Research progress of continuous nursing care in patients with percutaneous coronary intervention

Huiping Wang,Siqi Xiong,Ming Sang,Yanqiu Huang,Changde Jin

1Graduate College,Tianjin University of Traditional Chinese Medicine,Tianjin,China.2School of Nursing,Tianjin University Traditional Chinese Medicine,Tianjin,China.

Introduction

Coronary heart disease(CHD)is a common disease that harms human health.The mortality rate accounts for 67.1% of cardiovascular diseases, and its hospitalization cost ranks the first among medical diseases[1].PCI is a kind of safe,effective,less damage, and low cost treatment [2]. Percutaneous coronary intervention therapy (PCI) refers to the expansion of the balloon in the narrow artery and the placement of the stent to open the narrow or blocked artery,which is the most commonly used vascular reconstruction method in patients with coronary heart disease[10,11].For the short hospitalization time,hospital-to-family continuous care is challenging[3-4].

Continuous care refers to the measures to ensure that patients in different health care places(Such as from hospital to home or from hospital to other care institutions).Initially,the goal of continuous care is to improve postoperative resilience in high-risk populations[5].With the development of continuous care,it has been widely used to reduce the readmission rate and improve the quality of life of patients with coronary heart disease [6]. In 2010, the Chinese government advocated for the continuation of care[7],which promoted the development of the researches of the continuity of care in the diet,medication,exercise and psychological research.However,for the lack of professional theoretical framework, there is no standard operation procedure[8].This study mainly reviews the studies on continuous care for patients after coronary intervention to provide a basis for the implementation of continuous care for patients with coronary intervention.

Life style guidance after discharge

Diet guidance

The studies have found that dietary and multi-nutrient intake is of great significance for the recovery of diseases[12].Lai HP points out that diet with low-salt and oil,less cholesterol,more cellulose,more fruit and vegetable can promote patient recovery after PCI operation[13].Scholars such as Yang ZH and Luo Q also pointed out those patients should be instructed to have a healthy and reasonable diet and lifestyle to avoid high-fat food,ban alcohol,eat small amounts of food,and avoid overeating[14-16].

Guidance on medication

Fokkema ML pointed out that drug treatment is an important link to prevent heart disease recurrence[17].Pan CM investigated 100 patients with percutaneous coronary intervention and found that 87%of them needed medication guidance[18].Lou LL also pointed out that the guidance of medication is at the top of the list in the patient's needs[19].Shi CH,et al.conducted continuous nursing intervention on 100 patients. The study found that patients were instructed to take medicine correctly and were informed of possible adverse reactions. It is prohibited to add or remove drugs without permission, which can reduce the rate of cardiovascular adverse events and readmission rate[20].Wang XJ found in her study of 84 patients that continuous care can effectively improve their medication compliance. Patients should separate the medicine box and lay out the medicine on the second day before going to bed.Placing it in a prominent place can prevent drug leakage[21].In continuing care interventions for 84 patients,Yu suggested that for patients taking digital-yellow drugs,medical staff should teach them to count their pulses regularly and record them. Patients who take diuretics should be required to measure fluid volume on a daily basis.If the patient is taking nitrate preparations,he should be informed of the precautions to avoid adverse drug reactions[22].If the patient has periodontal bleeding, nosebleed, skin bleeding point or increased menstrual volume of female patients, she should contact the attending physician immediately[23].

Exercise guidance

Proper exercise can reduce the mortality rate and readmission rate of patients with cardiovascular diseases,improve the quality of life of patients,reduce the corresponding medical expenses,and reduce the pressure on medical and health resources[24].Ding DD pointed out that patients after PCI operation should engage in moderate activity without angina[25]. Moderate activity refers to a half an hour or so daily exercise to keep your heart rate between 90 and 110 beats per minute while exercising without tired feeling in next day[26].In the study of 100 researchers,Sun GQ instructed the patients to pay attention to the combination of work and rest and ensure adequate sleep[27].

Emergency treatment guidance

When Chen XJ, et al. perform continuous care intervention on 74 participants;they guide patients and their families to master self-emergency treatment,including nitrate preparation taking and basic technology of cardiopulmonary resuscitation(CPR),etc. [28]. Nurses should tell patients to carry emergency medicines with them.When the patient has chest tightness or chest pain, they should immediately rest on the ground and take isosorbide dinitrate or nitroglycerin tablets under the tongue.If the symptoms cannot be relieved or worse,you should call 120 immediately [29]. When scholars Wu [30]conduct continuous nursing care intervention on 80 patients,she explained to the patient angina pectoris,symptoms of acute myocardial infarction,how to identify and self-help methods when the symptoms appear.She tells patients that they should see a doctor immediately in the event of chest pain,so as not to miss an effective time.Liu J instructed 63 patients in the control group to carry emergency CARDS and emergency treatment CARDS with them when conducting continuous care intervention[31].

Psychological guidance

Continuous nursing intervention can relieve the anxiety,depression and other negative emotions of patients with coronary heart disease after PCI, and it can improve the satisfaction of patients and their families with nursing services [32]. Ziebarth found that depression was one of the predictors of readmission after PCI[33].Patients with coronary heart disease often have higher levels of anxiety and depression[34].The stronger self-control you have,the lower anxiety and depression you have[32].Some scholars point out that future studies on PCI patients should focus on intervention measures to reduce depression and improve self-control[35].Bi YL put forward that those who have negative and pessimistic psychology are given patient and careful guidance and help patients build confidence in the fight against disease.Meanwhile, nurses should provide face-to-face communication opportunities for inpatients and discharged patients[36].

Methods of continuous nursing for patients with coronary intervention

Establish a continuous care working group

A medical team(consisting of doctors,head nurses and nurses)was established to be specifically responsible for the medical treatment,nursing intervention and follow-up of patients [37]. Fu GL studies 116 participants and finds that establishing a good relationship between nurses and patients or their family members can greatly improve the patient's compliance[38]. Team members are assigned different tasks according to specific situations. For example,in a study of 320 participants,Yu B point out that doctors are in charge of the treatment plans and drug adjustment. However, nurses are responsible for collecting information and implementing continuous care which promote the rehabilitation of patients better[22].Wei LQ conduct a study on 150 participants,then he points out those medical team members should be trained strictly to master relevant knowledge expertly and propose that the head nurse should be the leader[39].Hu suggest that the deputy director of the nursing department should be responsible for organizing implementation, inspection and coordination.The attending doctor is responsible for patients'consultation,guidance and questions[40].

Follow-up

Family follow-up

Family follow-up is one of the most effective ways to improve patient satisfaction in continuous care, which enhance the trust and affection between nurses and patients.It is effective for patients to improve the therapeutic compliance after discharge[41].The follow-up led by nurses can make regular contact with patients,which is beneficial for nurses to conduct on-the-spot observation and improve patient self-management confident [42]. Zhao Y, et al. conduct home follow-up for 74 participants once a week in the first month,twice a month in the second month and once a month from the fourth month after discharge, which is combined with telephone follow-up.Family follow-up includes check the patient's knowledge about "handbook of PCI patients’recovery situation”,assess the health of the patient,develop individualized plans based on the patient's physical changes and encourage family members to participate in it[43].Based on a study of 118 participants,Zhang Y pointed out if the patients have a high level of education can be detailed in the pathogenesis, clinical manifestations of coronary heart disease, the pharmacological effect of drugs taken after PCI and the important role of long-term medication;For patients with low level of culture,they should choose easy-to-understand language[44].

Telephone follow-up

Telephone follow-up is convenient and economical.Gong X M,etc.arrange nurses to conduct weekly telephone follow-up, then gradually once a month after the patient is discharged from the hospital.The nurse managers give detailed understanding and gave targeted guidance about the patient's smoking,drinking,psychological,exercise,diet,medication,disease,etc.[45~47].When L J conducted continuous care intervention for 186 subjects,she also pointed out that telephone follow-up should be carried out every month to understand the patient's condition,cognition and self-management[48].

Patient club

When Shao QL conducted a study on 120 participants,she organized a monthly symposium for 60 participants in the control group to make patients exchange their experiences with other patients who have good medication compliance and effective treatments,which improve patient's self-management and medication compliance[49].The nurse managers organize the patients with relatively close addresses to establish the support team for patients.They organize activities to exchange experiences about diet,sports and other situations regularly.It can be summarized by those with a high level of education.Then they fed back to the nurse managers through WeChat,QQ,SMS or telephone,etc.,which will be answered by the nurse managers[27].

Health knowledge lectures

He ZX,et al.organize patients to participate in CHDrelated health lectures held monthly actively and distribute health materials at the meeting to further promote self-care knowledge [50]. In the lecture,experts'lectures,communication between patients and friends and expert consultation are combined to ensure that everyone can understand the knowledge of coronary heart disease[30].Guo WJ,et al.conducted a three-month study on 142 subjects,suggesting that the lecture should include:patients'diet,lifestyle,rational drug use,and regular review[51].

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