Iran Journal of Nursing
نشریه پرستاری ایران
IJN
Medical Sciences
http://ijn.iums.ac.ir
108
journal108
2008-5931
2008-5931
10.52547/ijn
fa
jalali
1398
8
1
gregorian
2019
11
1
32
120
online
1
fulltext
fa
تأثیر عملکرد پرستار رابط بر فراوانی عوارض حرکتی ناشی از سکته مغزی پس از ترخیص از بیمارستان: یک کارآزمایی بالینی تصادفی
Effect of the Performance of the Liaison Nurses on the Motor Complications in Stroke Patients after Discharge: A Randomized Clinical Trial
پرستاری
nursing
پژوهشي
Research
<div style="text-align: justify;"><strong><span style="color:black;"><span style="font-family:B Lotus;"><span style="font-size:10.0pt;">زمینه و هدف:</span></span></span></strong><span style="font-family:B Lotus;"><span style="font-size:10.0pt;"> با وجود پیشگیری و تشخیص سریع و مدیریت عوارض <span style="color:black;">سکته مغزی، بیماران همچنان در معرض بالای خطر بروز عوارض هستند. </span></span>پرستاران رابط متخصصانی هستند که با بررسی همه جانبه و استفاده از مهارتهای ارتباطی و تکنیکی در بیماران سکته مغزی وظیفه بهبود برنامه ترخیص و ادامه روند مراقبت در این بیماران را به عهده دارند<span style="color:black;">. این مطالعه با هدف تعیین تأثیر عملکرد پرستار رابط بر میزان بروز عوارض حرکتی بیماران دچار سکته مغزی بعد از ترخیص از بیمارستان طراحی و اجرا شد.</span></span><br>
<strong><span style="font-family:B Lotus;"><span style="font-size:10.0pt;">روش بررسی:</span></span></strong><span style="font-family:B Lotus;"><span style="font-size:10.0pt;"> <span style="color:black;">پژوهش حاضر یک مطالعه نیمه تجربی است که در </span></span>سال 1396-1395 <span style="color:black;">در بیمارستانی در شیراز انجام شد. </span></span>تعداد 80 بیمار با روش نمونهگیری در دسترس مبتنی بر هدف انتخاب و به صورت تصادفی به دو گروه آزمون و کنترل تقسیم شدند. بیماران گروه آزمون قبل از ترخیص توسط پرستار رابط مورد ارزیابی قرار گرفته و برنامه مراقبتی و آموزشی با تمرکز بر نیازهای هر بیمار تدوین و هنگام ترخیص کتابچه آموزشی جهت جلوگیری از عوارض حرکتی ناشی از سکته مغزی (یبوست، سقوط، زخم بستر) به بیمار و یا مراقبین وی تحویل داده شد. در صورت لزوم پرستار رابط بر بالین بیمار در منزل حاضر میشد و جهت برطرف کردن مشکلات بیمار با بیماران در تماس بود. گروه کنترل مراقبت روتین بخش دریافت و مرخص شدند.<span style="color:black;"> بیماران دو هفته و دو ماه بعد از ترخیص از نظر فراوانی زخم بستر و سقوط با گزارش بیمار و خانواده مورد ارزیابی قرار گرفتند و فراوانی یبوست با استفاده از معیار </span><span dir="LTR"><span style="color:black;"><span style="font-family:Times New Roman,serif;"><span style="font-size:10.0pt;">3</span></span></span></span> <span dir="LTR"><span style="color:black;"><span style="font-family:Times New Roman,serif;"><span style="font-size:10.0pt;">Rome</span></span></span></span> <span style="font-family:B Lotus;"><span style="font-size:10.0pt;">بررسی شد.<span style="color:black;"> دادههای جمع آوری شده با تستهای آماری من ویتنی و مجذور کای تحلیل شد</span></span><span style="color:red;">. </span></span><span dir="LTR"><span style="color:red;"><span style="font-size:10.0pt;"></span></span></span><br>
<strong><span style="font-family:B Lotus;"><span style="font-size:10.0pt;">یافتهها:</span></span></strong><span style="font-family:B Lotus;"><span style="font-size:10.0pt;"> دو گروه از نظر میانگین سن و </span></span><span style="font-family:B Lotus;"><span style="font-size:10.0pt;">معیار سنجش سکته مغزی </span></span><span style="font-family:B Lotus;"><span style="font-size:10.0pt;">تفاوتی نداشتند، </span></span><span style="font-family:B Lotus;"><span style="font-size:10.0pt;">توزیع فراوانی بیماران از نظر معیار</span></span><span dir="LTR"><span style="font-family:Times New Roman,serif;"><span style="font-size:10.0pt;">Braden </span></span></span><span style="font-family:B Lotus;"><span style="font-size:10.0pt;">،</span></span> <span style="font-family:B Lotus;"><span style="font-size:10.0pt;">معیار </span></span> <span dir="LTR"><span style="font-family:Times New Roman,serif;"><span style="font-size:10.0pt;">Mors</span></span></span><span style="color:black;"><span style="font-family:B Lotus;"><span style="font-size:10.0pt;">و جنس همسان بودند. فراوانی زخم بستر در دو گروه از نظر آماری تفاوت معنیداری نداشت (068/0</span></span></span><span dir="LTR"><span style="color:black;"><span style="font-family:Times New Roman,serif;"><span style="font-size:10.0pt;">P</span></span></span></span><span dir="LTR"><span style="color:black;"><span style="font-size:10.0pt;">=</span></span></span><span style="color:black;"><span style="font-family:B Lotus;"><span style="font-size:10.0pt;">). فراوانی یبوست (001/0</span></span></span><span dir="LTR"><span style="color:black;"><span style="font-family:Times New Roman,serif;"><span style="font-size:10.0pt;">P</span></span></span></span><span dir="LTR"><span style="color:black;"><span style="font-size:10.0pt;"> <</span></span></span><span style="color:black;"><span style="font-family:B Lotus;"><span style="font-size:10.0pt;">) و فراوانی سقوط (041/0</span></span></span><span dir="LTR"><span style="color:black;"><span style="font-family:Times New Roman,serif;"><span style="font-size:10.0pt;">P</span></span></span></span><span dir="LTR"><span style="color:black;"><span style="font-size:10.0pt;"> =</span></span></span><span style="color:black;"><span style="font-family:B Lotus;"><span style="font-size:10.0pt;">) در دو گروه تفاوت معنیدار آماری داشت.</span></span></span><span style="background:yellow;"><span style="font-family:B Lotus;"><span style="font-size:10.0pt;"></span></span></span><br>
<strong><span dir="RTL"><span style="font-family:B Lotus;"><span style="font-size:10.0pt;">نتیجهگیری کلی</span></span></span></strong><span dir="RTL"><span style="font-family:B Lotus;"><span style="font-size:10.0pt;">: <span style="color:black;">طرح </span></span></span></span><span dir="RTL"><span style="color:black;"><span style="font-family:B Lotus;"><span style="font-size:10.0pt;">پرستار رابط سکته مغزی که در زمان ترخیص هر بیمار را جداگانه با توجه به وضعیتش ارزیابی نمود، منجر به کاهش فراوانی عوارض حرکتی سقوط و یبوست بعد از سکته مغزی شد.</span></span></span></span></div>
<div style="text-align: justify;"><strong>Background & Aims: </strong>Worldwide, cerebrovascular accidents (stroke) are the second leading cause of death and the third leading cause of long-term and serious disabilities in adults. Motor and sensory impairments due to stroke cause common complications such as bedsores, constipation, and falls. In addition, strokes, directly and indirectly, affect the outcomes of patient treatment, including the duration of stay and death. Despite the rapid prevention and diagnosis and management of stroke, patients are still at high risk for complications. Given the prevalence of stroke complications, comprehensive nursing care during four weeks after a stroker plays a significant role in the decrease of the outcomes, disabilities, and mortality caused by the disorder. One of the most important roles of a liaison nurse is improving care quality by better preparing the patient for discharge. In fact, liaison nurse nurses are those who take care of patients with strokes after a holistic assessment and the application of technical and communication skills and improve their condition for discharge and continued care. Through coordination with other healthcare team members, they ensure that all the needs of patients and their families are met. In other words, the role of the liaison nurse is to improve pre-discharge planning, establish and improve communication between hospital staff and health care providers in the community, and provide home care facilities to assist hospital staff. Therefore, this study aimed to determine the effect of the performance of liaison nurses on the motor complications caused by a stroke after discharge.<br>
<strong>Materials & Methods:</strong> This quasi-experimental research had a randomized trial design and was performed in a hospital in Shiraz, Iran in 2016-2017. In total, 80 patients were selected by purposeful convivence sampling and were randomly divided into two test (n=35) and control (n=45) groups. Patients in the test group were evaluated before discharge by the liaison nurse and care and educational program focusing on the needs of each patient was developed. During discharge, an educational booklet was given to the patients or their caretakers in the test group to prevent motor complications caused by stroke (constipation, falls, bed sores). If necessary, the liaison nurse would be present at the patient's bedside at home and would be in contact with the patients to resolve their problems. On the other hand, the subjects in the control group received routine ward care and were discharged. In this study, falls were determined based on the report of patients and their families two weeks and two months after discharge (any type of fall due to imbalance and physical weakness). In addition, bedsores were determined based on the diagnosis of the liaison nurse after examining the patients, and constipation was determined by the same expert using Rome3 criteria. Data analysis was performed in SPSS version 16 using independent t-test (to compare the mean age and criteria for stroker) and Chi-square (to compare qualitative variables). Moreover, Mann-Whitney U was used to compare the risk of bedsores and falls due to non-compliance with normal distribution, and the Chi-square test was used to compare the frequency of complications in the two groups.<br>
<strong>Results:</strong> In this study, no significant difference was observed between the two groups in terms of age (P=0.319). the two groups were homogenous in terms of other baseline conditions, including the distribution of patients in terms of gender, Braden criterion, Morse criterion, and NIHSS. According to the results, no significant difference was observed between the groups regarding the frequency of falls two weeks (P=0.060) and two months (P=0.509) after discharge. Overall, a significant difference was observed between the two groups (P=0.041). Moreover, the groups had no significant difference regarding the frequency of constipation two weeks (P=0.121) and two months (P=0.102) after discharge, but the overall difference in the frequency of constipation was significant (P<0.001). In terms of bedsores, no significant difference was observed between the two groups two weeks (P=0.861) and two months (P=0.037) after discharge and in total (P=0.068).<br>
<strong>Conclusion:</strong> In this study, no significant difference was observed in the frequency of bed sores following the intervention of a liaison nurse. One of the positive points in this study was the use of the Braden criterion to predict the risk of bedsores and plan care based on the results in the test group. The criterion evaluates sensory perception, immobility, incontinence, and nutritional status. For each of the factors, separate measures were considered by the liaison nurse in order to reduce the occurrence of further problems and patient referral due to high-grade and infectious bed sores. According to the results of the study, the intervention of the liaison nurse significantly decreased the frequency fall in the test group, compared to the control group. By assessing the risk of falls in stroke patients based on Morse criterion, the liaison nurse increased sensitivity toward the topic in the patients and their families and pointed out the causes of falls. In the control group, two patients fell despite the low risk of falling according to Morse's criterion, which might be due to the insufficient knowledge of patients and their caregivers about the issue in the absence of a liaison nurse. The results were different in terms of the incidence of falls with the clinical trial of the fall prevention program with several factors that were performed at home after the rehabilitation phase of stroke patients. We found a significantly lower frequency of constipation in the test group. One of the expected results in this trial was the implementation of self-care behaviors in patients with stroke. Since sampling was carried out in a short duration and only in two internal brain and nervous systems and brain ICU sectors, it seems that the implementation of the liaison nurse plan on stroke patients to achieve more accurate results requires more time and a larger sample size. Some of the important measures to be taken by liaison nurses include special care and education of these individuals and following up patients after discharge. According to the results, the performance of liaison nurses regarding stroke patients was effective in the decrease of motor complications such as constipation and falls. However, they played no role in the decrease of bedsores in these patients.</div>
سکته مغزی, پرستار رابط, زخم بستر, یبوست, سقوط
Stroke, Liaison Nurses, Bedsore, Constipation, Fall
14
25
http://ijn.iums.ac.ir/browse.php?a_code=A-10-2269-2&slc_lang=fa&sid=1
S
Ebrahimi
صدیقه
ابراهیمی
10800319475328460024925
10800319475328460024925
No
MS in Critical Care Nursing, School of Nursing and Midwifery, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
کارشناسی ارشد پرستاری مراقبتهای ویژه، دانشکده پرستاری و مامائی، دانشگاه علوم پزشکی و خدمات بهداشتی درمانی شهید صدوقی، یزد، ایران
Z
Kalani
زهره
کلانی
10800319475328460024926
10800319475328460024926
Yes
Instructor, Nursing and Midwifery Care Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran (*Corresponding author) Tel: 09133524935 Email: z.kalani@ssu.ac.ir
مربی، مرکز تحقیقات مراقبتهای پرستاری و مامایی، گروه پرستاری، دانشگاه علوم پزشکی و خدمات بهداشتی درمانی شهید صدوقی، یزد، ایران (*نویسنده مسئول) شماره تماس: 09133524935 Email: z.kalani@ssu.ac.ir