| Background:As the enhanced recovery after surgery idea is widely used in colorectal surgery,the patient's hospital stay has been significantly shortened.Temporary stoma for rectal cancer is mostly an ileostomy.The excretion of the stoma is thin,large and corrosive,and it is difficult to care for the stoma.How to enable temporary stoma patients to master stoma care technology in a relatively short period of time has become a difficult point in the current clinical ostomy care work.More and more studies have found that after the temporary stoma is restored,most patients will have varying degrees of intestinal dysfunction,which reduces their postoperative quality of life.At present,the practice and research on ostomy care are focused on the establishment of the ostomy,and there is still a lack of nursing plans for patients after the treatment.Objective:Describe and analyze the supportive care need status,quality of life and the impact of supportive care demand status on the quality of life of patients with rectal cancer provisional stoma during the stoma establishment phase and the stoma return phase;systematic retrieval,evaluation and Summarize the evidence-based evidence of rectal cancer perioperative care,stoma establishment and return care under the ERAS idea;construct the "Nursing Plan for Patients with Temporary Intestinal Stoma of Rectal Cancer under ERAS Idea" and verify its clinical application effects.Method:This research takes the JBI evidence-based health care idea as the theoretical framework,and conducts research according to the four links of patient needs,evidence synthesis,evidence dissemination,and evidence application.1.Patient needs: The convergent parallel mixed method in the mixed-method study was used to analyze the needs of patients with temporary stoma in the two stages of stoma establishment and stoma return.At the same time,quantitative and qualitative studies were carried out for patients with temporary stomas in the two stages of stoma establishment and stoma return.In the quantitative research part,a questionnaire survey was conducted on patients in the establishment stage of the stoma who underwent radical resection of rectal cancer and temporary ostomy under the ERAS mode in two third-class hospitals in Changchun City,and the patients in the stage of stoma who underwent stoma remission..The questionnaires include a simplified version of the questionnaire for cancer supportive care needs and a colorectal cancer patient quality of life scale.The questionnaire for remission patients also included a low anterior resection syndrome score scale.In the qualitative research part,the largest difference sampling method was used to select patients with temporary stoma of rectal cancer in the two stages of stoma establishment and remission to conduct semi-structured in-depth interviews according to the pre-designed interview outline.Use thematic analysis method to analyze and integrate the interview content.2.Evidence synthesis: A systematic search method is used to search and screen the relevant literature on rectal cancer perioperative nursing and stoma establishment nursing under the ERAS idea,and perform quality evaluation and content analysis on the literature that meets the inclusion and exclusion conditions,and extract and summarize relevant documents Evidence and the classification of evidence and the division of recommendation strength,and finally form a best practice information book or summary.Using the method of systematic review,the quality evaluation and summary of the original literature related to the nursing of the stoma return period were carried out.3.Evidence dissemination: Based on the results of the analysis of the needs of patients in the pre-stoma establishment stage and the return stage,and the best practice information booklet on the evidence-based evidence-based care of rectal cancer perioperative care and stoma establishment care under the ERAS idea Based on the results of the systematic review of the relevant literature on nursing care,the first draft of the "Nursing Plan for Patients with Temporary Enterostomy for Rectal Cancer under the ERAS Idea" was constructed,and the first draft of the plan was revised by inviting clinical first-line nursing experts to conduct expert meetings to form the final draft.4.Evidence implementation: Through prospective contemporaneous experimental studies in two tertiary hospitals in Jilin Province,one hospital adopts the above-mentioned nursing plan,and the other adopts the routine nursing plan under the VI ERAS idea.Continue to conduct continuous follow-up evaluation of patients for 9months to evaluate the feasibility and effectiveness of the program.Result:1.Patient needs: The quality of life of patients during the establishment of the stoma is poor.The median quality of life is 68 and the interquartile range is 19.75.They all have a wide range of supportive care needs,including information needs and support needs And psychological needs scored the highest,the median(interquartile range)was57.95(47.73),50.00(50.00)and 47.50(40.00).Patient information needs at this stage mainly include information related to stoma care and cancer treatment,and the support needs are mainly to obtain support from the medical team.Inferiority complex,powerlessness,guilt and worry are the main psychological problems of patients at this stage.The quality of life of patients in the stage of stoma is poor,the median of the total score of quality of life is 95,and the interquartile range is 35,which is slightly better than that of patients in the established stage of stoma.Information needs and support needs are the supportive care needs with the highest scores for patients at this stage,and the median(interquartile range)is 72.73(36.36)and 40.00(45.00),respectively.Patient information needs at this stage mainly include the methods of managing symptoms and prognosis related information of the disease,and the support needs include the support of the medical team and peer support.2.Evidence synthesis: Through literature search on the guidelines and systematic reviews of rectal cancer perioperative nursing and stoma establishment nursing under the ERAS idea,5 guide documents and 7 systematic reviews,9 guide documents and 3systematic reviews were finally included.Through the quality evaluation of these documents,the summary of evidence,and the argumentation of the expert panel,the best practice information booklet for rectal cancer perioperative care and stoma establishment care under the ERAS idea is finally formed.Due to the lack of nursing guidelines for the stoma return period,the original literature related to stoma return period nursing was systematically reviewed,and the results of the systematic review in9 aspects were summarized.3.Evidence dissemination: Based on the above research results,after repeated discussions by the research team,the first draft of the "Nursing Plan for Patients with Temporary Enterostomy for Rectal Cancer under the ERAS Idea" was constructed,including nursing principles,stoma two-stage nursing sub-plans,and complications The prevention and care sub-program has three parts.The plan was simplified and revised through the expert argumentation method,and the final draft was formed,including three parts: nursing principles,stoma establishment period nursing plan and stoma repayment period nursing plan,stoma establishment period nursing plan and stoma repayment period The nursing plan mainly includes three aspects: preoperative care,postoperative care and continuous care.4.Evidence application: Except for the dimensions of social and family status,the total score of quality of life and other dimensions of patients in the intervention group were significantly higher than those in the control group(p<0.05).Except for the dimension of sexual needs,the total score of supportive care needs and the scores of all dimensions of patients in the intervention group were significantly lower than those in the control group(p<0.05).The incidence of stoma complications,stoma restoration time and the severity of LARS in the intervention group were significantly lower than those in the control group(p<0.05).Conclusion:1.Under the ERAS idea,the quality of life of patients during the establishment of the stoma is poor,and the need for supportive care is relatively high.Among them,information needs,especially information related to stoma care and cancer treatment,and the support of the medical team are the most important support for patients at this stage Sexual care needs content.2.The quality of life of patients with stoma in the ERAS idea is poor,and the need for supportive care is high.The information needs,especially the methods of managing symptoms and the prognosis of the disease,as well as the support of the medical team and peers The main supportive care needs of patients.3.The constructed "Nursing Plan for Patients with Temporary Enterostomy for Rectal Cancer under the ERAS Mode" has certain validity and feasibility when applied to the clinical setting of colorectal ERAS in our country,and it is worthy of promotion and provide reference for clinical related practice. |
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