| BackgroundIn recent years,the incidence and mortality of lung cancer have grown rapidly around the world,seriously threatening human life and health.Early and accurate diagnosis and early treatment are the key to improve the survival rate and prognosis of lung cancer patients.Cytological and histopathological diagnosis is the gold standard for the diagnosis of malignant tumors,and bronchoscopy has obvious advantages in obtaining pathological specimens.Endobronchial ultrasound-guided transbronchial needle aspiration(EBUS-TBNA)is the latest minimally invasive technique for the diagnosis and treatment of hilar and mediastinal lesions.It is equipped with a miniature ultrasound probe in electronics,the bronchoscope front end enters the trachea and bronchial lumen with the bronchoscope,and performs real-time ultrasound scanning on the lesion wall and adjacent lesions,and forms a high-definition image,which enables the surgeon to make the lesion more precisely and safely under ultrasound.Diagnosis and treatment operations.It is an invasive irritant test,and the bronchoscope probe is thicker,has strong stimulation to the trachea,and has a longer examination time.Therefore,patients who receive the test often have obvious discomfort and even anxiety,tension and fear.It does not work well with the examination,which requires a lot of time for the operator,and increases the difficulty of the operator intubating and aiming at the material,thus increase the risk of complications.Patient health education can eliminate patients' nervousness,improve patient cooperation,shorten the operating time,and complete the examination safely and efficiently.However,the current health education on EBUS-TBNA examinations is mostly a regular mission,with a single form,lack of theoretical guidance,no attributes of nursing pathways,and lack of specificity and sensitivity of health education evaluation indicators.This study aims to investigate the health education needs of patients receiving EBUS-TBNA examination.and based on the results of the survey to develop standardized health education pathways under the guidance of multiple media,advanced education theory and apply to patients receiving EBUS-TBNA examination,and to explore the application and education effect of standardized health education pathways.Objectives1.Investigate the health education needs of patients who implement EBUS-TBNA examination and analyze their relevant influencing factors2.Establish standardized health education pathways that meet the needs of patients and have clinical feasibility,and guide clinical nurses' work practices3.Apply the standardized health education pathway to patients who receive EBUS-TBNA examination and evaluate its education effectMethods1.Using the convenient sampling method,select the patient who was admitted to the endoscopic diagnosis and treatment center of the thoracic surgery department of the top three hospitals in Jiangsu Province from December 2016 to August 2017 for the first time to conduct EBUS-TBNA examination,use the self-designed questionnaire to investigate the content and method demand in health education of patients with EBUS-TBNA during the patient's appointment,and the data is collected into the statistical software.The frequency,composition ratio,mean,standard deviation are used to calculate the general information,the health education content demand and method demand score statistical description.Univariate statistical analysis was performed using independent sample t-test and single factor variance analysis.The influencing factors were analyzed using multiple stepwise linear regression.2.Domestic and foreign related literatures were reviewed,and valuable literatures were retrieved by inputting keywords bronchoscopy,EBUS-TBNA,health education,nursing pathway,standardized health education,etc.,to understand the research trends in related fields,in combination with the results of early EBUS-TBNA health education needs survey,the initial form of the health education path was developed.2 medical experts and 7 nursing experts were selected for in-depth discussion,evaluation and modification of the contents,professionalism systematicness,and feasibility of the EBUS-TBNA health education pathway.After clinical trial and modification,the contents of the EBUS-TBNA health education pathway were finally determined.3.101 patients who were admitted to the thoracic surgery department of a grade a hospital from September 2017 to April 2018 for the first time to undergo EBUS-TBNA examination in the endoscopic diagnosis and treatment center and met the inclusion and exclusion criteria were selected as study objects.Patients from September 2017 to January 2018 were included in the control group,and patients from February 2018 to June 2018 were included in the experimental group.The control group received routine health education,the experimental group received standardized education under self-developed health education pathway.Two groups of patients with self-rating anxiety scale,heart rate recovery time,blood oxygen saturation recovery time,a success rate of intubation and satisfaction were collected and compared.The data were statistically processed by SPSS20.0 software.The count data was expressed by frequency and percentage.The comparison analysis of the group was performed by ?2 test.The measurement data were described by mean ±standard deviation.The two groups were compared by t test.The test hypothesis used two-sided test.,and the difference was statistically significant at P<0.05.Results1.In the EBUS-TBNA survey of patients' health education needs,the average score of healthy education content needs were 68.83±9.80,total score of the way of health education needs were 13.84±1.30.The higher the score,the higher the demand,the items with higher demand are concentrated in the coordination of inspections,post-inspection precautions and matters for reporting,the way to listen to professional explanation is most needed.The single factor analysis of patients' general data showed that age,occupation,cultural level,caregivers,medical treatment charge payment all scores have an impact on demand for health education,further the multivariate linear regression analysis showed that different age,culture level,health care payment has independent factors influence to the score,statistically significant difference(P<0.05).2.The construction of the standardization of health education pathway table,including time,place and content of health education,practitioners and effect evaluation of five parts,practitioners were competent doctors,nurses on duty and bronchoscope room doctor on duty,nurse on duty four categories,health education content points were booking,before inspection,examination,after inspection,and there are 20 items of four entries.After the preliminary experiments show that the route table is practical,normative and maneuverability.3.51 people were in the experimental group,and 50 people were in the control group,two groups of patients with basic information comparable(P>0.05),for two sample data do not obey the normal distribution,so use Wilcoxon rank sum test.The experimental group SAS scores significantly decreased,compared with the control group,the difference was statistically significant(P<0.001);The experimental group the heart rate,blood oxygen saturation recovery time were down,compared with the control group was statistically significant difference(P<0.001);The success rate of primary intubation in the experimental group was higher than that in the control group,and the difference was statistically significant(P=0.007).Education satisfaction of health in the experimental group was higher than that in the control group,and the difference was statistically significant(P=0.013).conclusions1.EBUS-TBNA is a newly emerging minimally invasive diagnostic and treatment technology of thoracic surgery,and its patients have high demand for health education.Patients of different ages,education levels and medical insurance payment have statistical significance in the difference of health education demand for EBUS-TBNA examination.In terms of demand methods,professional explanation is the most needed.Therefore,individualized health education should be provided to patients in clinical work.2.Standardization health education pathway for patients with EBUS-TBNA inspection based on the results of the survey,combined with literature review,expert discussion has clinical maneuverability.The implementation of the pathway to reduce patients' anxiety and stress,the heart rate and blood oxygen saturation return to the steady state more quickly,improve the success rate of intubation,improve the medical service quality,won the patients satisfaction of the patients.Compared with the conventional health education,standardized health education has better effect. |
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