| Objective:1.Collect and summarize the best evidence of clinical nursing services among patients with enterostomy.2.Describe the needs of discharge planningin elderly colorectal cancer patients with colostomy.3.Based on the “Theory of Goal Attainment”,combined with the best clinical evidence and patient’s needs,construct the discharge planning for elderly colorectal cancer patients with colostomy.4.Verify the effectiveness of the discharge planning for elderly colorectal cancer patients with colostomy.Methods:1.Evidence synthesisThe literatures related to patient care services of enterostomy published from January 2010 to February2021 were searched systematically.To integrate the best clinical evidence,then the evidence graded and recommended intensity was divided,finally forming the best evidence summary of enterostomy patient care services.2.Describe the needs of patientsPhenomenological analysis was used for this qualitative research,a semi-structured in-depth interview was conducted among elderly colorectal cancer patients with colostomy to explored their needs of discharge planning,in a 3A hospital in Henan Province.From April 2021 to May 2021.3.Scheme constructionBased on the “Theory of Goal Attainment”,combined with the best clinical evidence of care services among patients with enterostomyand the analysis results of patient’s needs,construct the first draft of discharge planning for elderly colorectal cancer patients with colostomy.And the final draft of the intervention scheme was formed after expert consultation and preliminary experiment.4.Empirical researchEighty patients who met the inclusion and exclusion criteria in a 3A hospital in Henan Province were selected as the study objects.Control group,40 patients received routine nursing while the intervention group,40 patients were implemented the discharge planning based on the theory of goal attainment for elderly colorectal cancer patients with colostomy.At discharge,the discharge readiness,patient engagement degree,discharge guidance quality of the two groups were compared,and the incidence of ostomy-related complications at discharge,the 4th and 12 th week after surgery were compared between the two groups.Results:1.Evidence synthesis resultsRetrieval,screening and analysis of literatures related to enterostomy patient care services.Finally,10 articles were included,including 6 guidelines,2 best practice of clinical,1 expert consensus and 1 evidence summary.By summarizing the evidence,27 recommendations were finally obtained,of which 25 were Alevel recommendations and 2 were B-level recommendations.2.Outcome of patient needs15 patients reached data saturation,and interview recordings were transcribed verbatim,repeatedly classified,collected and summarized.Ten conceptually similar themes were eventually produced.Then the10 themes were analyzed and classified into fourthemes: need for disease knowledge,need for discharge guidance skills,need for participate,need for emotional and social support.3.Scheme construction resultsThe implementation process of the discharge planning include interactive evaluation,nurses and patients work together to set targets,carry out interactive measure for the targets and the effect evaluation.The contents of discharge planning include disease knowledge reserve,psychological adjustment,postoperative physiological and daily life adjustment,ostomy management,prevention and recognition of ostomy-related complications,social resource acquisition,return visit,etc.4.Empirical research results⑴Shedding of the research objects40 patients were selected to be the control group and 2 patients for in a critical condition and transferred to ICU after surgery were shed.In the intervention group,40 patients were selected,1 patients were shed for asked to quit due to personal matters.Finally,77 subjects were included in this study,38 in the control group,and 39 in the intervention group.In the follow-up phase: at the 12 th week after surgery,in the control group,1 patient died and 2 patients could not be contacted were shed;in the intervention group,one patient could not be contacted were shed.Finally,there were 35 in the control group and 38 in the intervention group at the 12 th week after surgery.⑵Before the interventionThe general data,health care participation scores were compared between the two groups,the results showed no statistical significance(P > 0.05)and were comparable.(3)After the intervention(1)On the day of discharge,the total score of discharge readiness in the intervention group was higher than that in the control group,and the difference was statistically significant(P<0.001).The score analysis of each dimension showed that the scores of each dimension in the intervention group were higher than those in the control group,but only the dimensions of disease knowledge and coping ability were statistically significant(P<0.001,P=0.006),while thedimensions of personal status and expected support were not statistically significant(P=0.248,P=0.095).(2)At discharge,the total score of health care participation in the intervention group was higher than that the control group and the difference was statistically significant(P=0.003).The scores of each dimension showed that the dimensions of participate in information interaction and treatment care in the intervention group were higher than those in the control group,and the differences were statistically significant(P < 0.001,P < 0.001).However,there were no significant differences in the dimensions of participatein medical decision-making,diagnosis and treatment decision-making,consultation and monitoring,and appeals between the intervention group and the control group(P=0.972,P=0.295,P =0.880,P=0.454).(3)At discharge,the total score and scores of all dimensions of discharge guidance quality in the intervention group were higher than those in the control group,and the differences were statistically significant(P < 0.05);(4)The incidence of ostomy-related complications at discharge,the 4th and 12 th week after surgery were compared between the two groups.The results showed that there was no significant difference in the incidence of complications between the two groups at discharge and the 12 th week after operation(P=0.615,P=0.313).But the incidence of ostomy-related complications in the intervention group was lower than that in the control group at the 4th week after surgery,and the difference was statistically significant(P=0.029).Conclusion:1.The evidence of clinical care for patients with enterostomy is sufficient and comprehensive,however,due to the national conditions and cultural differences between China and the countries where the guidelines are issued,the clinical adaptability of recommended needs to be considered.2.The needs of discharge planning among elderly colorectal cancer patients with colostomy have not been fully met.Clinical nursing staff should make discharge planning according to the needs of patients to meet the personalized needs of elderly patients.3.The discharge planning was constructed based on the summary of best clinical evidence,patients’ needs and the “Theory of Goal Attainment”.Which makes the the intervention content comprehensive,intervention process clear and feasible,and the initiative of patients was fully stimulated.4.The discharge planningbased on the “Theory of Goal Attainment” for elderly colorectal cancer patients with colostomy can improve discharge readiness degree,engagement degree of elderly patients with enterostomy,andimprove the discharge guidance quality of clinical nursing staff,can also reduce the incidence of ostomy-related complications in early discharge stage,can provide reference for clinical practice. |
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