To Establish And Validate The Effectiveness Of Community-based Nursing Practices Which Based On Social Support Network

Background:The number of older adults continues to grow,and promoting healthy aging has become an important strategy for community nursing to deal with the aging population.Social support network as an important part of social environment has become a focus of promoting healthy aging in recent years.At the same time,as one of the main forces to promote the health of the population in the community,under the condition of limited human resources,how to effectively and continuously promote healthy aging in community nursing is still worth thinking.Therefore,it is necessary to clarify the relationship between the social support network of the elderly and healthy aging in the social environment,and it is necessary to explore an efficient and sustainable community nursing practice model which based on the social support network of older adults.Objectives:(1)Part 1:To describe the relationship between the social support network and healthy aging among community-dwelling older adults.(2)Part 2:To establish and validate the effectiveness of community-based nursing practices which based on social support network.Methods:(1)Part 1:It is a cross-sectional study.485 community-dwelling older adults aged 60 and older were recruited from Beijing,China.Data were collected by using the Lubben's Social Network Scale-18,the Medical Outcomes Study Social Support Survey,the Self-rated Abilities for Health Practices Scale,the Health-Promoting Lifestyle Profile ?,the Healthy Ageing Instrument and the general data questionnaire.To describe the healthy aging of older adults and their current status of the social support network.Path analysis was applied to analyze the pattern of social support network affecting healthy aging.(2)Part 2:This part is divided into two stages.The first phase combined with the foundation of theory,policy and research I established a community health aging nursing practice model based on social support network,which was demonstrated by 6 experts.Second stageis a quasi-experimental study.106 community-dwelling older adults aged 60 and older were recruited from four communities.Participants were divided into intervention group and control group by coin tossing,and corresponding interventions were conducted for 6 months.Older adults' healthy aging,health-promoting behavior,self-efficacy and neighbor support were measured before the interventions,3 months after the interventions and 6 months after the interventions.T-test and repeated measurement analysis were applied to clarify the effectives of interventions.The evaluation of the intervention progress were collected in intervention group.Results:(1)Part1:A total of 485 valid questionnaires were collected in this part.The results showed that:1)The average score of healthy aging was 120.62±23.15,and the average score of social support network was 41.18±12.58,which were all at a medium level.2)In the final model,family relationship,neighbor relationship could promote healthy aging directly.The standardized path coefficients were:0.07 and 0.14.Besides,family relationship and neighbor relationship could also affect healthy aging indirectly,the standardized path coefficients were:0.08 and 0.09.Friend relationship mainly promoted healthy aging indirectly with a standardized coefficient of 0.14.Self-efficacy and health promotion behavior could promote healthy aging directly.The standardized path coefficients were:0.57 and 0.18.The self-efficacy could also indirectly promote healthy aging through health promotion behavior,and the standardized coefficient was 0.14.Each of the above path ways were statistically significant(P<0.05).(2)Part 2:The first stage:Experts demonstrated the practical significance of the integration of neighbor relationships in the community nursing practice.At the same time,they emphasized the role of nurses as coordinators and managers.In addition,in the discussion of distinguishing the relationship between neighbors and friends,experts believe that the combination of the two roles may be better to promote healthy aging.Finally,it is recommended to modify the presentation form of the schematic diagram of the practice mode in order to show the logical relationships between the systems.The second stage:A total of 99 participants in both groups completed all the interventions.1)Comparing the scores of outcome indicators between two groups before and after the intervention at each time point:the health aging score,neighbor support score,health promotion behavior score and self-efficacy score of the subjects in the intervention group increased after the intervention,and they continued to rise and there was a significant difference between the scores at each time point(P<0.001);the scores of the corresponding indicators of the control subjects were not significantly different at each time point(P>0.05).At 3 months of intervention,the self-efficacy score of the subjects in the intervention group was higher than that of the subjects in the control group(P<0.05).At 6 months of intervention,the healthy aging score,and the scores of secondary outcome indicatorss of the intervention group were significantly higher than those of the corresponding indicators of the control group(P<0.001),2)Evaluation of the intervention process of the intervention group:More than 84%of the participants in the intervention group expressed "very satisfied" with the intervention method,the intervention content and the time schedule.More than 97%of the participants said that they will support and are willing to continue to participate in similar activities.Conclusion:(1)In this study,the healthy aging of older adults and their social support network were at a medium level.(2)The path ways of different types of social support network affected healthy aging in this study were:1)Family relationship and neighbor relationship can directly and indirectly promote the healthy aging of older adults.Friendship can only indirectly affect healthy aging.And the neighbor relationship has the strongest effect on promoting healthy aging.2)Self-efficacy and health promotion behavior could directly affect healthy aging,meanwhile,self-efficacy could directly affect healthy aging through health promotion behavior.(3)The effect of community nursing practice based on social support network to promote healthy aging was better than that of the regular community nursing practice,and could be accepted by older adults in the community and had high feasibility.