Study On Application Of Nursing Based On HBM And Orem Self-care Theory In The Rehabilitation Of Patients With Miles Enterostomy

Objective1.This paper proposes to understand the current situation of self-care ability and self-efficacy of enterostomy in patients with Miles operation at admission.2.To construct a health belief Model(HBM)model and Orem self-care theory of nursing program;.3.To observe the effect of the nursing program on the self-care ability and related self-efficacy of patients with miles'enterostomy.4.To explore the nursing methods to promote the self-care ability and related self-efficacy of patients with miles'enterostomy.Method1.This study is a kind of quasi-experimental study.From November 2018 to June 2019,60 patients who had Miles operation in a city's top three hospital were selected by convenience sampling method as the study objects,and numbered them according the time sequence of admission.Then divided them into the control group(n=30)and the intervention group(n=30)by random number table method.2.The control group was given routine nursing care of Miles operation,and the intervention group was given nursing based on HBM and Orem self-care theory on the basis of routine nursing.At the time of admission,WeChat group was set up and the manual"care for enterostomy"was distributed,which provided patients with the susceptibility and severity of enterostomy ostomy complications,the cognitive intervention of the benefits of changing their own behaviors and disorders,and the training of knowledge and skills related to stomatostomy nursing.during the period of hospitalization,evaluated the cognitive level of patients'self-health management dynamically,and given the targeted nursing intervention in combination with the nursing problems,self-care needs and self-care ability faced by patients at different stages.3.Evaluated the self-care ability and self-efficacy of enterostomy of the patient on the day of admission,1 day before operation,10 days after operation and the day of discharge by using the scale of enterostomy self-care ability and related self-efficacy.Nurses counted the time of postoperative self-care intention,the complications of enterostomy and the time of hospitalization.The score range of enterostomy self-care ability is 12-75points:<45 points mean low,45-59 points mean commonly,60-66 points mean relatively strong,?67 points means strong;The score range of enterostomy related self-efficacy was 28-140 points,<84 points mean low,84-110 points mean commonly,111-124 points mean relatively strong,and?125 points mean strong.4.SPSS 25.0 software was used for statistical analysis,X~2 test was used for counting data,t test was used for measuring data,and ANOVA was used for repeated measurement.Result1.There was no significant difference in gender,age and other basic information and health-related behaviors between the two groups(P>0.05).The equilibrium was well.2.The total average score of the enterostomy self-care ability of patients at admission:intervention group 42.27±3.732 and control group 41.77±3.402.There was no statistical difference(P>0.05).3.The total average score of the enterostomy self efficacy of patients at admission:intervention group 45.10±7.341 and control group 47.13±6.499.There was no statistical difference(P>0.05).4.The general average score of stoma self-care ability of the patients in the two groups at at admission,1 day before operation,10 days after operation and the day of discharge were:intervention group 42.27±3.732,54.30±3.261,58.17±2.842,65.47±2.849,controlgroup41.77±3.402,42.37±4.189,48.60±3.480,58.40±3.158.Am-ong,the total average score of self-care willingness on the day of discharge was43.87±2.374 in the intervention group and 40.60±2.787 in the control group;the total average score of self-care knowledge was 16.08±1.215 in the intervention group and 14.0±1.337 in the control group;the total average score of self-care skills were 4.80±0.610 in the intervention group and 3.73±0.640 in the control group.After the intervention,the total average score of enterostomy self-care ability and the total average score of all dimensions in the two groups increased gradually,and the total average score of enterostomy self-care ability and the total average score of all dimensions in the intervention group at all time points were higher than those in the control group,with significant statistical difference(P<0.01).At each time point,there was a significant statistical difference between the two groups in the total mean score of ostomy self-care ability(P<0.01).5.The total average score of stoma related self-efficacy of the two groups at at admission,1 day before operation,10 days after operation and the day of discharge were:intervention group 45.10±7.341,60.07±6.888,65.23±5.177,77.40±6.223,control group 47.13±6.499,48.27±6.502,55.93±4.495,65.20±3.699.Among,the total average score of self-care efficacy on the day of discharge was 43.57±4.761in the intervention group and 35.77±2.750 in the control group;the total average score of social efficacy was 17.33±2.139 in the intervention group and15.77±1.851 in the control group.The total average score of enterostomy related self-efficacy and enterostomy care efficacy of the two groups increased gradually,and the total average score of enterostomy related self-efficacy and enterostomy care efficacy of the intervention group at each time point was higher than that of the control group,with significant statistical difference(P<0.001).The total social efficacy of the two groups decreased at the day before surgery,and the total average score of social efficacy of the intervention group on the day of discharge was higher than that of the control group,with significant statistical difference(P<0.01).At each time point,there was a significant statistical difference between the two groups in the total mean score of self-efficacy(P<0.01).6.The generation time of self-care intention in two groups:the intervention group was postoperative 3.93±0.158 days,the control group was postoperative6.76±0.256 days,there was significant statistical difference(P<0.01).7.The average hospitalization time of the two groups:the intervention group was 18.83±2.679 day,control group was 20.96±2.658 days,there was significant statistical difference(P<0.01).8.The complications of stoma in the two groups were 1 case in the intervention group and 4 cases in the control group.There was no significant difference between the two groups(P>0.05).Conclusion1.At the time of admission,self-care intention of enterostomy in patients with Miles operation was strong,but they lacked knowledge related to enterostomy care,and their self-care skills and stoma related self-efficacy were both at a low level.2.The nursing based on HBM and Orem self care theory can improve the self-care willingness,knowledge and skills of patients with Miles'enterostomy,and the efficiency of enterostomy care,social interaction of patients with Miles.3.The nursing based on HBM and Orem self care theory can helps to reduce the risk of enterostomy complications.