Application Of Nursing Intervention Based On Chronic Illness Trajectory Model In Patients With Dysphagia After Stroke

Objective:1.Using the chronic disease trajectory model as the framework,interview the experiences and needs of patients with dysphagia after stroke in different periods of the disease,and summarize the dynamic changes of their experiences and needs in different periods,so as to provide a theoretical basis for the formulation of intervention programs.2.Explore the impact of nursing intervention based on the trajectory model of chronic diseases on swallowing function,negative mood and quality of life in patients with stroke dysphagia.Method:1.The first part is qualitative research:using purpose sampling method,22 patients aged 45 in a Grade A hospital in Shanxi Province from July 2021 to August 2021 were selected,using general data questionnaire and the literature review and expert guidance of the proposed interview outline for the half structured in-depth interview interview object,using colaizzi 7 steps analysis data.To understand the experience and needs of patients with stroke dysphagia in the acute onset period,early rehabilitation period and continuous rehabilitation period.Based on this approach,care interventions based on chronic disease trajectory model were developed.2.The second part is quantitative research:using convenient sampling method,selected in December 2021-October 2022 in a tertiary hospital neurology in Shanxi Province met the inclusion criteria of 96 cases of first stroke swallowing disorder and age45 patients as a research object,a ward of 48 cases as a test group,two ward 48 cases of study object as a control group.The control group received routine care and follow-up in the ward,and the trial group used care based on the chronic disease trajectory model,and collected data on the evaluated effect before intervention,at discharge,1 month after discharge,and 3 months after discharge.Drinking water test(WST),feeding assessment questionnaire(EAT-10),and hospital anxiety,depression scale(HADS),anxiety,depression and specific quality of life scale(SWAL-QOL)to evaluate the quality of life of stroke patients.Statistical analysis of the data was performed using SPSS 25.0.Results:1.Qualitative study results(1)In this study,7 cases in acute onset,10 in early rehabilitation and 5 in continuous rehabilitation were selected for interviews.Among them,17 were male and 5 were female;aged 47 to 72 years,mean(61.95±7.85).(2)According to the experience and needs of stroke patients with swallowing disorders in different periods,four themes were extracted during the acute onset period,covering 6 subthemes:(1)disease-related knowledge needs;(2)inner response mode:lack of self-concept and heavy uncertainty of prognosis;(3)daily care needs:assistance in eating and eating management;(4)social support needs:family support and medical staff support.In the early rehabilitation period,4 themes were extracted,covering 9 subthemes:(1)Rehabilitation guidance needs:swallowing exercise skills,feeding guidance,first aid measures guidance,medication guidance;(2)inner response mode:adapt to disease results,heavy negative emotions;(3)Social support needs:family support,peer support,medical staff support;(4)heavy economic burden.During the continuous rehabilitation period,two themes were extracted,covering four subthemes:(1)Disease-related information needs:referral information and prevention of disease recurrence information;(2)Inner coping methods:self-concept recovery and psychological support needs.2.Quantitative research results(1)At the end of the intervention,a total of 90 patients completed the study,including46 patients in the trial group and 44 patients in the control group.Before the intervention,the general data,swallowing disorder grade,EAT-10 score,anxiety and depression scores,and quality of life scores of the two groups were not significantly different(P>0.05),indicating that the baseline data between the two groups were comparable.(2)The results of repeated measurement analysis showed that the effect of swallowing function between the two groups was statistically different(Waldχ~2=3.894,P=0.028<0.05).And OR=1.980,95%CI=(1.005,3.904),indicating that the improvement of swallowing function in the test group was better than that in the control group.At the end of the intervention,the difference was statistically significant(χ~2=8.384,P=0.039<0.05);at discharge,the EAT-10 score of 1 month after discharge was lower than that of the control group(P<0.05).The results of repeated measures ANOVA showed significant differences in comparing EAT-10 scores at different time points(F=873.112,P<0.001),indicating lower EAT-10 scores in both groups.Group had an interaction with time(F=77.229,P<0.001),indicating that EAT-10 scores changed with time in the two groups and that EAT-10 scores decreased better than in the control group.(3)The results of repeated measures ANOVA showed that the total scores of anxiety and depression at different time points were statistically significant(F=51.915,P<0.001),indicating that the total scores of anxiety and depression decreased in both groups.There was an interaction between group and time(F=5.096,P<0.001),indicating that the total score of anxiety and depression changed with time,and the total score of anxiety and depression decreased higher in the test group than that in the control group.The total scores of anxiety and depression in the test group at discharge and 1 month after discharge and 3 months after discharge were lower than those in the control group,and the differences were statistically significant(P<0.05).(4)The results of repeated measures ANOVA showed that the difference in QOL scores at different time points was statistically significant(F=1325.851,P<0.001),indicating the improvement of QOL in both groups.Group and time interacted(F=51.984,P<0.001),indicating that the QOL scores in the two groups changed with time,and that the QOL scores in the test group improved higher than that in the control group.Quality of life scores at 1 month and 3 months after discharge were higher than that of the control group,and the differences were statistically significant(P<0.05).The two groups of patients in 1month after discharge,3 months after discharge in social interaction,fatigue,language communication differences(P>0.05),in the desire to eat,mental health,fear,swallowing,eating time,food choice,sleep,psychological burden has statistical significance(P<0.05).Conclusion:1.patients with dysphagia after stroke have differences in the experience and needs of the acute onset period,early recovery period and continuous recovery period,and show dynamic changes.Therefore,targeted interventions should be developed in combination with the needs of patients with swallowing disorders in different periods of the disease.2.Nursing intervention based on the chronic disease trajectory model can improve the swallowing function,reduce the anxiety and depression level,and improve the quality of life of patients with dysphagia after stroke.