| ObjectiveBased on the theoretical basis of the Omaha problem classification system and the classification system of nursing outcomes,we established the nursing-sensitive outcome indicators for patients with permanent colostomy through the Delphi expert consultation method.Based on this,we established “recording card of nursing intervention model for patients with permanent colostomy” combined with WeChat platform and applied to the patient’s transitional care,in order to increase their understanding of intestinal stoma disease,improve self-management ability,improve quality of life and reduce complications.Method1.To establish sensitive indicators of nursing outcome for permanent colostomy patients through the Delphi method.Based on the Omaha problem classification system and nursing outcomes classification system,27 experts were investigated using three rounds of Delphi consultation methods.The items of importance assignment satisfying the mean of >3.50 and the coefficient of variation <0.25 were included in the indicator system.Then indicators were confirmed after researching group’s discussion.2.The construction and clinical application of the recording card of the nursing intervention model for permanent colostomy patients based on nursing sensitive outcomes.Using the established nursing sensitive outcome indicators for permanent colostomy patients,following with corresponding nursing measures,we established a “recording card of nursing intervention model for patients with permanent colostomy” and used it to guide nurses to develop targeted care plans and implemented effective nursing interventions through the WeChat platform in order to give comprehensive care evaluation for patient outcomes.During the clinical application,72 permanent colostomy patients suffering primary ostomy in a tertiary comprehensive hospital were chosen for the purpose of sampling.The subjects were admitted to the hospital from January to March 2017 as the control group.The subjects admitted to the hospital from March to May were intervention groups with 36 patients in each group.Finally,35 patients in eachgroup completed the experiment.The researchers used the Omaha System Effectiveness Scale,the Permanent Gut Struction Patient Knowledge Test Questionnaire,the Permanent Intestinal Esophageal Self-Management Behavior Scale,and the Permanent Intestinal Mouths Patients Quality of Life Specific Scale questionnaire to investigate baseline data of patients when they were discharged.After the patients were discharged,we applied the WeChat platform to push “record cards” and used telephone to take follow-up and online interaction measures.The same questionnaires were used to evaluate the improvement of cognition,behavior,and state of the patients at the time of three months and six months after discharge.3.SPSS 17.0 statistical software was used to analyze the research data.The effective response rates of questionnaires and the submission rates of expert opinions were used to express the degree of activeness of the experts.The authority coefficient(Cr)and the Kendall Coordinated Coefficient were used to represent the degree of authority and coordination of the experts.The t-test,rank sum test,and variance analysis were used to evaluate the scores’ improvements of Omaha System Outcomes,Permanent Intestinal Esophagus Patient Knowledge Scores,Self-Management Behavior Scores,and Quality of Life Scores at discharge,3 months and 6 months after discharge.Result1.The results of the correspondence show that 27 experts from 25 tertiary A-level hospitals and 2 universities and colleges in 9 cities across the country have completed effective correspondence.The effective responses rates of the 3-round expert consultation were 96.6%,100%,and 96.4%,and the expert opinion submission rates were 55%,25%,and 12%.The authorities of experts were 0.895,0.899,and 0.909,and the coordination(coefficients)of Kendall’s W were 0.340,0.379,0.402,indicating that the results of this correspondence study were credible.2.The results of the inquiry showed that the common nursing problems of permanent colostomy patients covered the four major areas of physiology,health-related behaviors,social psychology and environment of the Omaha problem classification system,including ten nursing problems: defecation function,skin,cognition,rest and sleep patterns,self-care and care supervision,nutrition,contacting with community resources,interpersonal relationships,mental health and hygiene.The corresponding 69 indicators of nursing sensitive outcomes were 32,15,17 and 5 in the physical,health-related,psychosocial,and environmental fields,accounting for 46%,22%,25%and 7% of the total number of indicators.3.based on the care of permanent patients with colostomy and nursing sensitive outcomes,we start a construction of a nursing intervention record card and clinical validation in patients.The results of the study showed that at the time of discharge,there were no statistically significant differences in all aspects of nursing care between the two groups(P>0.05).Three months after discharge,except for the problem of contact with community resources,there was no difference in the overall scores between the two groups of patients.On other nursing problems,intervention group were significantly higher than the control group,and the difference was statistically significant(P<0.05).Six months after discharge,the scores of all nursing care intervention groups were significantly higher than those of the control group,and the difference was statistically significant(P<0.01).Within the group comparison,the intervention group used the WeChat platform combined with the record card to perform continuous,solidified and repeated interventions on patients for 3 months.The repeated measurements of variance analysis after their three-year discharge revealed that except for bowel movement function and skin condition,the behavior and situation of interpersonal relation,emotional health and community resources was statistically insignificant(P<0.05),and other nursing problems are scored all increased at discharge,and the difference was statistically significant(P<0.05).Six months after discharge,all the problems were statistically significant comparing with the those of discharge and the three months after discharge from this group of patients.The control group had no significant change in scores over time.At the time of discharge,the mastery scores of permanent enterostomy specialists in the two groups were(9.74±1.36)points and(9.49±1.44)points,both at a low level.After intervention,compared in group with the time of discharge,the score of social self-management dimension was not statistically significant at 3 months after discharge,and the self-management care score and total score improvement were statistically significant(P<0.05).Comparison among groups showed that all three dimensions were statistically significant,and six months after discharge,the significance was more significant(P<0.01).At discharge,there was no significant difference in the scores of total quality of life,physical dimensions,psychological dimensions,social dimensions,and spiritual dimensions between the two groups of patients.After intervention,the scores of social health dimension of the patients discharged after 3months were statistically insignificant(P>0.05),and the scores of other dimensions andtotal scores were all statistically significant(P<0.05)and the scores of all dimension were statistically significant compared in group(P<0.05).Six months after discharge,the scores of all dimensions were statistically significant even more significant(P<0.05).Conclusion1.The construction of nursing outcome-based sensitive indicators provides a theoretical basis for nurses to formulate nursing model for patients with permanent intestinal stoma.2.We effectively improve the nursing outcomes,physical and mental health,and social functions of patients with permanent colostomy,improve self-management and the quality of life through the "record card" combined with the WeChat platform. |
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