护理SCI晨读：衰弱的老年心脏病患者的再入院过程
衰弱老年心脏病患者的再入院过程
衰弱老年心脏病患者的再入院过程
分享智慧
共同成长
摘要
目标
这项研究的目的是探讨患者和（或）正式照护人员在“心脏护理桥”（CCB）计划中衰弱老年心脏病患者计划外入院的过程中其作用和影响因素的观点。
设计
该研究是基于扎根理论原则的定性多案例研究，与CCB随机试验并列。
方法
选择了干预组中的五例，在随机分组后六个月内计划外入院。在每种情况下， 于2019年4月至2019年6月对患者（n = 4），非正式照护人员（n = 5），理疗师（n = 4）和社区护士（n = 5）进行半结构式访谈。入院前收集病历以重建护理流程。使用了主题分析和Strauss＆Corbin的六步分析。
结果
出现了三个主要主题。在计划外的医院再次入院之前，患者经历了急性的身体恶化发作。正式照护人员对患者健康状况的充分观察对于防止再次住院至关重要（主题1）。患者和（非正式）照护人员对护理需求的认识并不总是匹配的，这妨碍了护理支持（主题2）。在某些情况下，CCB的照护人员在提供护理方面遇到了困难，因此除了现有的照护服务外，护理的提供也很有限（主题3）。
结论
由于疾病恶化的严重性，常常缺乏对导致再入院的恶化的健康状况的早期检测。赋予患者及其非正式照料者以识别恶化的早期迹象的能力，并且照料者之间的充分合作可以支持及早发现病情恶化。应优先考虑患者的护理需求和期望，以促进患者参与。
影响
正式照护人员可以通过确保：（1）及早发现健康恶化，（2）增强患者和非正式照护人员的能力，以及（3）清楚地了解患者的护理需求，来防止老年心脏病患者的计划外住院。
Abstract
Aim
The aim of this study is to explore patients’ and (in)formal caregivers’ perspectives on their role(s) and contributing factors in the course of unplanned hospital readmission of older cardiac patients in the Cardiac Care Bridge (CCB) program.
Design
This study is a qualitative multiple case study alongside the CCB randomized trial, based on grounded theory principles.
Methods
Five cases within the intervention group, with an unplanned hospital readmission within six months after randomization, were selected. In each case, semi-structured interviews were held with patients (n = 4), informal caregivers (n = 5), physical therapists (n = 4), and community nurses (n = 5) between April and June 2019. Patients’ medical records were collected to reconstruct care processes before the readmission. Thematic analysis and the six-step analysis of Strauss & Corbin have been used.
Results
Three main themes emerged. Patients experienced acute episodes of physical deterioration before unplanned hospital readmission. The involvement of (in)formal caregivers in adequate observation of patients’ health status is vital to prevent rehospitalization (theme 1). Patients and (in)formal caregivers’ perception of care needs did not always match, which resulted in hampering care support (theme 2). CCB caregivers experienced difficulties in providing care in some cases, resulting in limited care provision in addition to the existing care services (theme 3).
Conclusion
Early detection of deteriorating health status that leads to readmission was often lacking, due to the acuteness of the deterioration. Empowerment of patients and their informal caregivers in the recognition of early signs of deterioration and adequate collaboration between caregivers could support early detection. Patients’ care needs and expectations should be prioritized to stimulate participation.
Impact
(In)formal caregivers may be able to prevent unplanned hospital readmission of older cardiac patients by ensuring: (1) early detection of health deterioration, (2) empowerment of patient and informal caregivers, and (3) clear understanding of patients’ care needs and expectations.
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