Application Of Continuous Nursing Based On "Timing It Right" In Patients With Drug-Resistant Pulmonary Tuberculosis

ObjectiveTo explore the illness experience of drug-resistant pulmonary tuberculosis patients at different times of the disease and analyze its dynamic changes;to explore the influence of continuous nursing based on“Timing It Right” on medication compliance,psychological distress,social support level and treatment effect of drug-resistant tuberculosis patients,so as to provide reference for improving intervention plan of drug-resistant tuberculosis patients.Methods1.Phenomenological methods were used to select drug-resistant tuberculosis patients who were admitted to the drug-resistant tuberculosis department of a tertiary general hospital in Changsha from August 2019 to January 2020 and received anti-tuberculosis treatment as the research objects.The “Timing It Right” was used as the framework,we conducted targeted sampling according to the initial treatment and retreatment stratification.Semi-structured in-depth interviews were used to collect the true feelings of 46 patients with drug-resistant tuberculosis in 5 different disease times,and the data was analyzed by the Colaizzi analysis method to understand the illness experience of patients with drug-resistant tuberculosis at different times of the disease,and thus formulate a continuous nursing intervention plan for drug-resistant tuberculosis patients based on the “Timing It Right”.2.Using similar experimental research methods,we selected 80 patients with drug-resistant tuberculosis who met the inclusion criteria in the drug-resistant tuberculosis department of a general hospital in Chang Sha City,according to the order of admission,80 patients with drug-resistant pulmonary tuberculosis were included in the intervention group(n=40)and the control group(n=40)through the random number table method.The patients in control group were received with traditional care,and the drug-resistant pulmonary tuberculosis patients in the intervention group were received 6 months of continuous nursing intervention based on the “Timing It Right”.medication compliance,social support level,and psychological distress of drug-resistant pulmonary tuberculosis patients were assessed before intervention,at the end of 3 months after discharge,and at the end of 6 months after discharge,and the sputum conversion rate and the lesion absorption rate were compared between the two groups before and after the intervention.3.All data should be established with SPSS25.0 software and statistically processed.Descriptive statistics were used for the general data of patients.The two independent sample t-tests was used to compare the scores of medication compliance,social support,and psychological distress of the two groups at the same time point.The comparison of the social support scores and psychological distress scores of the two groups at each time point was performed by repeated measures ANOVA.Chi-square test was used for comparison of sputum conversion rate between groups,and rank-sum test was used for comparison of absorption effects of different lesions between groups.Results1.The “Timing It Right” was used as the framework,summarized the illness experience of 5 different disease times:(1)Diagnosis period:severe negative emotions,including(1)anger and worry;(2)regret and guilt;(3)anxiety and fear;(4)depression and disappointment.(2)Hospitalization period: different treatment attitudes,including(1)cooperate actively and try to solve difficulties;(2)cope negatively and lack relevant treatment knowledge.(3)Discharge preparation period:worry about helplessness,including(1)worry about home treatment and prognosis;(2)longing for the support of medical staff.(4)Adjustment period: Coping with difficulties,including(1)suffering from discrimination;(2)insufficient social support;(3)lack of awareness of disease management;(4)impact on work and life.(5)Adaptation period:multiple psychological and needs,including(1)worry about side effects of drugs;(2)worry about treatment costs;(3)worry about the future;(4)need for treatment knowledge.2.The data was collected in this study were 38 patients in the intervention group and 37 patients in the control group.The lost to follow-up rate was 6.25%.3.Before the intervention,there was no statistically significant difference in the general information,social support level score,and psychological distress score of the two groups of drug-resistant pulmonary tuberculosis patients(P>0.05).4.At the end of 3 months after discharge,there was no statistically difference in medication compliance scores between the two groups of drug-resistant tuberculosis patients(P>0.05);at the end of 6 months,the scores of drug-resistant tuberculosis patients in the intervention group(7.18±0.86)were higher than those in the control group(5.01±1.39)(P<0.05).5.At the end of 3 months after discharge,the total social support score and subjective support dimension scores of drug-resistant pulmonary tuberculosis patients in the intervention group were higher than those in the control group(P<0.05),and the others had no significant changes;At the end of 6 months after discharge,in addition to the utilization of social support,the total scores of social support and the scores of all dimensions of drug-resistant pulmonary tuberculosis patients in the intervention group increased,and were higher than those in the control group(P<0.05).The repeated measures ANOVA showed that the total scores of social support and the scores of various dimensions of the two groups of drug-resistant pulmonary tuberculosis patients were significantly different in time effect(P<0.05);The total scores of social support and the scores of subjective support dimensions of the two groups of drug-resistant pulmonary tuberculosis patients were significantly different in the inter-group effect,time and inter-group interaction effect(P<0.05).6.At the end of 3 months after discharge,there was no significant difference in the psychological distress score between the two groups of drug-resistant tuberculosis patients(P>0.05);at the end of 6 months after discharge,the psychological distress score(15.87±4.19)of the drug-resistant tuberculosis patients in the intervention group was lower than that in the control group.(20.57±4.78)(P<0.05).The repeated measures ANOVA showed that the psychological distress scores of the two groups of drug-resistant pulmonary tuberculosis patients were significantly different in time,inter-group effects,and the interaction effects between the two(P<0.05).7.At the end of 3 months after discharge,there was no significant difference in the sputum conversion rate between the two groups of drug-resistant pulmonary tuberculosis patients(P>0.05);at the end of 6months,the sputum conversion rate of the drug-resistant pulmonary tuberculosis patients in the intervention group(78.95%)was significantly higher than that in the control group(56.76%)(P<0.05).8.At the end of 6 months after discharge,there was a significant difference in the absorption effect of the two groups of drug-resistant tuberculosis patients(P<0.05);and the absorption rate of the drug-resistant tuberculosis patients in the intervention group(78.95%)was better than that of the control group(54.06%)(P <0.05).Conclusions1.The illness experience of drug-resistant pulmonary tuberculosis patients at different times of the disease is dynamically changing,and medical workers should provide specific support and assistance at different stages according to the patients’ different illness experiences.2.Continuous nursing based on the “Timing It Right” can improve the medication compliance and social support level of drug-resistant tuberculosis patients,improve their psychological distress and treatment effects,and help them return to family and society smoothly.