| ObjectiveTaking Omaha system as the theoretical basis,the Evaluation Record Form of Continuous Nursing Evaluation and Intervention for Patients with breast cancer after surgery after discharge was established,analyzed the nursing problems of breast cancer patients after surgery,and used We Chat platform to implement standardized continuous nursing for breast cancer patients after surgery,to estimate the improvement of nursing problems after intervention,so as to explore this model’s influence on shoulder range of motion,quality of life,limb dysfunction,and functional exercise compliance for breast cancer patients.MethodAccording to the Omaha system theory,combined with the characteristics of breast cancer patients after surgery and the local residents’ living habits,through consulting relevant literature,discussion in the continuity nursing group,and expert meetings,finally made the Evaluation Record Form of Continuous Nursing Evaluation and Intervention for Patients with breast cancer after surgery after discharge based on Omaha system.Quasi-experiment were carried out:From December 2021 to September 2022,98 patients with breast cancer who underwent elective surgery in the breast tumor surgery department of a third-grade hospital in Inner Mongolia Autonomous Region were selected to be included in this study.According to the way of random number table,98 patients were randomly divided into control group and intervention group with49 patients each group.Patients in the control group were given routine discharge guidance and follow-up,while patients in the intervention group were given continuous nursing based on Omaha system.The improvement effect of the nursing problems of the patients in the intervention group one day before discharge was analyzed at 1 month and 3 months after surgery.At the same time,the shoulder range of motion,the Functional Assessment of Cancer TherapyBreast scale for breast cancer patients,and the scores of Disabilities of the Arm,Shoulder and Hand were measured before and 1 month and 3 months after surgery in both groups,and the scores of the breast cancer postoperative functional exercise compliance scale at 1 month and3 months after surgery to evaluate the rehabilitation effect.SPSS25.0 was used for data analysis,and P<0.05,the difference was statistically significant.The statistical method is as follows: the counting data is described with frequency and constituent ratio(rate),and the measurement data is described withX±S if it conforms to normal distribution,otherwise,it is described with median(interquartile spacing);t-test and rank sum test were used for inter-group comparison,and repeated measurement analysis of variance was used to evaluate the intervention effect at different time points.Results1.A total of 98 patients with breast cancer were included in this study,2 patients were lost to follow-up.The effective sample size was 96 cases,and the loss-of-follow rate was 2%.2.The general data of the two groups of patients were comparable without statistical difference(P>0.05).3.The nursing problems of patients in the intervention group one day before discharge were mainly distributed in the health-related behavior field(37.4%),followed by the physiological field(35%)and the psychosocial field(27.6%).The common nursing problems were: neuro-muscle-skeletal(83.3%),personal care(81.2%),pain(62.5%),mental health(47.9%),sleep and rest patterns(41.7%),role change(39.6%),and social interaction(35.4%).4.The improvement effect analysis of 7 nursing problems(incidence ≥30%)of patients in the intervention group one day before discharge showed that the scores of cognition,behavior and status of other nursing problems were statistically significant at different stages after surgery,except for social status(S)in the field of social psychological(P < 0.05).5.Intervention results of shoulder range of motion of patients in the two groups: there was no statistically significant difference in shoulder range of motion of patients in the two groups before surgery(P>0.05),which was comparable.There was significant difference in the shoulder range of motion between 1 month and 3 months after surgery(P<0.05).The shoulder range of motion in the intervention group was better than the control group.The repeated measurement analysis of variance showed that there was an interactive effect between shoulder range of motion and time in the two groups(P<0.05).6.Intervention results of quality of life of patients in the two groups: there was no statistically significant difference in the total score of quality of life and the scores of each dimension between the two groups before surgery(P>0.05),which was comparable.There were statistically significant differences in the total score of quality of life and scores of each dimension between the two groups 1 month and 3 months after surgery(P<0.05).The quality of life of patients in the intervention group was higher than the control group.The analysis of variance of repeated measurements showed that there was no interaction between the score of social/family status and time(P>0.05),but there was interaction between the total score of quality of life and other dimension scores of patients in both groups and time(P<0.05).7.Intervention results of Disabilities of the Arm,Shoulder and Hand of patients in the two groups: there was no statistically significant difference in the preoperative Disabilities of the Arm,Shoulder and Hand scores of patients in the two groups(P>0.05),which was comparable.There was significant difference in the scores of Disabilities of the Arm,Shoulder and Hand between the two groups 1 month and 3 months after surgery(P<0.05),and the scores of Disabilities of the Arm,Shoulder and Hand in the intervention group were lower than those in the control group.The analysis of variance of repeated measurements showed that there was an interactive effect between the score of Disabilities of the Arm,Shoulder and Hand and time in the two groups(P<0.05).8.Intervention results of functional exercise compliance of patients in the two groups: At1 month and 3 months after operation,the total compliance of functional exercise,physical exercise compliance,and compliance of postoperative precautions were significantly different between the two groups(P<0.05),and the functional exercise compliance of patients in the intervention group was higher than that of the control group.At 3 months after surgery,there was no statistically significant difference in the two groups in the compliance of patients seeking advice actively(P>0.05).ConclusionThe continuous nursing based on Omaha system can comprehensively assess the nursing problems of breast cancer patients after surgery,provide standard rehabilitation guidance for breast cancer patients after surgery,promote the improvement of their Knowledge,Behavior and Status scores of major nursing problems,and at the same time can effectively improve the patients’ shoulder range of motion,quality of life,improve Disabilities of the Arm,Shoulder and Hand,improve functional exercise compliance,thus improving the postoperative rehabilitation effect of breast cancer patients. |
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