Effect Of Nursing Intervention On Quality Of Life In Hemodialysis Patients Based On KANO Model

Objective:This study is based on the fuzzy analysis method in the KANO model to explore the quality attributes of nursing needs of maintenance hemodialysis patients,and based on the results of demand,formulate and implement corresponding nursing interventions,evaluate their intervention effects,and provide new ideas for clinical nursing and new analytical methods for obtaining patient care needs.Methods:First part is prepare the questionnaire:Mainly used literature analysis method to determine the initial entry of the questionnaire,after two rounds of expert advice on the initial entry of the questionnaire deletion and revision,and then a large sample test of the questionnaire,this time the recovery of 231 valid questionnaires.After statistics and analysis,further adjustment of the content and structure of the questionnaire,and measured the questionnaire has good reliability and validity,suitable as a measurement tool of hemodialysis patient supportive care needs.Second Part is patient demand investigation and formation of nursing measures:78 high-throughput hemodialysis patients from a comprehensive top-three hospital in Harbin were selected as the research objects.The fuzzy KANO model and IPA analysis were used to analyze the nursing needs of the patients.The quality attributes and the degree of demand of the patients were obtained,based on the Needs Analysis Results,M-A-O nursing interventions were formulated(M-Essential Requirements,A-Potential Requirements,O-Expected Requirements).Third Part is clinical application:In the course of the questionnaire survey,six patients were detached,so the remaining 72 patients were randomly divided into a control group and a test group,and informed consent was signed.The control group was given routine care,and the test group was given M-A-O care measures based on routine care,the intervention time was three months.Before the intervention,the patient completed the general situation questionnaire.Before and after the intervention,the SAS self-rating scale,the SDS self-rating scale,the SF-36 health questionnaire were filled in.Finally,the data was input into SPSS22.0 statistical software for statistical analysis.Results:1.?Hemodialysis patients supportive care needs questionnaire?has three dimensions,25 entries,after statistics and analysis,the questionnaire dimensions Cronbach'sa coefficients were 0.885,0.830,0.871,the total questionnaire Cronbach'sa coefficient was 0.901,the questionnaire reliability is ideal;The questionnaire after eight experts after two rounds of comments by eight experts,the I-CVI value of each entry was greater than 0.8,and the S-CVI value of the scale was 0.967,which showed that the content validity of the questionnaire was good.In addition,the correlation coefficients of each dimension in the questionnaire are 0.251,0.323 and 0.660,respectively.The correlation coefficients between each dimension and the total score are 0.572,0.779 and 0.870,respectively.Therefore,the structural validity of the questionnaire is reasonable.2.Hemodialysis patient supportive care needs survey results,a1?a2?a6?a7?b1?b5 belong to the desired demand(O);a3?a4?a8?b3?b6 belong to the essential demand(M);a5?b3?b4?c1?c2?c3?c4?c6?c9?c10?c11 belong to the charm demand(A);no difference in demand(I)are c5?c7?c8;The entries of IPA analysis results which should be focused on improving are a2,a4,a5,a7,a8,b2,b4,b5,cl,c3,c4,c6,c11;Maintain performance with al,a3,b3,b6;transitional performance with a6,b1,c2,c9,c10;and no concern with c5,c7,c8.3.The results of research on the implementation of interventions:SAS,SDS and SF-36 scores of the two groups were not statistically significant(P>0.05)before intervention.Before and after the intervention,SAS,SDS and SF-36 score of the control group were compared within the group,although after the intervention compared with the data before intervention,the data were slightly different,but the difference was not statistically significant(P>0.05).There was significant difference between the SAS,SDS and SF-36 scores in the experimental group before and after intervention(P<0.05).Comparing the two groups after intervention,the scores of SAS,SDS and SF-36 in the experimental group were all better than those in the control group,with statistical significance(P<0.05).Conclusion:1.This study compiled the?Hemodialysis Patients Supportive Care Questionnaire?,with good reliability and validity,can be used to explore the maintenance of hemodialysis patients with supportive care needs quality attributes and degree of need,provide a basis for the development of clinical nursing.2.Based on the survey results of the?Hemodialysis Patients Supportive Care Questionnaire?,a plan of supportive care intervention was formulated to reduce the anxiety and depression and improve the quality of life of patients.3.During the demand analysis,it is found that simply applying the patient care needs determined by the fuzzy KANO model does not guide the implementation of the interventions in the later period.Therefore,this study is supplemented by IPA analysis to further analyze the needs of patients.The combination of this method can provide a new idea for future needs investigation in the medical field.