Construction And Application Of Transitional Care Program For Orthopedic Patients With High Risk Of VTE Based On BCW Theory

Objective1.To understand the the promotion and obstacle factors of the venous thromboembolism(VTE)prevention in orthopedic patients with high risk of VTE in the transitional period,and to construct a transitional care program for orthopedic patients with high risk of VTE based on the theory of behavior change wheel(BCW).2.To explore the impact of this intervention program on patients’ VTE cognitive level,self-efficacy,prevention experience and incidence of VTE.The aim is to provide theoretical basis for the management of orthopedic patients with high risk of VTE during the transition period.Methods1.A research group was set up to review relevant literature.Based on the BCW theory,the core layer-capability,opportunity,motivation-behavior(COM-B)model was applied.The theoretical domains framework(TDF)of the model was used to construct an interview outline for orthopedic patients with high risk of VTE,and semi-structured interviews were conducted to analyze the promotion and hindrance factors of VTE prevention in orthopedic patients with high risk of VTE during the transitional period.Combined with the nine intervention functions in the BCW theory,the transitional care program for orthopedic patients with high risk of VTE was initially constructed.2.18 experts were invited to conduct two rounds of expert letter consultation to evaluate and revise the draft intervention.Combined with the opinions of the pre-trial patients,the research team formed the transitional nursing intervention program for orthopedic patients with high risk of VTE based on BCW theory.3.According to the inclusion and exclusion criteria,144 patients with high-risk VTE after orthopedic surgery in a tertiary grade A hospital in Qingdao from February 2022 to August 2022 were selected and divided into 2 groups according to the time of admission.Seventy-two hospitalized patients from February 2022 to April 2022 were selected as the control group,which adopted conventional nursing program.A total of 72 hospitalized patients from June 2022 to August 2022 were selected as the intervention group,which adopted transitional nursing program based on BCW.The differences in VTE prevention knowledge,self-efficacy,social support,anxiety and VTE incidence were compared between the two groups.SPSS 26.0 software was used for statistical analysis.Statistical methods such as independent sample t-test,paired t-test,chi square test,repeated measure of variance analysis,and fisher exact test were used to evaluate the application effect transitional nursing intervention program based on BCW for orthopedic patients with high risk of VTE.Results1.Semi-structured interview results based on COM-B model and TDF.In this study,15 patients were interviewed,and it was found that the COM-B model was related to 8 domains of the TDF,and 15 themes and 30 sub-themes were extracted,including 11 promotion factors and 19 obstacle factors.2.A transitional nursing intervention plan for orthopedic patients with high risk of VTE was constructed.In the two rounds of Delphi experts’ consultation,the positive coefficients of experts were 90% and 100% respectively.The authority coefficients of expert were 0.87 and 0.89.Kendall’s W of the two rounds of expert letter consultation were 0.318 and 0.323,respectively,with statistically significant differences(P<0.05).An transitional nursing intervention program including 4 intervention objectives,16 intervention items and 41 specific contents was finally established.3.Implement BCW based transitional nursing intervention program for orthopedic patients with high risk of VTE.(1)A total of 134 patients were included in the final study,including 67 in the control group and 67 in the intervention group.There were no statistically significant differences in VTE prevention knowledge,self-efficacy,social support,anxiety scores between the two groups before discharge(P>0.05),indicating comparability.(2)The incidence of VTE in the intervention group was 0%,which was lower than that in the control group(8.96%)(P<0.05).(3)At 1 month after discharge,the VTE prevention knowledge scores in the intervention group was higher than that in the control group,the difference was statistically significant(P<0.05).The VTE prevention knowledge scores in both groups at1 months after discharge was higher than that before discharge(P<0.05).(3)The inter-group effect,time effect,and interaction effect of self-efficacy scores in the two groups at different time points were statistically significant(P<0.05).The self-efficacy scores of the intervention group were higher than those of the control group at 1 and 3 months after discharge(P<0.05).Self-efficacy scores in both groups were higher at 1 and 3 months after discharge than before discharge(P<0.05),and higher at 3months after discharge than at 1 month after discharge(P<0.05).(4)The inter-group effect,time effect,and interaction effect of social support scores in the two groups at different time points were statistically significant(P<0.05).At 1 and3 months after discharge,the scores of social support in intervention patients were higher than those in control group(P<0.05).There was no significant difference in the scores of social support in the intervention group 1 month after discharge and before discharge(P> 0.05),and the scores of social support in the intervention group 3 months after discharge were lower than that 1 month after discharge(P<0.05).In the control group,the scores of social support 1 and 3 months after surgery were lower than those before discharge(P<0.05),and the scores of social support 3 months after discharge were lower than those 1 month after discharge(P<0.05).(5)The inter-group effect,time effect,and interaction effect of anxiety scores in the two groups at different time points were statistically significant(P<0.05).At 1 months after discharge,the scores of anxiety in intervention patients were lower than those in control group(P<0.05).At 3 months after discharge,there was no significant difference in anxiety scores between the two groups(P>0.05).The anxiety scores in both groups were lower at 1 and 3 months after discharge than before discharge(P<0.05),and lower at3 months after discharge than at 1 month after discharge(P<0.05).ConclusionThis research constructed a transitional nursing intervention program for orthopedic patients with high risk of VTE based on BCW theory,including forming ability,strengthening ability,creating opportunities and motivating.The scheme is scientific,reliable and practical.This program can improve the cognitive level of VTE,self-efficacy and social support,improve patients’ anxiety and reduce the incidence of VTE in orthopedic patients at high risk of VTE.