OBJECTIVE: To evaluate the efficacy of seamless care management under FOCUS-PDCA for patients with acute cerebral infarction (ACI) complicated with dysphagia and its influence on nutrition status and neurological functions.
METHODS: A total of 98 patients with acute cerebral infarction complicated with dysphagia admitted to our hospital from March 2019 to December 2022 were selected and divided into two groups with equal numbers. The control group received routine nursing management. The study group implemented seamless nursing management under FOCUS-PDCA based on the control group. The therapeutic effect, nutritional status, and neurological function of the two groups were compared before and after intervention. Patients in both groups were intervened for 1 month.
RESULTS: (1) After the intervention, the Water Drinking Test (WDT) Grade I and Grade II of the study group increased from 0.00% before the intervention to 32.65%, and the control group also increased from 0.00% before the intervention to 14.29% and 22.45%. , while the number of Grade III, Grade IV, and Grade V decreased in both the control group and the study group. That is, the WDT level test of both groups after the intervention was better than before the intervention, and the research group was better than the control group, and the difference was statistically significant (Z=2.732, P = .006). (2) There was no statistical significance in the GUSS score and SWAL-QOL of the two groups before the intervention (P > .05); after the intervention, the GUSS score of the control group (16.32±4.26) was lower than that of the study group (18.52±4.85) (P < .001) , the SWAL-QOL score of the control group (116.48±31.05) was lower than that of the study group (143.08±33.85) (P < .001), and the GUSS scores and SWAL-QOL of the two groups after the intervention were higher than before the intervention (P < .001). (3) Compared with the nutritional status of the two groups, there was no statistical significance in PA, ALB, and Hb before intervention (P > .05); after intervention, PA, ALB, and Hb in the control group were (218.15±27.15) and (38.67±5.84) respectively. (120.85±31.05), all lower than the study group (261.15±22.52), (42.84±6.32), (134.18±30.47) (P < .01), and the PA, ALB and Hb of the two groups after intervention were all higher than before intervention (P < .001). (4) Comparing TSF and MAMC between the two groups, there was no statistical significance in TSF and MAMC before intervention (P > .05); after intervention, TSF and MAMC in the control group were (13.84±6.38) and (28.61±4.15) respectively, both of which were low. Compared with the study group (16.94±6.69), (33.15±3.84) (P < .001), and the TSF and MAMC of the two groups after the intervention were higher than before the intervention (P < .001). (5) Comparing the neurological function and limb function between the two groups, there was no statistical significance in NIHSS and FMA before intervention (P > .05); after intervention, NIHSS and FMA in the control group were (19.64±3.52) and (48.15±4.85) respectively. The NIHSS was higher than that of the study group (16.52±3.85), and the FMA was lower than that of the study group (58.84±5.63) (P < .001). The NIHSS and FMA of both groups after the intervention were better than those before the intervention (P < .001). (6) The incidence rate of complications in the study group was 4.08%, which was lower than 18.37% in the control group (P < .05).
CONCLUSION: Seamless nursing management for patients with ACI and dysphagia under the FOCUS-PDCA model has obvious effects. It can effectively improve the patient's swallowing function, reduce the degree of neurological deficit, improve their nutritional status and quality of life, and has fewer complications. It can be used clinically Promote within the application.