| Carcinoma of urinary bladder(CUB)refers to the most common malignant tumor that occurs on urinary system.According to statistics,the incidence of bladder cancer ranks ninth in malignant tumors worldwide.The incidence of bladder cancer in China ranks eighth in systemic malignant tumors..Most of the bladder cancer patients are pathologically classified as poorly differentiated malignant tumors.because the early symptoms of the patients are not obvious,the cancer cells have been seriously infiltrated and spread more frequently than the patients at the time of treatment,and accompanied by systemic metastasis,which seriously threatens the physical and mental health of human beings.Clinically,ureterocutaneostomy(UCST)is one of radical cystectomy(RC)operate method.For bladder cancer Patients who have short life expectancy,are associated with distant recurrence and metastasis,and have Poor systemic conditions due to intestinal abnormalities in which the intestinal tract cannot be used for urinary diversion.With the increase of the incidence of bladder cancer,there are more and more Patients with ureteral skin stoma,following survival time prolong,and the incidence of PostoPerative adverse reactions such as urine leakage and odor accomPanying Patients,dermatitis accomPanying Patients,metabolic disorder accomPanying Patients increase.the PostoPerative quality of life Problems of Patients have attracted much attention.The quality of life of patients mainly includes physiological factors,psychological factors and social functional factors.Self care of the patients is a key link to improving living quality.The results show that the ureteral skin stoma is lifelong existing,anxiety,depression and social dysfunction is the common phenomenon of these patients.These factors seriously influenced the quality life of patients with ureter skin stoma after discharge from hospitalFrom Routine Health Education Model to The Dual Track Interactive Health Belief Model(DTIHBM)in clinical Practice,The core concept of the health belief model is to strengthen the comprehensive interaction between patients and their care by combining the Patient’s track with the health belief model of the Patient’s interaction with their primary caregivers,In order to make up for the deficiency of the single Routine Health Education Model.At Present,there are clinical reports that the Dual Track Interactive Health Belief Model(DTIHBM)has a significant improvement effect on the living quality of diabetes patients and myocardial infarctione patients,but the amount of the dual track interactive health belief model(dtihbm)in living quality of the patients with ureteral skin stoma is less.ObjectiveTo explore the effect of dual-track interactive health belief model on the living quality of Patients with bladder cancer ureterocutaneous stoma.Analysis of the effect of the dual-track interactive health belief model on the Post-discharge living quality of patients with ureteral skin stoma,includes that the living quality of patients after 3 months and 6 months ureterostomy self-care ability of patients after 3 months and 6 months,postoperative mental state of patients after 3 months and 6 months and complications(including stoma-related complications and urinary tract infection)of patients after 3 months and 6 monthsMethods1.This study was using a convenient sampling method to select 100 Patients diagnosed with bladder cancer and ureterodermal ostomy in the Department of Urology,The First Affiliated HosPital of Zhengzhou University from APril 2017 to December 2018.The above Patients were divided into two-track interactive health belief model intervention group and routine health education control group according to the random number table method.2.In the control group,the routine health education model(oral or words)was used for living quality after ureterotomy;the intervention group combined with the dual-track interactive health belief model based on the routine health education model Patient track includes oral,words,picture,video that pushing microcourses cotents by differents stages,answering the questions in the wechart group,imparting knowledge by various education model that contains flipped classroon and so on.Family supporting system tract includes that using various education model and multiple ways for rehabilitation intervention For example,solution-focused approach methods mainly solving problems rather than finding essential reasons,assist with telephone-follow up,wechat,ostomy sodality and so on.3.For living quality intervention,all of the above Patients used a general demograPhic data questionnaire for bladder cancer ureterocutaneous stoma Patients and a questionnaire on the living quality of Patients after 3 months and 6 months of intervention using the conventional health belief model or the dual-Parameter interactive health belief model.Ureterostomy self-care Ability,PostoPerative mental state(SAS,SDS scale)and Post-intervention Patients comPlications(including stoma-related comPlications and urinary tract infection)were analyzed.Results1.Comparative analysis of general data and ostomy situation of the two groups of patients:A total of 100 patients were included in this study,the intervention group includes 50 patients,the number of male was 27 and he number of female was 23,the proportion of the male was 54%.The control group includes 50 patients,the number of male was 29 and he number of female was 21,the proportion of the male was 58%.The rates of married was higher in marriage status,the statistical analysis of the general demographic data questionnaire of the two groups of patients was no significant difference(P>0.05).Comparative analysis of the costing in ostomy nursing,there was 7 public expense patients in control group and the intervention group was 8,the others was private expense.2 patients only in the intervention group that discharge from the hospital 6months or so can not reexamine on time,because of the far distance to hospital and no complications.The number of re reexamine on time in the control group was gradually decreased following the time.2.Comparative analysis of general data of the two groups of primary caregivers:The proportion of the ralationship with patients,pair 52%,parents 4%,children 32%,brothers and sisters 12%in the intervention group.The proportion of the ralationship with patients,pair 56%,parents 6%,children 28%,brothers and sisters 10%in the control group.The proportion of the average daily care time,within 8 hours 24%,8-16hours 28%,above 16 hours 48%in the intervention group.The proportion of the average daily care time,within 8 hours 22%,8-16hours 32%,above 16 hours 46%in the control group.the statistical analysis of the general demographic data questionnaire of the two groups of patients primary caregivers was no significant difference(P>0.05).3.Analysis of the living quality effect of the two-group:Before discharging,the living quality of the intervention group scored 87.0±8.60,the control group scored 86.6±8.55,There was no significant difference(P>0.05).Discharge among 3months,the living quality of the intervention group scored 124.9±12.41,the control group scored 110.7±14.63,The intervention group were significantly better than the control group,the difference was statistically significant(P<0.001).Discharge among 6months,the living quality of the intervention group scored139.9±12.30,the control group scored 115.6±13.09,The intervention group were significantly better than the control group and the difference was significant(P<0.001).The time effect of living quality scored:Ftime=33.19,the difference was statistically significant(P<0.001),The grouping effect of living quality scored:Fgroup=7.29,the difference was significant(P<0.05),there was an interaction between time effect and grouping effect(P<0.05),The quality of life was improving gradually following time,The living quality of discharging among 6months was better than 3months,the difference was statistically significant(P<0.05).4.Analysis of ostomy self-protection ability in the two groups:90.3±4.42 in the Dual Track Interactive Health Belief Model group,89.9±6.38 in the control group,There was no significant difference(P>0.05),the ostomy self-protection ability of the intervention group scored 124.6±6.54.The self-protection ability in control group was 112.1 ± 15.44 among 3months after dicharging.The intervention group were significantly better than the control group and the difference was statistically significant(P<0.001).The ostomy self-protection ability of the intervention group scored 145.1±8.41,the self-protection ability in control group was 127.6±16.64 among 6months after dicharging.The intervention group were significantly better than the control group and the difference was statistically significant(P<0.001).The score was 42.91 in the time effect of ostomy self-protection ability,the difference was statistically significant(P<0.001),The score was 8.82 in grouping effect of ostomy self-protection ability,the difference was significant(P<0.05),there was an interaction between time effect and grouping effect(P<0.05),the score was 6.71.The four dimensions in ostomy self-protection ability was improving gradually following time,The self-protection ability of discharging among 6months was better than 3months,the difference was statistically significant(P<0.05).5.Comparative analysis of mental status(SAS,SDS scale)after intervention in the two groups:Before discharging,the intervention group was 81.91±4.15 and the control group was 82.31±5.17 for SAS,there was no significant difference(P>0.05).3 months post-discharing,anxiety self-rating scale(SAS)scores was 58.87±8.92 in the intervention group and the others was 69.91 ± 12.5,It was significantly better than before,and the intervention group was significantly better than the control group.6 months post-discharing,anxiety self-rating scale(SAS)scores was42.6±6.82 in the intervention group and the others was 60.4±13.95,It was significantly better than before,and the intervention group was significantly better than the control group.The score in the intervention group was normal.There was an interaction between time effect and grouping effect(P<0.05),The score was 6.03.The mental status was improving gradually following time.Before discharging,the intervention group was 78.41±5.35 and the control group was79.37±7.87 for SDS,there was no significant difference(P>0.05).3 months post-discharing,SDS scores was 53.8±9.24 in the intervention group and the others was 64.4±11.93,It was significantly better than before,and the intervention group was significantly better than the control group.6 months post-discharing,SDS scores was 45.2±11.in the intervention group and the others was 63.3±10.32,It was significantly better than before,and the intervention group was significantly better than the control group.The score in the intervention group was normal.There was an interaction between time effect and grouping effect(P<0.05),The score was 6.01.The mental status was improving gradually following time.6.Comparative analysis of the incidence of complications after intervention in the two groups:The postoperative follow-up records of the above patients showed that the clinically common complications were mainly stoma-related complications and urinary tract infections.The incidence of stenosis-related complications and urinary tract infection complications in the intervention group among 3 months and 6 months after discharging.were 10%、6%和 4%和 4%,respectively.The stoma-related complications and urinary tract infections in the control group at 3 and 6 months after discharging,the complication rates were 30%、20%和 18%和 18%,respectively.The follow-up results showed that the incidence of stoma-related complications and urinary tract infections in the intervention group were significantly lower than those in the control group at 3 and 6 months after discharging(P<0.05).Conclusions1.The dual-track interactive health belief model can significantly improve the postoperative living quality effect of patients,improve their postoperative daily life ability,and mobilize the enthusiasm and initiative of patients to participate in activities;2.The dual-track interactive health belief model can significantly enhance the postoperative ostomy self-health belief education ability,through the use of multi-channel and multi-modal comprehensive health education approaches.3.The dual-track interactive health belief model language is easy to understand,diverse in form,suitable for different Patients and is not restricted by geographical location,and can significantly imProve Patients.AccePtance and ParticiPation for relevant research and clinical aPPlications and shorten recovery time;4.The dual-track interactive health belief model can effectively reduce the incidence of PostoPerative anxiety and dePression in Patients;5.The dual-track interactive health belief model can effectively reduce the incidence of postoperative ostomy-related complications and urinary tract infection complications;... |
PDF Full Text Request