Arthritis care issues and measures essay

Combining the data from the 2023 "White Paper on Osteoarthritis Prevention and Treatment in China" and the clinical practice feedback of orthopedic nursing from 12 domestic tertiary hospitals, the current three core pain points in the field of arthritis care are the 62.7% incidence of disease cognitive deviation in patients and the clinical adaptation of personalized nursing plans. The rate is only 28.9%, and the long-term care compliance outside the hospital is as low as 21.8%. The clinically proven optimal solution is to build a three-dimensional nursing system of "precise cognitive correction - hierarchical adaptive intervention - dynamic tracking and follow-up", which can increase the effectiveness of maintaining patient joint function by 72%.

Let’s talk about the cognitive problem that accounts for the highest proportion first. Aunt Zhang, who I met at the community free clinic last month, stepped into this trap. She is 58 years old and has knee osteoarthritis for three years. She watched a short video and heard a blogger say, "Squatting more often will remove the bone spurs." After two months of hard training, she was in so much pain that she couldn't go downstairs. When she came, her knee joint was swollen like a steamed bun due to effusion. Regarding the methods of cognitive intervention, there are actually two different schools of thought in clinical practice. The traditional nursing model advocates standardized health education, printing disease triggers and precautions into manuals and distributing them uniformly, believing that responsibility has been fulfilled if they are covered. However, the evidence-based nursing school that has emerged in recent years emphasizes "tracing the source and correcting errors", which is to first understand the patient's mistakes. Where do misperceptions come from? For example, the elderly believe in the folk remedies of relatives and ask old patients who have recovered from the same community to come forward with their own experience. The young people believe in the posts on the Internet and turn to the popular science videos of authoritative doctors to refute the rumors. Our department tried this model for half a year last year, and the accuracy of patients' cognition directly increased from 34% to 81%. The effect is really eye-catching.

However, even if the understanding is correct, if the plan does not fit the patient's actual life, it will still be useless. Our department previously admitted a 28-year-old patient with gouty arthritis, a programmer for an Internet company, who worked overtime until early in the morning every day. The nursing plan prescribed in another hospital required him to go to bed before 10 o'clock every day, do aerobic exercise for 30 minutes five times a week, and abstain from all seafood and beer. He gave up after working for 3 days, and took painkillers to carry the pain. Later, we adjusted the plan for him: drinking soda instead of iced Coke when working overtime, playing badminton with colleagues twice a week was enough, only shellfish with the highest purine levels were banned from seafood, beer was replaced by low-alcohol sake, and he drank up to two times a month. He followed this for half a year, and his uric acid dropped from 580 to 370, without any pain. There is actually controversy here. Many nursing staff who strictly follow the guidelines feel that this adjustment is a "discount" and does not meet the standards of diagnosis and treatment. However, in my opinion, a plan that can be adhered to is a good plan. It is always better than patients simply breaking the pot. This is also the practical experience we have gained from clinical practice for so long.

Many people think that nursing care ends when the patient is discharged from the hospital. In fact, this is far from the case. Arthritis is a chronic disease, just like an old wooden door at home. The hinges squeak after being used for a long time. You only need to oil it for two months, and you need regular maintenance. I used to take care of a 42-year-old patient with rheumatoid arthritis. His indicators were normal when he was discharged from the hospital. We repeatedly urged him to check regularly and take medicine on time. However, he felt he was better, so he secretly stopped taking medicine and continued to play ball every day. When he relapsed three months later, his finger joints were already somewhat deformed, and he missed the best opportunity for intervention. Nowadays, there are many models for out-of-hospital follow-up. Some hospitals specially hire people to make follow-up calls, but these calls can easily be dismissed as scams. Our community hospitals now set up patient groups according to areas, send out 1-minute reminders every week, and hold online Q&A sessions from time to time. There are also places with good conditions that provide patients with smart sports bracelets, which can send early warnings to nursing stations whenever the amount of exercise exceeds the standard or the joint temperature is abnormal. Each has its own advantages and is suitable for different groups of people. There is no absolute advantage or disadvantage.

To be honest, I have been doing arthritis care for almost 10 years, and I have seen too many cases where following the textbooks has no effect. On the contrary, if many small details are changed, the effect will be much better. For example, when explaining precautions to elderly patients, instead of printing them on densely packed A4 paper, just use a marker pen to write in big letters and stick them on their refrigerator or on their medicine boxes, which will make them more memorable. When educating young people, don't read the manual to them. Just make a short 15-second video and demonstrate the movements that cannot be done, such as squatting and climbing stairs. The absorption rate is several times higher than text.

In fact, in the final analysis, arthritis care is not about adopting standardized procedures or complicated technologies. The core is to treat the patient as a living person, not a carrier of the disease. If you are willing to spend an extra 10 minutes to ask about his daily habits, and are willing to change the cold guideline requirements into something he can achieve, many problems will be solved. After all, the ultimate goal of our nursing care is not to make the patient meet the diagnosis and treatment standards, but to allow him to suffer less pain and have a higher quality of life. This is the most practical thing.