Construction Of Intervention Program For Bowel Dysfunction In Patients With Spinal Cord Injury

Objective:This research through evidence-based nursing research and expert meeting to construct the intervention program for bowel dysfunction in patients with spinal cord injury(SCI).Then demonstration of the program in clinical experiment,to further improve the content of the intervention program.The aim is to provide a theoretical reference for clinical nurses to carry out scientific,standardized and systematic intervention of bowel dysfunction in patients with SCI,and to reduce the incidence of bowel dysfunction in patients with SCI,improve the quality of life of bowel dysfunction in individuals with spinal cord injury.Methods:1.Based on the method of evidence-based nursing to summary and recommend high level evidences related to bowel dysfunction patients.Then combined with the contents of previous literature review,we formed a preliminary intervention program for SCI patients with bowel dysfunction.2.The preliminary intervention program is proved by expert meeting method,which makes the program more practical and operable.3.Carrying out short-term training of bowel dysfunction related knowledge and techniques for clinical nurses,and to assess the knowledge and technology of bowel dysfunction intervention in SCI before and after the training of nurses.And to evaluate the changes of nurses’ attitude and behavior to SCI bowel dysfunction before and after training.4.The intervention program was implemented and evaluated in a quasi-experimental research method,we selected 71 SCI patients who were admitted to the department of spinal cord injury rehabilitation of a rehabilitation center in Shanghai from January 2017 to December.Patients were divided into two groups,the 34 SCI patients admitted from January 2017 to May were in control group,and the 37 SCI patients from August 2017 to December were in intervention group.The control group was treated with routine nursing methods,and the intervention group carried out the intervention program of SCI patients with bowel dysfunction.Bowel function index(defecation time,abdominal distension,constipation and fecal incontinence rate,the defecation frequency score,stool score,drug dependence and stool control conditions),quality of life and patients’ knowledge of health education were used to evaluate the effect of interventions.SPSS22.0 software was used to analyze the data,and the general data of patients were analyzed by descriptive analysis.The measurement data according to normal distribution were tested by T test of two independent samples,non-parametric test was used for data not conforming to normal distribution,and Chi-square test was used for the comparison of counting data.P﹤0.05 was considered statistically significant.Results:1.Evidence-based research included 13 guidelines and 11 systematic reviews.We collected 62 items of evidence related to bowel dysfunction through discussion and collation,of which there were 13 items of grade A,22 items of grade B,11 items of grade C and 16 items of grade D.The contents involve assesment methods,intervention measures,intervention effect evaluation and health education.Then the draft intervention program for SCI patients with bowel dysfunction was formed.2.There were 12 experts participated in the expert demonstration meeting of the intervention program.The judging coefficient of experts to the research content was 0.94,the degree of familiarity was 0.92,the coefficient of expert authority was 0.92.The experts’ authority coefficient was high,and the result of demonstration was credible.3.The short-term training of the SCI rehabilitation nurses about the knowledge and techniques related to SCI bowel dysfunction.After training,the scores of nurses in knowledge and technique of SCI bowel dysfunction were significantly higher than those before training(P﹤0.001).At the same time,the nurses’ cognitive degree and the executive ability of intervention in bowel dysfunction patients was significantly improved(P﹤0.05).4.The results of clinical practice study showed that the defecation frequency score,stool score,the incidence of abdominal distension,constipation and drug dependence were significantly lower than those in the control group(P﹤0.05),and there was no significant difference in the incidence of fecal incontinence(P﹥0.05).The time of defecation in the intervention group was shorter than that in the control group(P﹤0.05).Although there was no significant difference in stool control between the two groups,the stool control score in the intervention group was higher than that in the control group.In terms of quality of life,the total score of quality of life and scores of all fields in the intervention group were higher than those in the control group(P﹤0.05).In the aspect of health education,the knowledge and technology of neurogenic bowel dysfunction in the intervention group was significantly higher than that in the control group,and the difference was statistically significant(P﹤0.01).Conclusions:This research based on the method of evidence-based nursing,through reviewed of guidelines and system reviews related to bowel dysfunction in SCI,we summarised high level evidences.Then combined with the contents of previous literature review,the darft intervention program of bowel dysfunction in SCI patients was formed.We used the method of expert meeting to demonstrated the intervention program to make it more in line with the clinical practice in our country.The effects of the intervention program were verified by quasi-experimental research.It was found that the intervention program could effectively improve the SCI patients’ bowel function,their quality of life,the level of knowledge and technology of health education.It lays a theoretical foundation for the extension and application of the later intervention program.