缺血性脑卒中多病共存患者出院准备度现状及其影响因素研究

doi:10.3761/j.issn.1672-9234.2023.05.012

摘要/Abstract

摘要：

目的探究缺血性脑卒中多病共存患者的出院准备度水平及其影响因素。方法选取2020年7月—2021年1月在沈阳市某三级甲等医院神经内科住院的256例缺血性脑卒中多病共存患者为研究对象，采用一般资料调查表、出院准备度量表、出院指导质量量表进行问卷调查。结果缺血性脑卒中多病共存患者的出院准备度总分为（83.05±13.78）分。多重线性回归分析结果显示，合并症数量、出院指导质量、文化程度及BMI值对患者的出院准备度有意义（调整后的R²=0.115，F=2.375，P<0.001）。结论本研究缺血性脑卒中多病共存患者的出院准备度水平较低，护理人员应重点关注合并疾病数量多、文化程度较低及肥胖的患者，构建针对性的照护方案。由于本研究结果得到的影响因素解释力度较低，未来还需进一步探索更多相关变量对缺血性脑卒中多病共存患者出院准备度水平的影响。

关键词: 脑卒中, 缺血性, 问卷调查, 多病共存, 出院准备度

Abstract:

Objective The aim of this study is to investigate the status of discharge readiness of patients with ischemic stroke and multimorbidity. Methods We investigated 256 patients with ischemic stroke and multimorbidity who admitted to the Department of Neurology of a Grade 3A hospital in Shenyang between July 2020 and January 2021 with general information questionnaire，Readiness for Hospital Discharge Scale，and Quality of Discharge Teaching Scale. Results The total score of discharge readiness of patients with ischemic stroke and multimorbidity was 83.05±13.78. The numbers of comorbidity，the quality of discharge teaching，educational level and BMI，had strong significance on patients’ discharge readiness（adjusted R²=0.115，F=2.375，P<0.001）. Conclusion The patients with ischemic stroke and multimorbidity have low-level discharge readiness. Nursing staff should focus on patients with high number of comorbidity，low education level and obesity. Because of the low explanatory power of the influencing factors obtained from the results of this study，it is necessary to further explore the impact of more relevant variables on the level of discharge readiness of patients with ischemic stroke coexisting with multiple diseases in the future.

Key words: Stroke, Ischemic, Questionnaires, Multimorbidity, Readiness for hospital discharge

于朋朋, 王艳梅, 朱蕊, 杜雪, 齐敬晗. 缺血性脑卒中多病共存患者出院准备度现状及其影响因素研究[J]. 中华护理教育, 2023, 20(5): 575-579.

YU Pengpeng, WANG Yanmei, ZHU Rui, DU Xue, QI Jinghan. Discharge readiness and its influencing factors in patients with ischemic stroke and multimorbidity[J]. Chinese Journal of Nursing Education, 2023, 20(5): 575-579.

图/表 4

参考文献 21

[1]	Markle-Reid M, Valaitis R, Bartholomew A, et al. An integrated hospital-to-home transitional care intervention for older adults with stroke and multimorbidity:a feasibility study[J]. J Comorb, 2020, 10:2235042X19900451.
[2]	Yarnall AJ, Sayer AA, Clegg A, et al. New horizons in multimorbidity in older adults[J]. Age Ageing, 2017, 46(6):882-888. doi: 10.1093/ageing/afx150 pmid: 28985248
[3]	Griffith LE, Gruneir A, Fisher K, et al. Insights on multimorbidity and associated health service use and costs from three population-based studies of older adults in Ontario with diabetes,dementia and stroke[J]. BMC Health Serv Res, 2019, 19(1):313. doi: 10.1186/s12913-019-4149-3 pmid: 31096989
[4]	Jiang XQ, Morgenstern LB, Cigolle CT, et al. Multiple chronic conditions and functional outcome after ischemic stroke:a systematic review and meta-analysis[J]. Neuroepidemiology, 2020, 54(3):205-213. doi: 10.1159/000503900
[5]	Galvin EC, Wills T, Coffey A. Readiness for hospital discharge:a concept analysis[J]. J Adv Nurs, 2017, 73(11):2547-2557. doi: 10.1111/jan.2017.73.issue-11
[6]	徐娟娟. 缺血性脑卒中老年患者出院准备度相关因素及其对非计划再入院影响的研究[D]. 开封: 河南大学, 2019.
	Xu JJ. Study on relevant factors of readiness for hospital discharge and effect on unplanned readmission to the elderly with ischemic stroke[D]. Kaifeng: Henan University, 2019.
[7]	袁晓旭. 脑卒中患者出院准备度现状及影响因素的研究[D]. 石河子: 石河子大学, 2019.
	Yuan XX. Survey of the readiness for hospital discharge and its influencing factors among stroke disease patients[D]. Shihe-zi: Shihezi University, 2019.
[8]	Nelson MLA, McKellar KA, Yi J, et al. Stroke rehabilitation evidence and comorbidity:a systematic scoping review of randomized controlled trials[J]. Top Stroke Rehabil, 2017, 24(5):374-380. doi: 10.1080/10749357.2017.1282412
[9]	肖顺贞. 临床科研设计[M]. 北京: 北京大学医学出版社, 2003.
[10]	Weiss ME, Piacentine LB. Psychometric properties of the rea-diness for hospital discharge scale[J]. J Nurs Meas, 2006, 14(3):163-180. doi: 10.1891/jnm-v14i3a002
[11]	林佑桦, 高家常, 黄阿美, 等. 中文版医院出院准备度量表之信效度检定[J]. 护理杂志, 2014, 61(4):56-65.
	Lin YH, Kao CC, Huang AM, et al. Psychometric testing of the Chinese version of the readiness for hospital discharge scale[J]. The Journal of Nursing, 2014, 61(4):56-65.
[12]	Weiss ME, Costa LL, Yakusheva O, et al. Validation of patient and nurse short forms of the Readiness for Hospital Discharge Scale and their relationship to return to the hospital[J]. Health Serv Res, 2014, 49(1):304-317. doi: 10.1111/1475-6773.12092 pmid: 23855675
[13]	Weiss ME, Piacentine LB, Lokken L, et al. Perceived readiness for hospital discharge in adult medical-surgical patients[J]. Clin Nurse Spec, 2007, 21(1):31-42. doi: 10.1097/00002800-200701000-00008 pmid: 17213738
[14]	王冰花, 汪晖, 杨纯子. 中文版出院指导质量量表的信效度测评[J]. 中华护理杂志, 2016, 51(6):752-755.
	Wang BH, Wang H, Yang CZ. Reliability and validity of the Chinese version of the Quality of Discharge Teaching Scale[J]. Chin J Nurs, 2016, 51(6):752-755.
[15]	孙振球, 徐勇勇. 医学统计学[M]. 4版. 北京: 人民卫生出版社, 2014.
[16]	戴金辉. 虚拟变量回归及其应用[J]. 统计与决策, 2019, 35(5):77-80.
[17]	Moffat K, Mercer SW. Challenges of managing people with multimorbidity in today’s healthcare systems[J]. BMC Fam Pract, 2015, 16(1):129. doi: 10.1186/s12875-015-0344-4
[18]	敖梅, 莫素莹, 颜玉贤, 等. 医联体模式的“互联网+护理服务”在脑卒中患者中的应用[J]. 护士进修杂志, 2021, 36(3):210-213.
[19]	俞红丽, 王敏凤, 林卫, 等. 长期护理保险制度下应用微信平台改善老年脑卒中病人家庭照顾者照护能力的效果[J]. 护理研究, 2020, 34(7):1246-1249.
	Yu HL, Wang MF, Lin W, et al. Effect of joint application of WeChat platform and long-term care insurance system on caring ability of family caregivers of elderly stroke patients[J]. Chin Nurs Res, 2020, 34(7):1246-1249.
[20]	王小凤, 朱宗红, 张洪霞. 缺血性脑卒中病人出院准备度与出院指导质量的相关性[J]. 护理研究, 2020, 34(3):511-513.
	Wang XF, Zhu ZH, Zhang HX. Correlation between readiness for discharge and quality of discharge guidance among pa-tients with ischemic stroke[J]. Chin Nurs Res, 2020, 34(3):511-513.
[21]	Wang XY, Huang YN, Chen YR, et al. The relationship between body mass index and stroke:a systemic review and meta-analysis[J]. J Neurol, 2022, 269(12):6279-6289. doi: 10.1007/s00415-022-11318-1