| ObjectiveThe aim of this study was to construct a family empowerment discharge program intervention for elderly stroke patients with disability,and to investigate the effect of the intervention program on self-efficacy,family functioning,stroke control knowledge and quality of life of elderly stroke patients with disability,and to provide a valuable reference and basis for clinical health care professionals to conduct related intervention studies.MethodsThis study consists of two parts1.The construction of a discharge planning intervention program based on family empowerment theory.Based on the literature research method,the relevant literature that meets the inclusion criteria was summarized and collated,and combined with the national guidelines and norms related to stroke rehabilitation and treatment,the subject group was established for discussion,and the Delphi method was used to select 15 experts in neurology-related fields for 2 rounds of correspondence,and 5 elderly stroke patients with disability and family caregivers for pre-experimentation to modify and improve the intervention program.The final draft of the intervention protocol was determined.2.Application of a discharge planning intervention program based on family empowerment theory.Using the convenience sampling method,elderly stroke patients with disability who met the study criteria in the first and second wards of the neurology department of a tertiary care general hospital in a city were selected as study subjects,and the two wards were randomly divided into an intervention group and a control group using a simple randomization method,with 43 participants in each group.The control group received routine care and health education in the neurology department during hospitalization and received two regular telephone follow-up visits after discharge.The intervention group implemented a discharge planning intervention program based on family empowerment theory on this basis.The Chinese version of the Stroke Rehabilitation Self-Efficacy Scale,the Family assessment device(FAD)the Stroke Prevention and Control Knowledge Questionnaire,and the Stroke Specific Quality of Life(SS-QOL)scale were used to evaluate the application of the intervention program immediately,one month,and three months after the intervention.The data collected were statistically analyzed using IBM SPSS 26.0 statistical software for descriptive analysis,chi-square test,t-test,rank-sum test,repeated measures ANOVA,and generalized estimating equations(GEE),P-value<0.05 were considered significant.Results1.A systematic search of Chinese and English literature related to family empowerment theory and discharge planning was conducted from January 2010 to July 2021.The literature was summarized in terms of“author,year,study population,study purpose,sample size,intervention form,intervention method,outcome indicators,study results,and study conclusions”,and 17 interventions that met the study criteria were finally selected.Through the discussion and analysis of the subject group,the two rounds of Delphi expert correspondence were 83.33%and 100%positive;the two rounds of expert correspondence authority coefficient were 0.870 and 0.890;the two rounds of expert correspondence Kendall cofficient of concordance(Kendall’s W)were 0.363 and 0.405(P<0.05),To finalize the administration draft of the discharge planning program based on family empowerment theory.2.A total of 92 elderly stroke with disability patients were included,with 6 patients were loss for follow up.Therefore,the mean age of the 43 patients the intervention group was(69.63±7.79)years,and 43 patients in the control group,with the mean age(70.81±8.44)years.The general demographic and sociological data such as age,gender,education level,and marital status of the patients and their primary caregivers in the intervention and control groups were compared.The results showed that the differences were not statistically significant(P<0.05).There were no statistically significant differences in the disease profiles of patients in the intervention and control groups in terms of stroke type,number of strokes since the onset of the disease,and other chronic diseases(P<0.05).Self-efficacy:The repeated measures ANOVA showed statistically significant between-group,within-group,and interaction effects for the total self-efficacy score of patients in the intervention and control groups(P<0.05).We found that were statistically significant difference in the total self-efficacy scores between two groups(F=6.058,P=0.016);for the within-group effect,there was a difference in the total self-efficacy score between the two groups at all three time points(F=73.418,P<0.001);for the interaction effect,there was a statistically significant interaction effect between the total self-efficacy score of the two groups at time and group(F=12.916,P<0.001).The results of comparing the total self-efficacy score of patients in the two groups at the three time points showed statistically significant differences between the two groups after post-intervention,one month post-intervention and three months post-intervention(P<0.05).Family functioning:The repeated measures ANOVA showed statistically significant difference in total family functioning scores between the two groups(F=21.192,P<0.05);within-group effect,difference in total family functioning score between the two groups at each time point(F=148.301,P<0.001);Also the interaction effect of total family functioning scores over time and grouping was statistically significant for both groups(F=44.984,P<0.001).The results of comparing the total FAD score of patients in the two groups at three time points showed statistically significant differences after post-intervention,one month post-intervention and three months post-intervention(P<0.001).Stroke prevention and control knowledge:The GEE showed a statistically significant difference in the total stroke prevention and control knowledge score between the two groups(Waldx~2=26.233,P<0.001);within-group effect,there was a difference in the total stroke prevention and control knowledge score between the two groups at each time(Waldx~2=417.093,P<0.001);interaction effect,there was a statistically significant interaction effect between the two groups of patients’total stroke control knowledge score at time and group(Waldx~2=120.624,P<0.001).The results of comparing the total Stroke prevention and control knowledge scores of patients in the two groups at the three time points showed statistically significant after post-intervention,one month post-intervention and three months post-intervention(P<0.001).Quality of life:The GEE showed a statistically significant difference in total quality of life scores between the two groups of patients was statistically different(Waldx~2=18.316,P<0.001),indicating that the intervention program had a significant effect on improving the quality of life of patients;within-group effect,the total quality of life scores of patients in the two groups differed at all time points(Waldx~2=417.093,P<0.001),indicating that patients’total quality of life score changed over time;interaction effect,the interaction effect of patients’total quality of life scores between the two groups at time and group was statistically significant(Waldx~2=49.622,P<0.001),for the each time.The results of the comparison of total quality of life score between the two groups of patients showed statistically significant differences after post-intervention,one month post-intervention and three months post-intervention(P<0.001).ConclusionsThis study through two rounds of Delphi expert correspondence,Two rounds of consultation by Delphi experts show that the experts have high enthusiasm,authority and consistency in the evaluation of the program,which is scientific and feasible,and has certain reference and application value for clinical nursing work.We applied the family empowerment theory-based discharge planning intervention program to elderly patients with stroke disability and founded it can improve the self-efficacy of elderly stroke patients with disability and enhance their recovery belief.Improve the family function of patients,enhance mutual affection,improve the care skills of patients’main caregivers,reduce the care burden and psychological pressure;Improve the knowledge level of stroke prevention and treatment,enhance the cognition of patients to the disease,change the healthy behavior,improve the quality of life. |
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