| BackgroundLow vision patient, whose visual acuity is below 0.3 and radius of view is below 10°, still has functional lesion after receiving the treatment or correction of refractive errors. Low vision patient can still accomplish some activities using peripheral vision. Low vision classification:visual acuity below 0.3 but above 0.1 is diagnosed low vision; visual acuity below 0.05 but above 0.002 is diagnosed level three low vision; visual acuity below 0.02 but above the light sense is diagnosed level four low vision; visual acuity below the light sense is diagnosed level five low vision. All mentioned above refer to the binoculus and the best-spectacle corrected visual acuity of the eye in best condition. The result of 2nd nationwide sampling survey on the disabled in 2006 shows that the case rate of vision disability in China is 1.53%. Accordingly, there are approximately 20.035 million people with visual disability in China. Among the old citizens over 70 in USA, Low Vision has become the third chronic disease, patient needing to be taken care of in daily life, after arthritis and cardiopathy. A person with low vision may find it difficult or impossible to accomplish daily activities such as reading, working, exercising and self-care, which results in patient’s Negative emotions such as depression, anxiety and eventually affects the social support with self efficacy and the quality of life of patient. The research shows that adult patient with low vision has lower social support with self efficacy and the quality of life. Besides, the self efficacy has high positive correlation with the quality of life. As the development of the Ophthalmology nursing and the holistic nursing, the low vision patient in hospital can basically receive systematic and safe nursing as well as all-round health guidance.However, extended care like home nursing is rarely reported. home nursing intervention is a kind of new nursing intervention which follow the development of economy. It combines nursing with family and society apart form hospital, highlighting that the staff, patient and the family members should be all involved in a long term. In recent years, home nursing intervention has been positively recognized in many diseases such as Ⅱ type diabetes, hypertension, autistic disorder, amblyopia and coronary disease, saying it has positive influence on patient’s self efficacy and the quality of life. Therefore, this research, aiming to investigate the influence of individual home nursing on self efficacy and the quality of life of the patient, adopts home nursing theory, using questionnaire survey on the family economy, self efficacy and the quality of life of the patient. So the attention on the quality of life of the low vision patient is raised and the feasible individual home nursing plan to the patient and the family is provided. The plan, giving the patient and the family correct nursing guidance, helps them know more about the disease and get rid of the shadow of low vision. Besides, it helps patient adapt to the low vision life and face the life and work more positively.Objectives1. To explore the characteristics of social support, self efficacy, the quality of life and the health problem of low vision patients.2. To set personal home nursing intervention plan, according to the ophthalmology nursing as well as the health problem of the low vision patient, investigate the influence of home nursing on the patient’s social support, self efficacy and the quality of life as well as provide proof for the nursing and complete the extended nursing in family and community.Objects And Methods Objects:220 low vision patients who hospitalized in a third-grade class-A hospital during June 2014 and December 2015. The patient must meet the following criteria:Inclusion Criteria:1. The patient’s better vision acuity after correction is between 0.05-0.03.2. The patient should be adult must have the ability of listening, speaking and comprehension.3. No other serious diseases.4. The patient should be local or living on the pearl river delta.5. The patient must be willing to participate in this study. Exclusion Criteria:1. The patient has serious impaired verbal communication.2. The patient has mental disorders.3. The patient has other serious diseases.4. The patient has to receive ophthalmologic operation or is unwilling to cooperate.Methods:The survey divides the cases selected into home nursing group and common nursing group through random sampling. The personal home nursing intervention, conducted upon the basic common nursing, mainly consists of the followings. First, the home nursing team organization. Second, the synchronous teaching for family members. Third, skills training. Forth, home safety assessment. Fifth, follow-up. The survey uses the originally-designed questionnaire and adopts Social Support Assessment Scale, SSAS and the general self-efficacy scale, GSS and Chinese-version low vision quality of life questionnaire, CLVQOL, as assessment equipment. The general situation questionnaire concludes gender, age, nation, marriage, address, contact, education, economy situation, family monthly income, case history, whether use visual aids and so on. SSAS concludes the availability of objective, subjective and social support, which consists of ten items. The higher the grads of the ten item is, the higher the level of social support will be. GSS, the single dimension, adopts Likter Level Four point system. The interviewer should answer the questions according to the reality. CLVQOL consists of 25 equal items about vision impairment, which concluding distant vision, movement senses and light senses; the ability of self-adjustment; reading and fine work; self-care ability of daily life. Each item takes zero to five points and there are 125 points in total. This survey lasts for three months. The points collected before the patient discharges from hospital, namely one week after the operation, are considered the basic condition and the points collected three months after the hospital discharge are considered the results of intervention.Statistical AnalysisAll the information is recorded by two people and analyzed by SPSS20.0. The measurement data meets normal distribution and is presented as x ± s. General demographic information is described by frequency, percentage, mean, standard deviation and the difference between two groups of general demographic information is analyzed by Cbi-Squared. Two independent sample t-test is adopted to compare the self efficacy, the social support and the quality of life and the scores before and after the intervention is respectively compared by two independent sample t-test. p<0.05, as mentioned above, is of significance in statistics science.Results1.828 questionnaires was sent in this research and 819 questionnaires was effectively recycled. The valid return tare is 98.9%. The youngest patient selected among 207 is 27 years old, the eldest 68 years old. The average age is 47.21 years old.2. The result of the two independent sample t-test of two group of patients shows that the differences in the age, gender, census register types, culture degree, family income, source of costs has no statistical significance. Yet the equilibrium between this two is comparable.3. The influence of home nursing intervention on the self efficacy of low vision patient. One hundred cases of low vision patient score 16.21±2.213 before the intervention. The scores of the patients’self efficacy in the intervention group is the two independent sample t-test before intervention has no statistical significance. Three months after the intervention, the result of paired sample t-test shows that the scores was greatly improved after the intervention; while that of control group has no statistical significance. (P>0.05) Two groups of the self efficacy scores after the intervention, (26.74±2.325 VS 16.65±2.192) as is shown in the two independent sample t-test, have the statistical significance. (P<0.05)4. The influence of home nursing intervention on the social support of low vision patient. One hundred cases of low vision patient score 35.94±5.271 in the social support before the intervention. While one hundred cases in control group scores 36.12±5.389 in total. As is shown in the two independent sample t-test, the differences in the scores of the patients’social support as well as the dimension have no statistical significance. (.P>0.05) Three months after the intervention, the results of the paired sample t-test shows that the social support (t=-4.705,P=0.000) and its dimension has apparently improved(P<0.05). Two independent sample t-test shows that the scores of social support (39.05±5.389 VS 35.25±5.740) and its dimension (P<0.05) have the statistical significance.5. The influence of home nursing intervention on the the quality of the life of low vision patient. One hundred cases of low vision patient score 34.76±3.5 in the quality of life before the intervention and 34.76±4.165 in the control group. Two independent sample t-test shows that the scores of patient in the quality of life and its dimension have no statistical significance. (P<0.05) Three months after the intervention, the results of the paired sample t-test shows that the scores in the quality of life (t=-4.705, P=0.000) and its dimension has greatly improved(P<0.05). But that in the control group do not. (P>0.05) As is shown in the two independent sample t-test, the scores in the quality of life (t=-4.705, P=0.000) and its dimension after intervention have statistical significance.Conclusion1. The social support, self efficacy, the quality of life and the other index of low vision patient, reflecting the objective state, are at the low level. Therefore, it is necessary to make personal home nursing intervention plan according to the characteristics of ophthalmology nursing as well as the health problem of the low vision patient.2. The home nursing intervention can effectively promote the social support of low vision patient. Without such intervention, the scores in the self efficacy, the objective support and the utilization of support will be lower. The support of family is the most significant among all kinds of social support and the objective support of patient mainly comes from their families. Therefore, The home nursing intervention can effectively benefit the recovery of patients, both mentally and psychically.3. The home nursing intervention can effectively promote the self efficacy and the quality of life of low vision patient. By organizing home nursing team to instruct the patient’s family in the living safety nursing, skill training as well as follow-ups in depth, the home nursing intervention enable low vision patient fully use the side vision and improve their living skill so that promote patient’s self efficacy and the quality of life.4. The home nursing intervention mode can be adopted to the continuing nursing of low vision patient. The home nursing intervention is feasible, which is exactly what the patients and their family eagerly need. Therefore, it is high time that the staff, Community clerk as well as the government should lay more attention on the home nursing, doing more research to regulate improve the home nursing system. |
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