Biomedical Research 2018; 29 (9): 1779-1783 ISSN 0970-938X www.biomedres.info The effec of ized nursing based on CGA on he qualiy of for elderly paiens wih chronic diseases. Fen Gong 1, Yan-ling Hu 2* 1 Deparmen of Surgical Oupaien, Jining No.1 eople s Hospial, Jining Ciy, Shandong rovince, R China 2 Deparmen of Basic Medicine, Chongqing Three Gorges Medical College, Wanzhou Disric, Chongqing Ciy, R China Absrac Objecive: To explore he effec and clinical value of ized nursing according o Comprehensive Geriaric Assessmen (CGA) on he qualiy of in elderly paiens wih chronic diseases. Mehods: A oal of 300 elderly paiens wih chronic diseases were randomly divided ino conrol group (n=150) and observaion group (n=150). The paiens in he conrol group were reaed wih rouine nursing. On he basis of rouine nursing, he observaion group was reaed wih ized nursing based on CGA. Before and a six monhs afer discharged, wo groups were assessed by using he qualiy of scale, and heir effec on qualiy of and saisfacion rae of reamen and nursing work were compared before and afer he. Resuls: Afer he, he scores in he elderly paiens wih he observaion group in physiology, psychology, independence, social relaions, environmen, and general qualiy of were higher han hose of he conrol group (=4.998, 4.937, 7.174, 5.106, 4.087, all <0.05), and differences were saisically significan, and nursing saisfacion a six monhs afer discharged were significanly higher han ha of he conrol group (χ 2 =5.556, <0.05). Conclusion: ersonalized nursing based on CGA can improve he nursing of elderly paiens wih chronic diseases and improve he saisfacion of paien during hospializaion and nursing afer discharged, hen improve he qualiy of of paiens. Keywords: Comprehensive geriaric assessmen, Elder paiens, Chronic diseases, ersonalized nursing. Acceped on December 18, 2017 Inroducion Wih he increasing aging of he global populaion, elderly paiens wih chronic diseases are increasing year by year [1]. The elderly, due o cogniive impairmen, reduced mobiliy, unsable movemens, inconinence (more han 65 y old) and oher characerisics, seriously affec heir qualiy of, hus promoing he demand for medical services [2,3]. Acive and effecive nursing for elderly paiens wih chronic diseases is helpful o improve he reamen effec and he qualiy of [4,5]. Comprehensive Geriaric Assessmen (CGA) is he process of diagnosis and reamen of a mulilaiude inerdisciplinary, and he conens of evaluaion mainly consis of healh assessmen, cogniive and psychological funcion, physical funcion assessmen, social assessmen and environmenal assessmen, o develop a comprehensive coordinaion reamen and rehabiliaion plan and long-erm follow-up plan for elderly paiens, and o maximize he healh of elderly people [6]. ersonalized care comes from he holisic nursing mode of hinking developmen, regards paiens as he inegriy of he individual, he inegraion of he iy characerisics of medical care and he paiens hemselves, o provide he mos suiable nursing service for paiens [7]. The focus of ized nursing is o improve he cogniion of elderly paiens on disease, reduce he pain of paiens, improve he qualiy of, and promoe physical and menal healh [8]. The sudy of individualized nursing comprehensive geriaric assessmen based on he formulaion of on he qualiy of of elderly paiens wih chronic diseases, seeking effecive nursing measures can improve he qualiy of in elderly paiens wih chronic diseases, he clinical nursing service qualiy and provide a heoreical basis for he clinical promoion of qualiy care services. Biomed Res 2018 Volume 29 Issue 9 1779
Gong/Hu General Informaion Research subjecs Toally, 300 cases as he objec of sudy from January 2014 o Sepember 2016 from deparmen of Respiraory Medicine, Cardiology, Hyperension Endocrinology, Oncology ward were colleced in our hospial, inclusion crieria: 1. chronic diseases such as he high blood pressure, coronary hear disease, diabees, chronic respiraory diseases, malignan umors of he elderly paiens, aged 60-85 y; 2. conscious and normal communicaors. Exclusive crieria: 1. incomplee clinical records or paiens unable o communicae wih each oher; 2. paiens wih acue and severe diseases; 3. complee loss of living abiliy. aiens and heir families volunarily paricipaed in and signed informed consen and he sudy was approved by he Ehics Commiee of our insiue. The subjecs were randomly divided ino conrol group and observaion group, 150 cases in each group. There was no significan difference in gender, age, duraion, complicaion and Body Mass Index (BMI) in he wo groups (<0.05, Table 1). Table 1. Comparison of wo groups of paiens wih general informaion (mean ± SD). Group Cases Male/female Age (y) Course of disease (y) More han 2 kinds of complicaions (n (%)) BMI (kg/m 2 ) Conrol group 150 78/72 68.95 ± 7.35 8.62 ± 2.14 130 (86.67) 23.10 ± 0.85 Observaion group 150 76/74 70.85 ± 9.45 8.75 ± 2.57 135 (90.00) 23.21 ± 1.02 χ 2 / 0.053 1.944 0.476 0.809 1.015 0.817 0.053 0.634 0.369 0.311 Mehod Conrol group: The conrol group was given rouine care, afer admission, he nurses carried ou healh educaion o he paiens and heir families, o undersand he causes of chronic diseases, reamen and precauions, o help paiens esablish a correc concep of. Monioring he paien's medicaion (such as anihyperensive drugs, hypoglycemic agens, lipidlowering drugs, ec.) and die, o avoid spicy excian food, ligh die, ec. should also ensure he safey of paiens o avoid falling down from bed or falling down and so on. Observaion group: The observaion group: on he basis of he conrol group, he observaion group were given ized nursing based on CGA. Rouine medical assessmen was carried ou a admission, and CGA manual was filled in and CGA files were brough ino he medical records. Firs, CGA posiive paiens were screened by 1-3 d afer admission, and CGA labels were aached o medical records and nursing care, which caused medical saff o pay aenion o hem and needed o focus on key shif. Second, bringing he issues such as comprehensive care, cogniive abiliy, psychological saus, physical funcion and nuriion assessed by CGA ino he nursing plan. Third, poining ou he exising deficiencies and goals in nursing care according o posiive problems ha have been assessed. Forh, formulaing plan wih he chief physician. Fifh, formulaing he key prescripions for sleep disorders, cogniive disorders, consipaion, chronic pain, malnuriion and oher complicaions, giving he corresponding nursing measures, and ized educaion, finding ou poenial problems imely, conducing he mulidisciplinary consulaion when necessary. Hospial referral cards were issued by nurses, he guidance before discharged and he care afer discharged were offered by nurses. Follow up ime: one week afer discharged, he nurses followed up by elephone, 3 monhs afer discharged by family visi, 6 monhs afer discharged, he paiens were sen back o he deparmen for reexaminaion, in order o sysemaically undersand he qualiy of of paiens. Evaluaion of elderly paiens wih chronic diseases in CGA manual mainly includes: (1) medical assessmen: including medical hisory, medicaion managemen, vision, hearing, eeh, defecaion and urinaion, sleep, falls, chronic pain and oher issues. (2) cogniive funcion assessmen: he Loewensein Occupaional Therapy Cogniive Assessmen (LOTCA) scale [9] was used. (3) assessmen of psychological funcion (emoional saus): he elderly depression scale was used o assess [10]. (4) physical funcion assessmen: he use of abiliy of daily, insrumenal daily living abiliy scale and fall risk assessmen scale [11]. (5) assessmen of nuriional risk: he Mini Nuriional Assessmen scale (MNA) score was used [12]. (6) assessmen of social, environmenal and economic saus, including economic siuaion, social suppor sysem, living environmen, residenial safey, ec. Evaluaion of efficacy Firs, he qualiy of : The World Healh Organizaion Qualiy of Life Insrumens (WHOQOL-100) is covering he physiology (pain and discomfor, energy and faigue, sleep and res), psychology (posiive feelings, houghs, learning, memory and aenion, self-eseem, physical and appearance, negaive feelings), independence (mobiliy, daily, medical care and drug dependence, abiliy o work), social relaionships ( relaionship, required social suppor saisfacion, sexual ) and environmen (social securiy, housing environmen, economic sources, medical services and social securiy, access o new informaion, knowledge and skills opporuniies, recreaion paricipaion, environmenal condiions, raffic condiions), and spiriual suppor/religious/ 1780 Biomed Res 2018 Volume 29 Issue 9
The effec of ized nursing based on CGA on he qualiy of for elderly paiens wih chronic diseases beliefs, he six dimensions and weny-four aspecs were assessed for evaluaing qualiy of. I is an effecive ool o assess he qualiy of of he elderly [13]. Elderly paiens can score according o heir own feelings in he pas 2 w, he scores are divided ino saisfacion, basic saisfacion and dissaisfacion. The higher he score was, he beer he qualiy of was. The ime of ized nursing can be chosen he day of admission and 6 monhs afer discharged. Second, saisfacion rae: he scores on nursing saisfacion according o he nursing saff's working aiude and serious degree, professional operaion level, and heir disease recovery, using percenile sysem, 80-100 poins was divided ino saisfacion, 60-80 poins was regarded as he basic saisfacion, <60 poins was no saisfied. Saisical analysis The sofware SSS 21.0 was used o analyse all he daa. The measuremen daa were expressed as mean ± sandard deviaion, and analysed by -es. The enumeraion daa were expressed as number or percenage of cases, and analysed by Chi-square es. <0.05 was considered as he criical crierion for saisical significance. Resuls and he difference was saisically significan (<0.05, Table 5). Table 2. Comparison of scores of qualiy of beween he wo groups before (mean ± SD). Iems Observaion group (n=150) Conrol (n=150) group hysiology 11.81 ± 3.05 12.03 ± 2.58 0.675 0.500 sychology 12.02 ± 2.91 12.29 ± 2.14 0.916 0.361 Independence 11.10 ± 2.92 11.80 ± 3.51 1.878 0.061 Social relaions 11.41 ± 2.63 11.92 ± 2.04 1.877 0.062 Environmen 11.28 ± 2.59 11.58 ± 1.92 1.140 0.255 Spiriual Overall qualiy of suppor/ 10.67 ± 2.41 10.39 ± 2.82 0.925 0.356 belief/ 11.23 ± 2.18 11.26 ± 1.93 0.126 0.900 Table 3. Comparison of qualiy scores before and afer in he conrol group (mean ± SD). Iems Afer Before hysiology 12.68 ± 3.28 12.03 ± 2.58 1.937 0.054 Comparison of qualiy of beween he wo groups before Before he, here were no significan differences in he scores of he qualiy of scale beween he observaion group and he conrol group (>0.05, Table 2). Comparison of qualiy of before and afer in conrol group In he conrol group, here was no significan difference in he scores of qualiy of scale before and afer he (>0.0, Table 3). Comparison of qualiy of before and afer in observaion group Afer, he scores of he qualiy scale of he observaion group were significanly higher han hose before he (<0.05, Table 4). Comparison of saisfacion of reamen and nursing beween he wo groups afer Afer, he elderly paiens wih he observaion group were more saisfied wih he nursing work han he conrol group in hospializaion and 6 monhs afer discharged, sychology 12.84 ± 2.91 12.29 ± 2.14 1.865 0.063 Independence 12.45 ± 3.39 11.80 ± 3.51 1.631 0.104 Social relaions 12.28 ± 1.95 11.92 ± 2.04 1.562 0.119 Environmen 11.86 ± 2.28 11.58 ± 1.92 1.151 0.251 Spiriual Overall qualiy of suppor/ 10.83 ± 2.97 10.39 ± 2.82 1.316 0.189 Belief/ 11.57 ± 2.88 11.26 ± 1.93 1.095 0.275 Table 4. Comparison of he scores of qualiy before and afer in he observaion group (mean ± SD). Iems Afer Before hysiology 13.34 ± 2.18 11.81 ± 3.05 4.998 0.000 sychology 13.41 ± 1.85 12.02 ± 2.91 4.937 0.000 Independence 13.16 ± 1.96 11.10 ± 2.92 7.174 0.000 Social relaions 12.70 ± 1.63 11.41 ± 2.63 5.106 0.000 Environmen 12.37 ± 1.99 11.28 ± 2.59 4.087 0.000 Spiriual suppor/ 11.44 ± 2.13 10.67 ± 2.41 2.932 0.004 belief/ Biomed Res 2018 Volume 29 Issue 9 1781
Gong/Hu Overall qualiy of 12.96 ± 2.23 11.23 ± 2.18 6.794 0.000 Table 5. Comparison of saisfacion rae of nursing care beween wo groups of paiens afer (n (%)). Group Cases Saisfacory rae of reamen during hospializaion Saisfacion rae of nursing work during hospializaion The overall saisfacion rae a 6 monhs afer discharged Observaion group 150 120 (80.00) 130 (86.67) 100 (66.67) Conrol group 150 98 (65.33) 110 (73.33) 80 (53.33) χ 2 8.123 8.333 5.556 0.004 0.004 0.018 Discussion Chronic diseases means chronic non-communicable diseases, including coronary hear disease, hyperension, diabees, chronic respiraory diseases, malignan umor, characerized by insidious onse, difficuly of cure, incurable and complex eiology, clinical characerisics are high incidence, high morbidiy and high moraliy. The characerisics of elderly paiens wih chronic diseases: firs, he prevalence of chronic diseases in he elderly is increasing year by year [14]. Second, i is he coexisence of 1-3 kinds of chronic diseases in he elderly. Third, i is he physical and psychological changes of he elderly, elderly paiens prone o sense of loss, anxiey, loneliness, depression, despair and oher negaive emoions [15]. Chronic diseases promoe he demand for medical resources in elderly paiens [16]. Rouine medical assessmens and single s have significan deficiencies in he assessmen of elderly paiens wih chronic diseases, leading o he emergence of a Comprehensive Geriaric Assessmen (CGA) model [17]. Compared wih he convenional medical assessmen, CGA also includes physical funcion assessmen, psychological evaluaion, social and economic assessmen, environmenal healh assessmen, qualiy of assessmen, assessmen of common elderly syndrome or problems, and obacco and alcohol, healh producs and oher evaluaion [18]. CGA is a muli-dimensional, inerdisciplinary assessmen and diagnosic approach, using subjecive and objecive way o comprehensively judge physical funcion, menal, social and economic and he elderly funcional saus and qualiy of, has become he focus of elderly medical research in recen years. Research shows ha CGA can mee he healh needs of older paiens, improve he healh funcion of he elderly, reduce medical coss, and in cancer paiens, dialysis paiens, demenia and emergency recovery paiens play an imporan role [19,20]. The role of nurses in elderly paiens wih chronic diseases is o provide paien-cenered, ized care. Nurses play an imporan role in assessing paien s condiion, finding problems and inegraing CGA recommendaions and coordinaing follow-up care [21]. According o he resuls of CGA, nurses can have he care of paiens wih problems: (1) publiciy and educaion: hrough he mission video, healh alks o srenghen he paien's awareness of he disease, o undersand he possible complicaions of he disease, inform he prevenion measures, o develop good habis. (2) psychological care: for paiens wih bad mood such as anxiey, depression, fear and so on, srenghen communicaion and implemen individualized psychological guidance and. (3) drug care: aiens wih poor memory and poor compliance, nurses need o repeaedly inform he correc medicaion and he ime of scienific medicaion. (4) die care: for poor die and malnuriion, we can make a scienific and reasonable die plan wih he nuriion deparmen. (5) exercise care: choose walking, walking, jogging and oher appropriae exercise according o he condiions of he paiens, increase he body's defense capabiliy. The resuls showed ha here was no significan difference in he conrol group before and afer he in he physiology, psychology, independence, environmen, he social relaions and he overall qualiy of, indicaing ha no significan change in qualiy of afer he. The resuls showed ha he observaion group afer he in he field of physiology, psychology, independence, environmen, social relaions, overall qualiy of were higher han hose of he observaion group before he, indicaing ha qualiy of was beer han before. Afer he, he saisfacion rae of he observaion group and he conrol group showed ha he saisfacion rae and nursing saisfacion of he observaion group were significanly higher han hose of he conrol group. From he above resuls: because of he complexiy and specificiy of elderly paiens, he exising convenional medical care can improve he disease saus of paiens o a cerain exen. The individualized nursing based on he CGA of he elderly is in line wih he modern biological-psychologicalsocial medical model, which can find he poenial clinical problems, psychological problems, social demands and economic siuaion of he elderly paiens, pay aenion o he individual differences of he paiens, saisfy he diverse requiremens, make ou he paiens wih ized nursing plan and feasible reamen measures and he, prevenion and healh care, can improve he qualiy of of paiens, and wih he approval of paiens and heir families, improve paien saisfacion. Therefore, he individualized nursing based on CGA is an acive exploraion and exension of he convenional nursing mehods, and explores he direcion of he reform direcion of he medical 1782 Biomed Res 2018 Volume 29 Issue 9
The effec of ized nursing based on CGA on he qualiy of for elderly paiens wih chronic diseases care model. A number of foreign hospials have been regarded CGA as a rouine reamen [22], bu in our counry, CGA mosly in he elderly oupaien deparmen, communiy and oher local communiies, individualized nursing based on CGA carried ou a home and hospial medical saff is very limied, is worh exploring. In summary, ized care based on CGA can provide individualized nursing plan for paiens wih chronic diseases, no only improve he paiens' saisfacion wih nursing service, improve he qualiy of of paiens, which is o explore a new mode of nursing, worhy of clinical promoion. References 1. Lance T. Global elderly care in crisis. Lance 2014; 383: 927-935. 2. Clegg A, Young J, Iliffe S. Fraily in elderly people. Lance 2013; 381: 752-762. 3. Koroukian SM, Schilz N, Warner DF. Combinaions of chronic condiions, funcional imiaions, and geriaric syndromes ha predic healh oucomes. J Gen Inern Med 2016; 31: 630-637. 4. Luo Z. Effec of psychological nursing on psychological sae of elderly paiens wih chronic diseases. China Med harm 2016; 32: 521-526. 5. Overcash J, Momeyer MA. Comprehensive geriaric assessmen and caring for he older person wih cancer. Semin Oncol Nurs 2017; 35: 850-858. 6. iloo A, Cella A, iloo A. Three decades of comprehensive geriaric assessmen: evidence coming from differen healhcare seings and specific clinical condiions. J Am Med Dir Assoc 2017; 18: 191-197. 7. Jian JY, Liu Y. The effec of individualized nursing on he reamen and qualiy of wih elderly chronic obsrucive pulmonary disease. China Mod Med 2016; 51: 530-539. 8. eng LJ, Chen Y, Fei XU. The effec of individualized nursing mehod guided by Omaha sysem on elderly paiens wih coronary hear disease. Nurs rac Res 2017; 45: 850-858. 9. Case IA. Loewensein occupaional herapy cogniive assessmen o evaluae people wih addicions. Occup Ther In 2017; 2017: 1-7. 10. Kakrani VA, Desale AV, Meha C. Geriaric depression scale (GDS): a ool for assessmen of depression in elderly. J Krishna Ins Med Sci Univ 2015; 4: 24-31. 11. Io T. Comprehensive physical funcion assessmen in elderly people. Clin hys Ther 2017; 28: 2572-2579. 12. Sharvanan E, Shravan S, Anand KBS. A cross secional sudy on assessmen of mini nuriional saus and depression saus among elderly in he villages of V. Koa Mandal, Chioor Disric, A.. In J Healh Sci Res 2015; 5: 26-31. 13. Yazdani K, Nedja S, Karimlou M. Developing a shorened qualiy of scale from ersian version of he WHOQOL-100 using he Rasch analysis. Iran J ubl Healh 2015; 44: 522-534. 14. Mwangi J, Kulane A, Le VH. Chronic diseases among he elderly in a rural Vienam: prevalence, associaed sociodemographic facors and healhcare expendiures. In J Equiy Healh 2015; 14: 1-8. 15. Imahori M, Izumida N, Shirase Y. Effecs of prevenive long-erm care on physical and psychological healh saus for he elderly: evidence from a salon for he elderly in Abashiri Ciy. Nihon Koshu Eisei Zasshi 2016; 63: 675-682. 16. Ellis G, Gardner M, Tsiachrisas A. Comprehensive geriaric assessmen for older aduls admied o hospial. Cochr Daab Sys Rev 2017; 24: 890-899. 17. Tule CSL, Maier AB. Towards a biological geriaric assessmen. Exp Geronol 2017; 8: 556-565. 18. Tucci A, Marelli M, Rigacci L. Comprehensive geriaric assessmen is an essenial ool o suppor reamen decisions in elderly paiens wih diffuse large B cell lymphoma: a prospecive mulicener evaluaion on 173 paiens by he lymphoma Ialian Foundaion (FIL). Leuk Lymph 2015; 56: 921-927. 19. Shahrokni A, Kim SJ, Bosl GJ. How we care for an older paien wih cancer. J Oncol rac 2017; 13: 95-102. 20. iloo A, Cella A, iloo A. Three decades of comprehensive geriaric assessmen: evidence coming from differen healhcare seings and specific clinical condiions. J Am Med Dir Assoc 2017; 18: 192-197. 21. Ekdahl AW, Sjosrand F, Ehrenberg A. Fraily and comprehensive geriaric assessmen organized as CGAward, or CGA-consul, for older adul paiens in he acue care seing: A sysemaic review and mea-analysis. Eur Geriar Med 2015; 6: 523-540. 22. Mccarhy AL, Cook S, Yaes. Engineering he finess of older paiens for chemoherapy: an exploraion of comprehensive geriaric assessmen in pracice. Healh (London) 2014; 18: 196-212. * Correspondence o Yan-ling Hu Deparmen of Basic Medicine Chongqing Three Gorges Medical College R China Biomed Res 2018 Volume 29 Issue 9 1783