Application Of Nursing Based On HBM And King’s Theory Of Goal Attainment In The Rehabilitation Of Patients With Lumbar Intervertebral Fusion

Objective To understand the knowledge level and influencing factors of disease,operation and rehabilitation of patients with lumbar intervertebral disc herniation(LDH)undergoing posterior lumbar interbody fusion(PLIF),and to explore the effect of nursing intervention based on health belief model(HBM)and King’s theory of goal attainment on rehabilitation of PLIF patients with lumbar disc herniation,so as to provide a new method for the care of patients from this type of surgery.Methods1.Investigation of status quo: referring to the literature and consulting experts,the item pool of "Questionnaire on Knowledge Related to Lumbar Disc Herniation and Posterior Lumbar Intervertebral Fusion"(hereinafter referred to as LDH-PLIF Questionnaire)was compiled.After two rounds of expert consultation,group discussion,revision and improvement of the questionnaire,and then through pre-investigation,the reliability and validity of the questionnaire were tested and finalized.From October 2017 to December 2017,220 patients with lumbar intervertebral disc herniation2.in four tertiary hospitals in Hengyang City were investigated by using the questionnaire.The data were analyzed by descriptive statistical analysis,variance analysis,Welch(W)approximation t test and multiple stepwise regression analysis,which provided the basis for formulating intervention programs of HBM combined with King’s theory of goal attainment.2.Study on intervention: February 2018 to July 2018,80 patients from A Class-A Third-Class Hospital in Hengyang City were randomly divided into control group(40 cases)and intervention group(40 cases)via convenience sampling.The control group was given routine nursing,and the intervention group was Nursing Care Based on HBM and King’s theory of goal attainmen on the basis of routine nursing.LDH-PLIF related knowledge questionnaire,general self-efficacy scale and Oswestry dysfunction scale were used to evaluate the knowledge,self-efficacy and lumbar function of the two groups before intervention,at discharge,1 month after operation and 3 months after operation.Comparisons of complications during hospitalization,lower limb muscle strength before intervention and 3 months after operation were also compared between the two groups.The imaging results were obtained.SPSS 18.0 statistical software was applied to descriptive analysis,t test,Chi-square test,repeated measurement variance analysis,Fisher’s exact probability method.Result1.Survey of the status quoThe total score of related knowledge of patients was(18.80±7.10).LDH-PLIF knowledge level was compared among patients of different ages,occupations,behavioral habits and living habits,education levels,family monthly income,as well as courses of disease,and the differences were statistically significant(P<0.05).Multivariate linear stepwise regression analysis of influencing factors of LDH-PLIF related knowledge showed that the educational level t=16.988,P=0.000,age t=-3.276,P=0.001,behavioral and life habits t=-2.115,P=0.036.2.Study on interventionThe have 39 patients were engaged in the intervention group,and 38 patients in the control group in the completion of the study.Basic data,Oswestry dysfunction score,LDH-PLIF-related knowledge score,general self-efficacy score,and muscle strength comparison between the two groups before intervention were not statistically significant(P > 0.05).After discharge,1 month and 3 months,the LDH-PLIF related knowledge scores of the intervention group were(22.10±2.43),(24.10±1.77),(25.13±2.90)higher than those of the control group(20.89±1.66),(22.79±2.30),(22.42±1.87)respectively,the differences were statistically significant(P<0.05).After discharge,1 month and 3 months,the general self-efficacy scores of the intervention group were(21.13±1.45),(23.08±1.30),(25.41±1.71)higher than those of the control group(20.32±1.68),(22.24±1.55),(23.68±2.49)respectively,the differences were statistically significant(P < 0.05).After discharge,1 month and 3 months,the Oswestry dysfunction scores in the intervention group were(27.56 ±1.83),(23.38 ±1.68),(14.10 ±1.97)lower than those in the control group(28.68±2.02),(24.18± 0.83),(16.39 ±0.92)respectively,the differences were statistically significant(P < 0.05).During hospitalization,there were 1 case of pulmonary infection,1 case of urinary tract infection and 1 case of constipation in the intervention group,2 cases of complications of pulmonary infection,2 cases of urinary tract infection,5 cases of constipation and 1 case of deep venous thrombosis in the control group,the difference was statistically significant(P = 0.036).Three months after the surgery,4 patients with grade 2～4(abnormal)muscle strength were from the intervention group,11 patients with grade 2～4 muscle strength from the control group,hence the differences were statistically significant(P=0.047).Conclusion1.The knowledge level of PLIF patients with lumbar disc herniation was relatively low;educational level,age,behavior and living habits are the important influencing factors.2.Nursing Care Based on HBM and King’s theory of goal attainmen can improve the knowledge level and self-efficacy of patients.Nursing intervention based on health belief model and King’s theory of goal attainment.3.Nursing Care Based on HBM and King’s theory of goal attainmen can reduce incidence of complications during the hospitalization of patients,promote the recovery of back and lower limb muscle strength,lumbar function.