Symptom Management Intervention in Elderly CABG Patients

老年cabg术后患者的有效随访和管理在整体康复过程中非常重要。具体而言，本研究将试图弥补目前文献中关于随访干预对提高冠脉搭桥患者康复效果影响的空白。本实验研究的主要目的是测试症状管理家庭护理干预（SMHCNI）对老年CABG患者康复结果的影响，采用随机两组（N=284）重复测量设计，分别在出院时、术后3周和6周以及术后3和6个月进行测量。一组接受干预和常规护理（RC），另一组只接受RC。主要目的是确定干预组是否表现出：更好的生理功能（减少症状对身体功能的干扰（减少症状对身体功能的干扰）；SF 36子量表：身体，角色-身体和活力得分更高，活动和运动能量消耗增加）；生理条件改善（症状对身体功能的干扰减少；SF 36量表得分提高；角色-情感、社交、心理和活力）；更少的术后问题（如感染、肺部积液、心率节律问题）。次要目标的其他结果是：较低水平的医疗保健利用[HCU]（即，较少的医疗保健提供者访问次数，较少的急诊科访问次数，较少的家庭健康访问次数，较少的再住院次数）；以及更高的患者满意度（功能水平和接受的护理）。此外，本研究还将研究中介的潜在影响（功能水平评估和接受的护理）。此外，本研究将研究中介的潜在影响（功能水平评估和接受的护理）。此外，本研究将考察中介（症状评估、感知自我效能）和调节变量（参与心脏康复）对上述结果的干预的潜在影响。干预措施将通过一种名为“健康伙伴”的设备提供，该设备连接到患者的电话线上，每天可以下载到一个免费的安全互联网站点，但医疗保健提供者不能使用该设备进行出院后的后续护理。为期6周的SMHCNI是根据班杜拉（1986）对自我效能的定义设计的，自我效能感是指增强人们对组织和执行管理未来情景所需的资源和行动的能力的信念。初步数据显示，这些患者回家时会出现症状管理问题，但这些问题引起的并发症可以通过早期发现和管理来预防。使用诸如SMHCNI之类的后续干预措施有望改善功能、控制症状和减少术后问题。此外，更好地理解HCU，患者满意度和自我效能感作为变量将被描述。

Effective follow-up and management of elderly post-CABG patients is important in the overall recovery process. Specifically, this study will attempt to bridge the gap in current literature related to the impact of follow-up interventions to enhance recovery outcomes in the CABG population. The major purpose of this experimental study is to test the effects of the symptom management home care nursing intervention (SMHCNI) on recovery outcomes of elderly CABG patients using a randomized, two group (N=284) repeated measures design with measurements at discharge, at 3 and 6 weeks, and 3 and 6 months post- operatively. One group will receive the intervention and routine care (RC) and the other group will receive only RC. The major aim will be to determine if the intervention group will demonstrate: better physiological functioning (decreased symptom interference on physical functioning (decreased symptom interference on physical functioning; better scores on the SF 36 subscales: physical, role-physical and vitality, and increased activity and exercise energy expenditure); better physiological conditioning (decreased symptom interference on physical functioning; better scores on the SF 36 subscales; role-emotional, social, mental, and vitality); and fewer post-operative problems (e.g., infections, fluid in lungs, heart rate rhythm problems). Additional outcomes for secondary aims are: lower levels of health care utilization [HCU] (i.e., fewer number of visits to health care providers, fewer number of emergency department visits, fewer number of home health visits, fewer rehospitalizations); and higher patient satisfaction (with level of functioning and care received). In addition this study will examine the potential effects of mediating (evaluation of level of functioning and care received)> In addition this study will examine the potential effects of mediating (evaluation of level of functioning and care received). In addition this study will examine the potential effects of mediating (evaluation of symptoms, and perceived self-efficacy, and moderating variables (participation in cardiac rehabilitation) with the intervention on outcomes identified above. The intervention will be delivered using a device called the Health Buddy that is attached to the patient's telephone line, able to download to a free secure Internet site daily, and cannot be used by health care providers for post-hospital follow up care. The 6- week SMHCNI was designed using Bandura's (1986) definition of self- efficacy which is to enhance the beliefs in ones capabilities to organize and execute the sources and actions required to manage prospective situations. Preliminary data have shown that these patients are going home with symptom management problems, but that complications arising from these problems might be prevented with early detection and management. Using a follow-up intervention such as the SMHCNI is expected to result in better functioning, management of symptoms and fewer post-operative problems. Also, a better understanding of HCU, patient satisfaction, and self-efficacy as variables will be described.