| ObjectiveOn the basis of determining influencing factors of self-management in patients undergoing coronary artery bypass grafting(CABG), we constructed the self-management model following the clinical practice guidelines, through the revision and certification by panel meeting. And then evaluate the effect of clinical application. We hope that the model can strengthen the awareness of self-management of patients undergoing CABG, increase the self-efficacy, improve the self-management behaviors, enhance the self-management ability, and provide a reference for self-management interventions on patients undergoing CABG. Methods1. Researching the influencing factors of self-management on patients after CABG surgery. A convenient sample of 237 eligible patients who underwent CABG surgery between June 2013 and June 2014 in cardiac surgery department of one grade-Ⅲ general hospital in Shanghai were investigated. The questionnaire datas were collected by researcher herself through telephone follow-up: datas were collected by the self-made personal characteristic questionnaire、coronary heart disease self-management scale、the Chinese version of chronic disease self-efficacy scale. Descriptive statistics、two-sample t-test、one-way anova analysis、Pearson correlation and multiple stepwise regression analysis were adopted.2. Refer to chronic disease self-management programs and the recommendation of high levels of evidence in guidelines for patients after CABG, we constructed the mode of self-management based the theory of self-efficacy for patients undergoing CABG surgery.3. A quasi-experimental study was conducted to evaluate the clinical effect of the self-management mode for CABG patients. We selected the eligible CABG patients who were in cardiac surgery department general ward from a three level of first-class hospital in Shanghai from October to December 2014 and then they were divided into two groups: patients of a ward were assigned to the control group(n=16) who accepted usual care only; and patients of another ward to the intervention group(n=17) who accepted usual care and at the same time the intervention of self-management mode. The evaluation indicators were collected before surgery and 3 months after surgery. And SPSS Statistics Version 17.0 was used to perform statistical analysis, descriptive statistics、Fisher exact probabilities、CMH(Cochrane,s and Mantel-Haenszel)test、two sample t-test and Wilcoxon signed-rank test were used. Results1.The average score of self-efficacy of CABG patients was(6.56±0.99) points, 64.41% of patients had moderate level of self-efficacy; the total score of self-management was(86.11±9.88) points,score indicator was 63.79%, 64.86% of patients had medium level of self-management. And among the 7 dimensions of self-management, score indicator from high to low in turn were bad habits management(84.90%)、general life management(74.35%)、emotional cognitive management(66.60%)、emergency management(66.13%)、symptom management(61.73%)、disease knowledge management(55.52%) and treatment compliance management(52.40%). According to self-management tasks, 7 dimensions were consolidated to 3 dimensions: daily life management(79.65%)、medical disease management(54.56%) and emotion management(65.00%).2. There was a statistical significance between CABG patients’ self-efficacy and gender、ways of payment(P<0.05). There was a statistical difference between CABG patients’ self-management and economic level 、 state of job 、 postoperative time and self-efficacy(P<0.05). Meanwhile self-efficacy had the strongest influence on self-management(Beta=0.756). Multiple stepwise regression analysis about influencing factors of every dimension of self-management showed that the main factors influencing daily life management were age、economic level and self-efficacy(P<0.05); The main factor influencing medical disease management and emotion management was self-efficacy only(P<0.05).3. There was significant positive correlation between self-efficacy and self- management、daily life management、medical disease management and emotion management. And the correlation coefficient(r) were 0.593、0.350、0.548 and 0.496(P<0.01)4. Refer to chronic disease self-management programs and clinical practice guidelines, self-management mode of patients undergoing CABG was constructed initially. And then the mode was determined through revision and certification by panel meeting: the mode including intervenon goals、perpetrator、the object of intervention、intervention format、intervention content、intervention and evaluation time 、evaluation indicators.5. A quasi-experimental study was taken to examine the clinical application effect of self-management mode for patients undergoing CABG.(1) t-test: Parallel t-test results showed that there existed statistical significances in the scores of self-management and its every dimension、self-efficacy and its every dimension(P<0.05) between pre-operation and 3 months post-operation in the intervention group(table 4-4 and table 4-5). This indicated that patient’s self-efficacy and self-management ability 3 months post-operation in the intervention group had enhanced compared with pre-operation. There were significantly differences in the scores of self- management and its every dimension between surgery and 3 months after surgery in the control group(P<0.05), and there were not statistically different on other indicators(P>0.05)(table 4-6 and table 4-7). This indicated that patient’s self-management ability in the control group had enhanced compared with pre-operation.(2) Wilcoxon test: Wilcoxon rank test showed that the changes of scores of selfmanagement 、 symptom management 、 disease knowledge management 、 emergency management、emotion-cognition management、self-efficacy and general disease common management self-efficacy before and 3 months after surgery had statistical significances between control group and intervention group(P<0.05)(table 4-10 and table 4-11). This indicated that the ability of self-management、symptom management、disease knowledge management、emergency management、emotion-cognition management、self-efficacy and general disease common management self-efficacy enhanced in the intervention group compared with the control group 3 months after CABG surgery, in other words, self-management mode could improve patient’s self-efficacy and sele-management ability.(3) 76.47% of study subjects considered that self-management activities were very meaningful and no one considered they had no meaning; 70.58% of study subjects in the intervention group were satisfied with the knowledge and skills to manage their disease they learned; 58.82% of study subjects in the intervention group responded that self- management activity was able to meet their own needs to manage the disease and health.ConclusionsSelf-efficacy of CABG patients was at a medium level, ways of payment and gender were the main affecting factors; The levels of self-management of CABG patients were between moderate and low levels, self-efficacy 、 economic level 、 state of job and post-operative time were the affecting factors; We constructed self- management mode for patients undergoing CABG on the basis of chronic disease and clinical practice guidelines, and it was also revised and certificated through panel meeting; A quasi-experimental studywas taken to prove the feasibility and effectiveness of the self-management mode for CABG patients, it could improve the ability of self-management and self-efficacy, and it should be promoted in clinical practice. |
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