Abstract
Objective To explore the effectiveness of Omaha system on transitional care in elderly patients with chronic heart failure. Methods A total of 42 elderly patients with chronic heart failure were selected by convenient sampling method, and five consecutive nursing interventions were conducted from 3 days before discharge to 3 months after discharge. The Omaha system was applied to evaluate the outcome of the patients' cognition, behavior and condition(K-B-S)from four aspects of environment, physiology, psychology and health-related behaviors. Results After continuous nursing intervention, 3 months after discharge, the patients showed improvement in circulation, respiration, digestion-hydration problems, neuro-muscle-skeletal function, social interaction, mental health, sleep, drug treatment program and hygiene compared with 3 days before discharge, and the difference in K-B-S score was statistically significant(P<0.01 or P<0.05). The improvement of defecation status and medical expenses was not obvious, and the difference of K-B-S score was not statistically significant. Conclusions The transitional care plan for elderly patients with chronic heart failure based on Omaha system can reflect the nursing problems of patients and the direction of intervention, and improve the nursing outcome of patients. Key words: Chronic heart failure; Transitional care; Omaha system
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