The Development Of Family Caregivers' Needs Directed Discharge Planning For Children With Type 1 Diabetes

Objective: The objective of this research was to develop the family caregivers' needs directed discharge planning for children with type 1 diabetes.1)To describe the parents' true feelings and caring experiences when caring for children with type 1diabetes and explore the types and themes of care needs;2)To describe discharge readiness status of parents of children with type 1 diabetes,and explore the influencing factors of parents' discharge readiness of children with type 1 diabetes;3)To develop an individualized discharge plan that can provide continuing care for children with type 1 diabetes and their families.Methods:Mixed methods combined quantitative study with qualitative study was used.Part ?:Qualitative Research on Parental Care Experience and Home Care Needs of Children with Type 1 Diabetes.The qualitative description was carried out from January 2016 to June 2017.Purposive sampling was used to recruit 20 parents of children with type 1 diabetes.Information was collected through in-depth individual interviews which were tape-recorded and subsequently transcribed.Thematic analysis was used for data analysis.Part ?: Research on the status and influencing factors of Parental discharge readiness of children with type 1 diabetes.A cross sectional descriptive study was conducted with patients of children with type 1 diabetes in the pediatric neuroendocrine ward of hospital between June 2017 and December 2018.Participants were assessed with the general situation questionnaire of children and their families,the discharge readiness scale and the quality of discharge education.Descriptive statistics,bivariate analyses,multiple stepwise regression were conducted to explore predictors for discharge readiness.Part ?: The construction of discharge planning for children with type 1 diabetes.Based on the individual and family self-management theory,combining the results of quantitative and qualitative studies,referring to the results of literature analysis and the recommendations of expert seminars,discharge planning for children with type 1 diabetes was constructed.Results:Part ?: Parental care experience and home care needs of children with type 1diabetes.Content analysis revealed 5 common themes with 14 subthemes of parental care experience,including persistent psychological stress(catastrophic emotions,emotional distress,and altered self-efficacy),family function change(altered family life patterns and changes in parental role/function),challenges in daily management(technical challenges,emotional regulation,parent-child conflict,and transition of care autonomy from parent to child),financial burden(cost burden of treatment and altered family economics),and lack of social support(social activity limitations and insufficient support systems).The care needs of parents of children with type 1 diabetes were extracted from 4themes and 12 subthemes,including information needs(disease-related information,home care information,channels of information acquisition),skill needs(insulin injection techniques,skills required for symptom management,skills for parent–child communication),emotional needs(family support,peer support from other parents of children with type 1 diabetes,professional support),and social needs(needs for financial support,needs for social security).Part ?: Research on the status and influencing factors of Parental discharge readiness of children with type 1 diabetes.1.The average score of the discharge preparation level of 272 parents of children with type 1 diabetes was 215.82±36.31,and the average score of items was 7.20 ±1.24.Children's parental readiness for discharge is above average.2.The average score of quality of discharge education of the 272 parents of children with type 1 diabetes was 124.13±15.56,and the average score of items was6.89±0.86.Educational content scores were moderate,educational skills and effect scores are above average.3.The correlation analysis results indicated that there was a significant positive correlation between the quality of discharge education and the level of discharge readiness of parents of children with type 1 diabetes(r=0.638,P<0.001).4.The results of multiple step by step regression analysis showed that economic income,educational content,whether or not to live with grandparents,teaching skills,parents' education level and only child were the influencing factors of hospital discharge readiness,which could explain 71.5% of the total variation of parents' hospital discharge readiness.Part ?: The construction of discharge planning for children with type 1 diabetes.Based on the theory of individual and family self-management,combined with the results of quantitative and qualitative studies,the results of reference content analysis and the recommendations of expert discussions,the implementation plan of discharge planning for children with type 1 diabetes was initially constructed.The implementation planning aims to improve the discharge readiness of the parents of children with type 1 diabetes and the ability of family self-management after discharge,and to improve the health outcomes of the children.The implementation plan includes the study design,study object,implementer,implementation method,implementation dose,evaluation index and evaluation time Conclusions:1.Children with type 1 diabetes need the assistance of their parents for disease management.Parents are under heavy care pressure during home care,and there is a lot of demand for supportive care.Understanding parental care experience and care needs is of great significance to helping parents of children with their caregiver role adaptation.Nursing staff should provide professional guidance in stages and in a planned way,especially in the transitional stage from the discharge of the child to home care.The care needs extracted from the research at this stage laid the foundation for the construction of the discharge plan module for children with type 1 diabetes.2.The readiness of parents of children with type 1 diabetes to be discharged from the hospital is at an upper-moderate level.Finding out the weak links in the readiness for discharge through item analysis can mutually confirm the need for care in qualitative research.Through the analysis of influencing factors,it is concluded that the quality of discharge education is the influencing factor of discharge readiness.Through the analysis of education quality items,it can provide a basis for the implementation of the discharge plan and specific intervention measures.It is of great practical significance to carry out targeted intervention studies on the readiness for discharge of parents of children with type 1 diabetes,promote the transition of children and their parents from hospital to family and effectively implement self-management.3.Based on the theory of individual and family self-management,combined with the results of quantitative and qualitative research,the results of reference analysis and the recommendations of expert seminars,and initially constructed the implementation plan for the discharge planning for children with type 1 diabetes.This implementation scheme is based on theoretical guidance and fully considers the needs of caregivers of children with type 1 diabetes,so it has good practicality.It is hoped that this implementation plan will play an active guiding role in helping children and their families to realize the transition from hospital care to home self-management.