Construction Of Home Nutrition Management Program For Postoperative Patients With Gastric Cancer

Research Purpose:To establish a set of scientific and standardized postoperative home nutrition management program for gastric cancer patients,clarify the specific process and intervention measures of nutritional rehabilitation after discharge,so as to improve the nutritional status of patients,thereby promoting disease recovery and improving the quality of life.At the same time,it provides evidence-based reference for clinical nurses to manage nutrition out of hospital.Research Methods:Literature research and evidence-based methodology were used to comprehensively search domestic and foreign clinical practice guidelines and Chinese and English databases.Relevant literatures on home nutrition management after gastric cancer surgery were screened according to the admission criteria.Quality evaluation was carried out by JBI Evidence-based Health Care Center（2016）evaluation tool and Johns Hopkins Guide-Quality Assessment tool.At the same time,JBI2014 evidence pre-grading system was used for evidence rating,and finally,a preliminary plan was drawn up through evidence extraction and summary and subject group discussion.Qualitative research was used to conduct group interviews with gastric cancer patients and their family members respectively,to deeply analyze the real experience of postoperative home diet change and extract the theme of interview data,so as to obtain relevant measures of nutrition management,so as to supplement and improve the items in the initial draft plan.Delphi method was adopted to select 20 clinical experts from provincial general hospitals to carry out two rounds of letter consultation.According to the statistical values and expert opinions of each item,the project group adjusted and revised the preliminary draft after consultation and formed the final plan.Research Results:42 Chinese and English literatures were included in this study,including 3 systematic evaluations,20 RCTS,4 category experiments,3 observational studies,1 qualitative study,7evidence-based guidelines and 4 expert consensus,of which 10 were Grade A literatures and 32 were Grade B literatures.The group interview was divided into patient group and family group.According to the interview data,three themes and eight subcategories were extracted.The positive coefficients of the two rounds of expert consultation were 100%,the authority coefficients were0.825 and 0.858,the Kendall harmony coefficients were 0.135-0.267（P < 0.01）,the importance and operability coefficients of items in the first round were 0.06-0.38 and 0.09-0.35,respectively.The importance and operability coefficients of items in the second round were0.09-0.24 and 0.06-0.21,respectively.Finally,a home-based nutrition management program after gastric cancer surgery was formed,including 7 first-level items,18 second-level items and 64third-level items.Research Conclusion:Based on evidence-based nursing and Delphi method and supplemented by group interview,this study constructed a home-based nutrition management program for postoperative gastric cancer patients.The program is standardized and rigorous in the construction steps,scientific and reliable in methodology,and based on the needs of patients,comprehensive and specific,close to the clinical,with certain pertinence and feasibility,which can provide reference for nursing work.