关键词: 病例管理, 结核, 脑膜, 健康教育, 方案评价, 护理

Abstract:

The 60 patients with tuberculous meningitis, who were newly treated at the First Affiliated Hospitail of Xinxiang Medical University from 1 January 2015 to 31 December 2016, were selected as the research subjects. The 60 patients were hospitalized in four wards of tuberculosis department. Thirty patients in the first and second wards were selected as the observation group and another 30 patients in the third and fourth wards as control group. The control group was applied with routine health education pattern including notifying the patients of rules of hospitalization, common inspections, and laboratory tests and offering them with health education materials. The observation group was applied with case management model on the basis of the routine health education. Personal health education profile was established, individual assessment was conducted by the nurse in charge, and the individual management plan was also drawn up and implemented. At discharge, all the patients in the observation group were satisfied with the nurse (completely satisfied in 25 (83.3%) cases, basically satisfied in 5 (16.7%) cases, and dissatisfied in 0 (0.0%) cases), and only 86.7% of the patients in control group were satisfied with the nurse (completely satisfied 15 (50.0%) cases, basically satisfied with 11 (36.7%) cases, and dissatisfied with 4 (13.3%) cases). The difference in the degree of satisfaction for nurse was statistically significant (χ ²=8.75, P=0.013) between two groups. In the observation group, the scores for knowledge acquisition of treatment of tuberculous meningitis, dietary knowledge, notices for rest and exercise, knowledge of drugs, and knowledge acquisition of measures to prevent drug resistance were (18.54±0.23), (19.14±0.32), (18.54±0.31), (19.01±0.11), and (19.16±0.25), which were significantly higher than those in the control group ((13.41±0.43), (15.21±0.33), (15.21±0.56), (14.54±0.14), and (15.76±0.34)). The differences were statistically significant (t=12.48, P=0.005; t=11.63, P=0.012; t=8.91, P=0.021; t=11.98, P=0.010; t=10.30, P=0.016). At 1, 3, and 6 months after discharge, the treatment compliance rate in the observation group were 100.0% (30/30), 93.3% (28/30), and 86.7% (26/30), respectively, which were significantly higher than those in the control group (85.7% (24/28), 60.7% (17/28), and 53.6% (15/28), respectively); the difference was statistically significant (χ ²=4.60, P=0.032; χ ²=8.86, P=0.003; χ ²=7.66, P=0.006). In conclusion, the application of case management model in the management of patients with tuberculous meningitis could greatly improve the degree of patient’s satisfaction with nursing care, enhance the knowledge acquisition of the disease, and improve the treatment compliance.

Key words: Case management, Tuberculosis, meningeal, Health education, Program evaluation, Nursing care