Construction Of Multidisciplinary Collaborative Nutrition Management Scheme For Pregnant Women With Gestational Diabetes Based On Triangle Hierarchical Management Model

Objective1.To understand and analyze the nutritional management needs and problems of pregnant women with gestational diabetes and the status quo of multidisciplinary nutrition management and obstacles.2.Based on Triangle’s hierarchical management model,a multidisciplinary collaborative nutrition management scheme for pregnant women with diabetes in pregnancy was constructed to provide reference for clinical medical staff to carry out multidisciplinary collaborative nutrition management for pregnant women with diabetes in pregnancy.Methods1.Qualitative interview method: To understand the nutritional management needs and problems of patients with gestational diabetes,the status quo of multidisciplinary nutrition management and obstacles.Using phenomenological research method,semistructured interviews were conducted with 17 pregnant women with gestational diabetes from a tertiary general hospital in Anhui Province and 16 clinical medical staff from the obstetrics department,endocrinology department and nutrition department from four tertiary general hospitals in Anhui Province.2.literature study: Based on the analysis of relevant literature at home and abroad,and the Triangle hierarchical management model as the theoretical basis,combined with the results of qualitative interviews in the early stage,a multidisciplinary collaborative nutrition management program for pregnant women with diabetes during pregnancy based on Triangle hierarchical management model was initially formulated.3.Expert correspondence method: Through two rounds of Delphi expert consultation,the expert opinions were summarized,and the corresponding items were deleted and revised,finally forming the final draft of multidisciplinary collaborative nutrition management scheme for pregnant women with diabetes in pregnancy based on Triangle hierarchical management model.Results1.Qualitative interviews: Through the interview of 17 pregnant women with GDM,the nutritional management needs of pregnant women with GDM were refined into three themes: the learning needs of GDM nutrition related knowledge and skills,the needs for professional nutritional guidance,and the needs for social support.Through the interview of 16 medical staff,five themes of the current situation and obstacles of multidisciplinary nutrition management were extracted:multidisciplinary collaborative nutrition management is important and necessary;Obstetrics,internal medicine,and nutrition departments are the basic organizational structures;the nutritional literacy of medical and nursing personnel needs to be improved;there is currently a lack of a multidisciplinary collaborative platform;the responsibilities of multidisciplinary personnel are unclear.Based on interview of both parties,four topics were extracted about the problems in nutrition management for pregnant women with GDM,including insufficient awareness of the importance and benefits of nutrition management among some pregnant women with GDM,difficulty in obtaining specialized nutrition information,difficulty in implementing nutrition recipes,and misleading incorrect information.2.Literature research: A total of 26 articles were included,including 11 evidencebased guidelines,1 expert consensus,2 evidence summaries,5 systematic evaluations,5 randomized controlled trials,and 2 reviews.Extract content around the structure and responsibilities of multidisciplinary collaborative personnel,GDM nutrition assessment,nutrition monitoring,nutrition education,nutrition follow-up,pregnancy health care,blood glucose monitoring,and form 72 potential application items of the program.3.Expert correspondence: A total of 16 experts participated in the inquiry.The questionnaire recovery rate for the first round of expert correspondence was 100%,the expert authority coefficient was 0.878,and the Kendall coordination coefficient was 0.143;The questionnaire recovery rate for the second round of expert correspondence was 93.75%,the expert authority coefficient was 0.878,and the Kendall coordination coefficient was 0.121.After two rounds of expert consultation and revision,the finally constructed multidisciplinary collaborative nutrition management plan for pregnant women with diabetes mellitus based on Triangle hierarchical management model includes two parts: organizational structure and plan implementation.The organizational structure includes the site conditions,team members,personnel responsibilities,team training,and information sharing and communication platform for multidisciplinary cooperation required for plan implementation.The content of the scheme implementation is hierarchical standards and hierarchical management measures(79 items in total,including 11 items at the first level,48 items at the second level,and 20 items at the third level).Conclusion1.GDM pregnant women have a high demand for nutrition management,but the current status of nutrition management is bad and there are many problems.Multidisciplinary nutrition management faces many obstacles and poor practice.2.The multi-disciplinary collaborative nutrition management plan for pregnant women with diabetes in pregnancy based on Triangle hierarchical management model,including organizational structure and plan implementation,covers nutrition assessment,nutrition monitoring,nutrition education,nutrition follow-up,pregnancy health care,blood glucose monitoring and other aspects,which is comprehensive.The plan can provide reference for multi-disciplinary collaborative nutrition management for pregnant women with diabetes in pregnancy.