Application Of Discharge Planning Based On Individual And Family Self-Management Theory In Patients With Preventive Enterostomy

ObjectiveTo investigate the current situation of self-management of preventive enterostomy patients,and to analyze the context factors affecting self-management of preventive enterostomy patients according to Individual and Family Self-Management Theory(IFSMT).To construct a discharge plan for patients with preventive enterostomy based on Individual and Family Self-Management Theory and to explore the effect of the discharge plan on readiness for hospital discharge,self-management level,self-efficacy and quality of life of patients with preventive enterostomy,in order to provide reference basis for clinical practice of improving readiness for hospital discharge level,self-management level and quality of life of patients with preventive enterostomy.Methods1.Analysis of self-management status and context factors of patients with preventive enterostomy based on Individual and Family Self-Management TheoryUsing the method of convenient sampling,266 patients who underwent preventive enterostomy for the first time in Department of Gastroenterology Surgey of a tertiary Class A hospital in Qingdao from June to December 2019 were selected as subjects.The patients were investigated with self-designed general information questionnaire,Chinese version Readiness for Hospital Discharge Scale and enterostomy patient self-management questionnaire.To analyze the current situation of self-management of patients with preventive enterostomy and the context factors affecting patients’ self-management.2.Construction of preventive enterostomy patient discharge plan based on Individual and Family Self-Management TheoryOn the basis of literature review and preliminary investigation,a preliminary draft of discharge plan for patients with preventive enterostomy based on Individual and Family Self-Management Theory was formed.Medical experts in the field of stoma were invited to carry out expert group meetings and select patients for pre-experiment.Combined with the opinions given by experts and the problems found in the pre-experiment,the final draft of discharge plan for patients with preventive enterostomy based on Individual and Family Self-Management Theory was finally formed.3.Application of discharge plan based on Individual and Family Self-Management Theory in patients with preventive enterostomyUsing the method of convenient sampling,a total of 69 patients who underwent preventive enterostomy in the Department of Gastroenterology Surgey of a tertiary Class A hospital in Qingdao from December 2019 to May 2020 were selected.The patients admitted from December 2019 to January 2020 were selected as the control group,and the patients admitted from February 2020 to may 2020 were selected as the intervention group.The control group was given routine nursing,and the intervention group was given the discharge plan based on Individual and Family Self-Management Theory.Baseline data were collected before intervention.The data of readiness for discharge were collected1 day before discharge,and the data of self-management level,self-efficacy and quality of life were collected 1 day before discharge,1 month after discharge and 3 months after discharge.Using SPSS 23.0 software,chi square test,independent sample t test,rank sum test,repeated measurement analysis of variance and other statistical methods to analyze the application effect of discharge plan based on Individual and Family Self-Management Theory in patients with preventive enterostomy.Results1.Analysis of self-management context factors of patients with preventive enterostomy based on Individual and Family Self-Management TheoryThe self-management score of patients with preventive enterostomy was(102.22±17.56),which belonged to the middle level.Single factors analysis showed that TNM stage,whether the patients have received radiotherapy and chemotherapy,whether they have stoma related complications had influence on patients’ self-management(all P<0.05);Pearson correlation analysis showed that there was a positive correlation between readiness for hospital discharge and self-management(P<0.05).Multiple linear regression analysis showed that whether the patients have received radiotherapy and chemotherapy,whether they have stoma related complications and readiness for hospital discharge were context factors affecting the self-management level of patients with preventive enterostomy,which could explain 30% of the total variance.2.Construction of preventive enterostomy patient discharge plan based on Individual and Family Self-Management TheoryOn the basis of literature review,expert group meetings and pre-experiment,the discharge plan for patients with preventive enterostomy based on Individual and Family Self-Management Theory was determined.The final draft included Knowledge &Belief,Self-Regulation(Goal Setting,Planning &action,Self-evaluation,Emotional control)and Social Facilitation.3.Evaluation of the application effect of discharge planning based on Individual and Family Self-Management Theory in patients with preventive enterostomy(1)The total score of discharge readiness and the scores of each dimension in the intervention group were significantly higher than those in the control group(P<0.001).(2)After intervention,the time effect,intergroup effect and interaction effect of self-management total score and each dimension score of the two groups after intervention were statistically significant(P<0.05),and the self-management total score and each dimension score of the intervention group were significantly higher than those of the control group 1 day before discharge,1 month after discharge and 3 months after discharge(P< 0.05).(3)In addition to the two items of confidence in and satisfaction with sexual life,the total scores of self-efficacy,other dimensions and items in the intervention group 1 day before discharge,1 month after discharge and 3 months after discharge were significantly higher than those in the control group(P<0.05).(4)After intervention,the time effect,intergroup effect and interaction effect of the total score of quality of life and the scores of each dimension in the two groups were statistically significant(P<0.05).Except for the physiological dimension,the total score of quality of life and the scores of each dimension in the intervention group 1 day before discharge,1 month after discharge and 3 months after discharge were significantly higher than those in the control group(P<0.05).Conclusions1.The self-management level of patients with preventive enterostomy is at a medium level.Based on Individual and Family Self-management Theory analysis,whether the patients have received radiotherapy and chemotherapy,whether they have stoma related complications,and the level of readiness for hospital discharge are important context’s factors affecting the self-management level of patients with preventive enterostomy.2.The discharge plan for patients with preventive enterostomy based on Individual and Family Self-Management Theory was constructed.The discharge plan was applied to clinical practice,which improved treadiness for hospital discharge level and self-management level of patients with preventive enterostomy,enhanced the self-efficacy of patients and improved the quality of life of patients.