Effectiveness Of Whole-course Family Nursing Intervention On Health Improvement In Ostomy Childrens And Their Parents

Objective To develop a whole-course family nursing intervention to parents of children with colostomy and intestinal stoma which including in-hospital and out-hospital and focusing on whole-course information support and psychological support for parents, nursing knowledge education and skills training. To evaluate the health promotion effect of whole-course family nursing intervention model on pediatric colostomy patients and their families.Methods Case control quasi experimental research design.23 colostomy children undergoing surgery in Children's Hospital of Fudan University from July 2009 to December 2009 were selected as control group through subjective sampling; 23 patients were selected from January 2010 to June 2010 as intervention group. After ostomy, patients were discharged and cared by parents at home for 3-6 months, then came back for colostomy closure procedure. The control group used the current the routine postoperative stoma care and outpatient follow-up, while whole-course family nursing intervention was carried out among the intervention group, including full implementation to provide information and psychological support, parental involvement in early postoperative stoma care, stoma care knowledge education and skills training, home visits after discharge and telephone consultation for three months in addition routine care. Stoma complications, nutrition indicators, parents' stoma care ability and Self-Rating Anxiety/Depression Scale were assessed upon early post-operation, discharge,1st month after surgery,3rd month after surgery. T-test, Chi-square test, Fisher's exact test, Linear Mixed Model of Repeated Measurements and One-way ANOVA were applied to compare the differences between intervention group and control group.Results There is no significant difference of the demographic data and disease data between two groups.①After enterostomy, the baseline survey showed the rough score of SAS was 37.32±5.91,36.96% of parents had anxiety symptoms; he rough score of SDS was 35.93±4.38, 32.61% of parents had depression symptoms; 23.91% (11/46) of parents had anxiety and depression co-exist. The SAS/SDS scores in parents before intervention were higher than the national norm (p<0.05). Before the intervention, SAS and SDS scores between the two groups was no significant difference (p> 0.05). After 1 month,3 months of the surgery, the score of SAS and SDS were significantly higher in the intervention group than in the control group (p<0.05). SAS scores between different groups has an interaction with time (p<0.05), prompt nursing intervention on the anxiety level of parents of children at different time points are different. Depression scores between different groups had no interaction with time (p> 0.05).②Degree of knowledge about ostomy care scores were significantly higher in the intervention group than in the control group upon discharge,1st month,3rd months after stomy, suggesting that parents in the intervention group had more stoma-related health knowledge (p<0.05).③There were significantly difference on leakage of stoma bag, the peristomal skin disorders, the severity of dermatitis, parents active participation in changing bags, changing bags independently before discharge, with or without central vein, the situation colostomy enema comparison (p<0.05). The questionnaire after discharge shows stoma bag paste, the peristomal skin disorders, the severity of dermatitis, ability to deal with the situation between two groups differed significantly (p< 0.05).④There was no significant difference between the value of comparison in weight, head circumference and length (p> 0.05). There was significantly difference on prealbumin between two groups on 3th month after stomy (p<0.05), prompted the nutritional status of the intervention group patients was better recovery than the control group after 3 months of stomy.Conclusion The whole-course family nursing intervention focusing on continuous information and psychological support for parents, nursing knowledge education and skills training could help to promote the ability of parents'stoma care and parental anxiety, depression level, reduce peristomal skin disorders, and promote nutrition in children as soon as possible after recovery. Therefore the continuous family nursing intervention is an effective approach in improving physical and psychological rehabilitation of enterostomy children and their families.