1.1 General Information
Thirty-four patients with obstetric and gynecological diseases combined with diabetes mellitus admitted to our hospital from March 2015 to March 2016 were selected as the object of the present medical study. They were divided into observation group and control group, 17 cases each. Among them, the age of the control group ranged from 26 to 52 years, with a mean age of (39.14?1.94) years; the duration of the disease ranged from 1 to 10 months, with a mean duration of (5.81?0.81) months. In the control group, the age ranged from 27 to 54 years, with a mean age of (39.68?2.02) years; the duration of the disease ranged from 2 to 9 months, with a mean duration of (5.63?1.11) months. By comparing the age and disease duration of the two groups, the difference was not statistically significant (P>0.05).
1.2 Methods
Pre-operative care: After the patients were admitted to the hospital for the patients to do a good routine examination, nursing staff also need to be based on the actual psychological situation of the patients to formulate an effective and targeted psychological care program for the patients. Attention to the patient's blood glucose changes, and need to do a reasonable arrangement and control of the patient's diet, especially the intake of salt [1]. Nursing staff need to advise patients to use medication scientifically and reasonably, in order to control the patient's blood glucose within a reasonable range. Three days before the operation, let the patient use ozone to wash the vagina, clean it well to avoid infection. One day before the operation, nursing staff need to do a good job of diarrhea, so that the patient will be intestinal feces. Intraoperative care: nursing staff in the operation need to accurately will be the doctor needs medical equipment, and need to always observe the patient's vital signs, once the abnormal situation immediately inform the doctor. In addition, it is also necessary to provide effective psychological care for the patient to enhance the patient's confidence in the fight against the disease and distract the patient's attention. Postoperative care: nursing staff need to always observe the changes in the patient's vital signs, reasonable and scientific to let the patient use insulin, in order to help the patient to restore health. Every day, patients should be instructed to scrub the perineum to keep it clean and prevent infection [2]. In addition, nursing staff need to strengthen the indwelling care of urinary catheter, and must ensure the hygiene and cleanliness of the indwelling urinary catheter to avoid infection. After the end of surgery, patients can be encouraged to exercise reasonably according to the actual situation of patients to avoid complications [3].
1.3 Observation indicators
Compare the hospitalization time, intraoperative bleeding and nursing satisfaction of the two groups of patients at the end of the treatment.1.4 Statistical methods The data were analyzed by using the SPSS19.0 statistical software, with ?x?s? to indicate the measurement data, using the t-test, and percentage (%) to indicate the count data, using the x2 test, and the P< 0.05 as the difference is statistically significant.
2 Results
2.1 Comparison of hospitalization time and intraoperative bleeding between the two groups of patients
The hospitalization time and intraoperative bleeding of patients in the observation group were lower than those in the control group, and the difference was statistically significant (P<0.05).
2.2 Comparison of nursing satisfaction between the two groups of patients
The nursing satisfaction of patients in the observation group was 94.12%, and the nursing satisfaction of patients in the control group was 64.71%, and the difference in data was statistically significant (P<0.05).
3 Discussion
Diabetes mellitus to a certain extent will form a more serious impact on the surgical results of gynecological diseases, if the patient's blood sugar is not effectively controlled, the patient in gynecological surgery is very prone to acidosis and coma and other situations. Our hospital found that the use of nursing interventions for gynecological diseases combined with diabetes mellitus has a significant effect on patients, and can improve the quality of life of patients. It can be seen that the hospitalization time and intraoperative bleeding of patients in the observation group were lower than those in the control group, and the nursing satisfaction of patients in the observation group was 94.12%, while that of patients in the control group was 64.71%, with a statistically significant difference (P<0.05). Therefore, the use of nursing intervention for the care of patients with obstetric and gynecological diseases combined with diabetes mellitus during the perioperative period has a good effect, and it is worthwhile to promote and learn from it in the clinic.
References
[1] Zhu Hongmei. Strengthening the perioperative nursing strategy discussion of gynecological surgery combined with diabetes mellitus patients[J]. Diabetes New World,2015,(16):140-141.
[2]Yang Xiu. Perioperative care of elderly patients with gynecologic oncology with combined diabetes mellitus[J]. Diabetes New World,2014,(21):102.
[3]Jia Yanhuan,Li Yuling. Analysis of perioperative clinical care for patients with diabetes mellitus combined with obstetric and gynecological diseases[J]. Nursing Research,2014,28(10):3535-3536.
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