Hongpeng Liu1, Dawei Zhu2, Jing Cao1, Jing Jiao1, Baoyun Song3, Jingfen Jin4, Yilan Liu5, Xianxiu Wen6, Shouzhen Cheng7, Stephen Nicholas8,9,10,11, Xinjuan Wu1. 1. Department of Nursing, Chinese Academy of Medical Sciences, Peking Union Medical College, Peking Union Medical College Hospital, Beijing, China. 2. China Center for Health Development Studies, Peking University, Beijing, China. 3. Department of Nursing, Henan Provincial People's Hospital, Zhengzhou, China. 4. The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China. 5. Department of Nursing, Wuhan Union Hospital, Wuhan, China. 6. Department of Nursing, Sichuan Provincial People's Hospital, Chengdu, China. 7. Department of Nursing, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China. 8. Guangdong Institute for International Strategies, Guangdong University of Foreign Studies, Baiyun Avenue North, Guangzhou, China. 9. School of Economics and School of Management, Tianjin Normal University, West Bin Shui Avenue, Tianjin, China. 10. TOP Education Institute 1 Central Avenue Australian Technology Park, Eveleigh Sydney, Australia. 11. Newcastle Business School, University of Newcastle, University Drive, Newcastle, Australia.
Abstract
BACKGROUND: Immobility complications, including pressure injuries (PIs), deep vein thrombosis (DVT), pneumonia, and urinary tract infections (UTIs), affect the clinical outcomes of stroke patients. A standardized nursing intervention model (SNIM) was constructed and implemented to improve the quality of care and clinical outcomes among immobile patients with stroke. AIMS: To assess the benefit of SNIM for immobility complication rates, including PIs, DVT, pneumonia, and UTIs, and mortalities in immobile patients with stroke. METHODS: A before and after study design was used. Patients were divided into a pre- and post-SNIM training original cohort and matched for socioeconomic, demographic, and disease characteristics using propensity score. We fitted logistic regression models to examine the effect of SNIM, and whether the benefit differed between tertiary and non-tertiary hospitals. RESULTS: In the original cohort, the rate of pneumonia, UTIs, and mortality was lower after SNIM training. Furthermore, in the matched cohort, the difference in PI rates was significant. Logistic regression analysis revealed that the probability of PIs, pneumonia, UTIs, and mortality were significantly reduced after SNIM training in the original cohort and this estimated value changed little in the matched cohort. Our results show that the decreased rates of pneumonia, UTIs, and mortality were mainly among non-tertiary hospitals. CONCLUSIONS: A structured and systematic SNIM benefited immobile stroke patients' clinical outcomes, but mainly in non-tertiary hospitals in China. Standardized nursing training is needed in non-tertiary hospitals.
BACKGROUND: Immobility complications, including pressure injuries (PIs), deep vein thrombosis (DVT), pneumonia, and urinary tract infections (UTIs), affect the clinical outcomes of stroke patients. A standardized nursing intervention model (SNIM) was constructed and implemented to improve the quality of care and clinical outcomes among immobile patients with stroke. AIMS: To assess the benefit of SNIM for immobility complication rates, including PIs, DVT, pneumonia, and UTIs, and mortalities in immobile patients with stroke. METHODS: A before and after study design was used. Patients were divided into a pre- and post-SNIM training original cohort and matched for socioeconomic, demographic, and disease characteristics using propensity score. We fitted logistic regression models to examine the effect of SNIM, and whether the benefit differed between tertiary and non-tertiary hospitals. RESULTS: In the original cohort, the rate of pneumonia, UTIs, and mortality was lower after SNIM training. Furthermore, in the matched cohort, the difference in PI rates was significant. Logistic regression analysis revealed that the probability of PIs, pneumonia, UTIs, and mortality were significantly reduced after SNIM training in the original cohort and this estimated value changed little in the matched cohort. Our results show that the decreased rates of pneumonia, UTIs, and mortality were mainly among non-tertiary hospitals. CONCLUSIONS: A structured and systematic SNIM benefited immobile stroke patients' clinical outcomes, but mainly in non-tertiary hospitals in China. Standardized nursing training is needed in non-tertiary hospitals.
Authors: Yukari Hisaka; Hirokazu Ito; Yuko Yasuhara; Kensaku Takase; Tetsuya Tanioka; Rozzano Locsin Journal: Int J Environ Res Public Health Date: 2021-12-04 Impact factor: 3.390