Continuous nursing extends treatment and rehabilitation care during hospitalization to the family after discharge to help improve the self-management of patients and ensure that information, treatment and nursing services continue without sudden interruption. Continuous nursing is a new nursing service model that occurred with the development of society and changes in medical services[11,12]. In China, the current medical services are mainly focused on hospitals, and the relationship between doctors and patients ends when the patients leave the hospital.
Mechanical valve replacement is an effective method for the treatment of cardiac valve diseases, and it greatly improves the cardiac function of patients and saves their lives. Most patients who undergo valve replacement in China are middle-aged people. These patients choose a mechanical valve, and they must be treated with lifelong anticoagulant therapy after surgery. Warfarin is the main anticoagulant in China. Therefore, these patients must regularly monitor the INR or PT after surgery and constantly adjust the dose of anticoagulant to prevent bleeding, embolism and other complications of improper anticoagulant treatment. Most of the mechanical valve replacement patients in China are from rural areas, and their academic qualifications are generally low. The lack of disease-related knowledge, poor self-management ability, and the lack of awareness of the importance of anticoagulant therapy result in an inability to take anticoagulant drugs correctly after discharge, which easily causes insufficient or excessive anticoagulant and complications, such as embolism and bleeding[14,15]. Therefore, we should strengthen the management of patients after valve replacement after discharge, inculcate health education knowledge into patients without interruption and give patients correct guidance and help to avoid the disconnect of the patients from hospitals to the family to solve the problem of insufficient support after discharge. Many studies have shown that continuous nursing can improve patients’ compliance after discharge and reduce complications. Chi S et al. conducted a prospective study to explore the impact of continuous nursing intervention on the rehabilitation of diabetic patients. The results showed that continuous nursing can improve patients' self-care ability, and reduce the occurrence of complications. Yu YL et al.conducted a randomized controlled study, and the report showed that continuation care can help patients with chronic obstructive pulmonary disease to improve their compliance with oxygen therapy and self-care ability. The study of Li P et al. shown that continuous care can improve the self-efficacy of chronic obstructive pulmonary disease patients and reduce complications. Our study has reached the same conclusion. In the continuous nursing group, we remind patients to review the INR as planned and help them adjust the warfarin dose in time through WeChat. However, many patients in the convention nursing group forget to review the INR regularly, especially for patients with poor compliance. It is also more inconvenient for them to ask doctors to adjust the dosage of warfarin. Therefore, there are fewer complications related to anticoagulation in the continuous nursing group.
Cardiac valve replacement has a relatively high risk of surgical complications compared to other surgeries, and the patient does not possess relevant knowledge of the operation. Therefore, fear and tension are inevitable before and after surgery. Cardiac mechanical valve replacement requires lifelong anticoagulant therapy. For most patients, there will be a heavy psychological burden. Some patients lose confidence, and the negative feelings are obvious. The main causes of anxiety should be evaluated during the diagnosis and treatment process and intervened in a timely manner. If negative emotions are caused by long-term disease remission, the main purpose of the intervention is to improve the main symptoms and comfort patients. If a patient’s anxiety is caused by a lack of understanding of the disease and doubts about the efficacy of the treatment, doctors and nurses should communicate with the patient as soon as possible and explain the process and effect of cardiac valve replacement. If necessary, other similar patients may be invited to share their personal experiences to enhance their confidence. If a patient is worried about their lack of drug and nursing knowledge after discharge, the continuous nursing model with improved WeChat, telephone and other follow-up methods to provide professional service and psychological support to patients after discharge may solve this problem. The services of continuous nursing provide not only professional knowledge and support for the treatment of symptoms but also psychological support to promote the physical and mental recovery of patients. Psychological support is helpful to enhance the patient’s subjective initiative and self-control ability, to meet the safety and comfort needs of patients with special conditions, to alleviate the patient’s undefined negative psychology, to eliminate the patient’s undefined worries, to help patients maintain the best physical and mental state and to improve the patient’s undefined psychological adaptability and quality of life. This study provided a series of continuous nursing services for patients after mechanical heart valve replacement to understand the patients’ needs, difficulties and psychological feelings in a timely manner and to provide effective communication and guidance to solve problems and effectively alleviate the symptoms of depression and anxiety in patients.
There are several limitations in this study. First, this study was a retrospective study with a small sample size, and patients who did not have independent reading ability, communication equipment or convenient information communication were not included in this study, which may cause selection bias. Second, this study was a single-centre study, and more research from multiple centers is mandatory to assess the value of continuous nursing in the future. Third, the follow-up period of this study was brief, and a longer term follow-up period is needed. Fourth, during the follow-up period, the coagulation function re-examination was performed in the local hospital, and the INR measurement method may be different in different hospitals.