Nursing Intervention Based On The Corbin And Strauss Chronic Illness Trajectory Model In CD Patients After Surgery

Objective:To learn about the real illness experience and needs of patients living with Crohn disease after operation based on the framework of chronic illness trajectory model,and deeply analyze the causes.On the basis of understanding the real experience and needs of patients,we formulate corresponding nursing intervention programs,and explore the nursing intervention programs based on chronic disease trajectory model for patients with Crohn's disease after operation on quality of life,disease symptoms,treatment compliance,anxiety,depression and so on.Methods:This study is mainly divided into three parts.The first part is literature research,through reading a large number of literature,systematic analysis of patients'experience with inflammatory bowel disease.The second part is a qualitative study,using the concept of chronic disease trajectory and the theoretical framework of chronic disease trajectory model,selecting patients with Crohn's disease after operation in one of hospital in Nanjing,using the method of hermeneutic phenomenology,using semi-structured in-depth interview analysis,Colaizzi's seven-step analysis method,to understand the disease-related behavior and self-determination of patients after Crohn's disease operation in this stage.The real needs and experiences of self-conceptual behavior and daily life behavior are three dimensions.On the basis of the results of qualitative research,nursing intervention program based on the framework of chronic disease trajectory model was formulated.The third part of this study is the application of nursing intervention based on chronic disease trajectory model in patients with Crohn's disease after surgery.A randomized controlled trial was conducted.On the basis of convenient sampling,a nursing intervention scheme based on the trajectory model of chronic diseases was adopted.Relevant data were collected before and after the intervention(1 month and 3 months after discharge).Simplified Chinese version of the Inflammatory Bowel Disease Quality of Life Questionnaire(IBDQ)is the main evaluation index of this study,the Hospital Anxiety and Depression Scale(HAD),Morisky Medication Compliance Scale(MMAS-8),IBD symptoms and signs rating scale are the assistant evaluation tools for this study.SPSS20.0 statistical software was used for data analysis and processing.Results:In the first part,fifteen qualitative studies were recruited.Seven themes were identified:To know about IBD,heavy psychological pressure,struggling with IBD,self-image changed;how to cope with IBD,adjustment and seeking help formation and emotional support.The second part of the qualitative research results show that disease-related behavior:lack of disease knowledge,desire for doctor-patient communication;improvement of symptoms after surgery,disease activity reduced or disappeared;concern about the formation of healthy living habits,prevention of recurrence.Self-concept behavior:attaching importance to disease,facing up to disease;adapting to the state of disease,readjusting self-concept;daily life behavior:the original role weakened,the role of patients increased;accompanied by a serious sense of disease uncertainty;greater economic pressure,eager for social support.The third part:After the implementation of nursing intervention based on chronic disease trajectory model,the quality of life score,General Hospital Anxiety and depression evaluation results of patients in the experimental group were better than those of the control group at 1 and3 months of re-examination,with statistical significance(P<0.05).The compliance and efficacy of the experimental group were also better than those of the control group,with statistical significance(P<0.05).Conclusion:Stress and need support are the most notable experience for IBD patients.Thus,Individual psychological intervention,professional disease information support and good social support are necessary.Nursing intervention based on chronic disease trajectory mode has a good effect in patients after CD surgery,which can effectively improve patients' quality of life,improve negative emotions,improve treatment compliance,and is worth promoting.