| Objective:To construct a continuing nursing program for malnourished children based on Omaha system.To evaluate and intervene children with malnutrition in different periods after discharge and to evaluate the effect,based on the Omaha system of continuing nursing for malnourished children.Methods:1.Scheme formulation: Through reading a large number of literature and taking The Omaha system as the theoretical framework,the program of continuing nursing for malnourished children was preliminarily formulated,including evaluation forms,intervention measures and evaluation.And the Delphi expert consultation method was adopted to screen and modify the indicators and items,and the Omaha system based continuing nursing plan for malnourished children was finally formed.2.Scheme application: A total of 100 patients who were admitted to the pediatric inpatient ward and child care hospital in Fujian Province from January 2021 to May2021 were included.According to the random number table generated by statistical software SAS9.1,they were randomly divided into two groups: control group(50cases)and intervention group(50 cases).Both groups completed general data collection at admission and an Omaha system based evaluation of nursing issues during hospitalization.The control group was given routine pediatric malnutrition nursing,discharge guidance and outpatient follow-up.The intervention group implemented the Omaha system based continuing nursing program for malnourished children,and communicated with doctors,dietitians,children and their families to jointly develop nursing intervention plans according to the nutrition related nursing problems of patients during hospitalization and after discharge.The improvement effect of nursing problems was evaluated from cognition,behavior and condition.Omaha system score,subjective comprehensive evaluation and biological index evaluation were performed at discharge,1 month and 3 months after discharge.Epi Data3.1 software was used for data entry,SPSS 25.0 software was used for statistical analysis,measurement data were represented by (?) ±SD,measurement data of normal distribution was analyzed by independent sample T test,non-normal distribution was analyzed by rank sum test,and counting data were described by composition ratio(%).Result:1.A total of 100 subjects were included in this study,including 50 in the intervention group and 50 in the control group.The general conditions of children in the two groups were compared and analyzed.The results showed that:There were no significant differences in gender,age,region,per capita monthly income,role of caregiver,marital status of caregiver,occupational status of caregiver and education level of caregiver between the two groups(P>0.05).2.Based on the Omaha System continuing nursing plan for malnourished children:After two rounds of expert consultation,the continuing nursing evaluation table of malnourished children was finally determined,and the authority coefficient of the two rounds of consultation was 0.901 and 0.900,respectively.After the consultation of five experts,the corresponding intervention measures and effectiveness evaluation plan were formulated.Likert 5-level scoring method was used to score the nursing problems of children with malnutrition from cognition,behavior and status,and the scoring basis was proposed.3.Based on the Omaha system,the application effect of continuing nursing for malnourished children shows that: Malnourished children nursing problems involved in four areas,namely environmental,social psychology,physiology and health related behaviors,including 10 nursing problems: infections,digestion-hydration,the supervision of the defecation function,nutrition,health care,sleep and rest,housing,health,links with the community resources that occupy the home,nursing/parenting.There were no significant differences in cognition,behavior and status evaluation in 4areas at discharge between the two groups(P>0.05).(1)Environmental areas: The experimental group continued to improve sanitation problems(P<0.05).The cognitive score of home residence was improved(P<0.05).Behavior and condition scores were not significantly improved(P>0.05).(2)Social psychology areas: Nursing/parenting cognition,behavior and status scores were significantly improved in the experimental group,and the improvement effect was more obvious with the time of intervention(P<0.05),and improved cognitive scores for association with community resources(P<0.05).The improvement of behavior and condition scores needed to be strengthened,without statistical significance(P>0.05).(3)Physiology areas: In terms of infection status,digestion-hydration,and defecation function,cognitive,behavioral,and status scores continued to improve after intervention(P<0.05).Health related behaviors areas: In terms of nutrition,health care supervision,sleep and rest patterns,cognitive,behavioral,and status scores continued to improve with the prolongation of intervention time,and the differences were statistically significant(P<0.05).4.The improvement of nutritional status of the two groups after discharge showed that:(1)There was no significant difference in body mass index(BMI)at discharge between the experimental group(14.62±3.13)and the control group(14.04±2.63)(P>0.05).There were significant differences between the experimental group(15.96±4.10)and the control group(13.34±2.59)1 month after discharge,and between the experimental group(16.58±3.55)and the control group(13.91±2.71)3months after discharge(P<0.05).(2)There was no significant difference in hemoglobin at discharge between the experimental group(117.28±17.50)and the control group(115.84±20.41)(P>0.05).One month after discharge,the experimental group(115.34±12.46)was higher than the control group(107.5±14.98),with statistical significance(P<0.05).3 months after discharge,the experimental group(115.02±9.03)was higher than the control group(108.98±16.46),with statistical significance(P<0.05).(3)In terms of subjective overall evaluation(SGA),the nutritional status of the experimental group(grade A)accounted for 10% of the total at discharge,and that of the control group(grade A)accounted for 14% of the total.After the intervention,the nutritional status of the experimental group(grade A)was better(20%)than that of the control group one month after discharge,with statistical significance(P<0.05).3 months after discharge,the nutritional status of the experimental group(grade A)(50%)was significantly higher than that of the control group(grade A)(20%),with statistical significance(P<0.05).5.The rehospitalization rate of the two groups after discharge showed that: The rehospitalization rate of the experimental group(4%)was lower than that of the control group(10%)within 1 month after discharge,and was comparable(P<0.05).The rehospitalization rate within 3 months(10%)was significantly lower than that in the control group(24%)(P<0.05).Conclusion:1.The Omaha system-based continuing nursing for malnourished children provides a comprehensive assessment of post-discharge care.Individualized intervention programs were selected for children with malnutrition in terms of intervention mode and intervention orientation,which could effectively improve the evaluation of cognition,behavior and status of children with malnutrition in environmental field,psychosocial field,physiological field and health-related behavior field.2.The Omaha system-based continuing nursing can effectively improve the nutritional status of malnourished children and reduce the readmission rate,so it is recommended to be applied in clinical practice. |
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