| Objective: Based on related medical evidence, we attempted to build the structured skin intervention program by Delphi methods applicable to local patients with fecal incontinence, and verify its effects on the incidence, severity, development time, healing time of IAD, the medical cost and nursing time, furthermore, to provide scientific guidance for nursing staff.Method: Part I: based on literature review, paper analysis and sorting, with combination to the clinical practices, we have achieved the first draft on structured skin intervention program for patients with fecal incontinence, after group discussion and revision, we formed the first round of inquiry questionnaire, and we selected 15 famous experts specialized on the area of critical care and incontinence care, two rounds of Delphi consultation have proceeded for advices on the entry modules and program, ultimately, we constructed structured skin intervention program for patients with fecal incontinence by discussion and strict revision. Part II: a quasi-experimental study was conducted. We collected 144 cases of fecal incontinence by convenience sampling method, all patients were recruited from 2 general ICU wards and 2 neurosurgical ICU wards of the First Affiliated Hospital to Suzhou University, with 72 patients respectively in the control group and intervention group, the control group have undergone the nursing routine of fecal incontinence and IAD, while the intervention group have received the structured skin intervention program for patients with fecal incontinence, the IAD incidence, severity,development time, healing time of IAD, the cost of care and nursing time was observed and analyzed, SPSS19.0 statistical software was adopted for data analysis and processing.Results: part I: 15 experts were selected, two rounds of experts active coefficient were 100% and 93.33% respectively, with 0.94 degree of experts pundits, finally we formed initially intervention program which included the evaluation, the interventions forhigh risk skin, the interventions for IAD and interventions for related complications four modules and 20 items. Part II: No statistically significant difference was found on the basic information before the intervention, with evidenced comparability. After the intervention:IAD rate in intervention group was 19.1% and 37.1% in the control group, the difference was statistically significant(P <0.05); IAD severity score in the intervention group ranged from 2 to 16 points, with a median score of 4 points, while 2 to 30 points in the control group, with a median score of six points, the difference was statistically significant(P<0.05); Time for IAD occurrence is 1~4d, with a median time of 2d in the intervention group, while 1~5d control group with a median time 3d, the two groups was not statistically significant(P> 0.05); the recovery time for IAD varied from 3 to 10 d in the intervention group, with a median time of 5d, while the control group was 3-13 d, with a median time of 7.5d, the difference was statistically significant(P <0.05); the nursing cost for patients with fecal IAD in the intervention group was significantly lower than the control group, and the difference was statistically significant(P <0.05),with the nursing cost for the patients without IAD in intervention group and the control group showed no significant difference(P> 0.05); no significant difference(P > 0.05) was found in the fecal incontinence patients between the intervention group and the control group, while the nursing time for patients with IAD was longer in the intervention group compared with control group, and the difference was statistically significant(P <0.05).Conclusion: A structured skin intervention program for patients with fecal incontinence has constructed in this study, with advantages of higher reliability, more specificity to the nursing care routing for incontinence and IAD, and its effectiveness has been clinically proven, Besides, it provides a good framework for guiding clinical nursing staff, with property of clinical implementation. |
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