| ObjectiveTo construct a self-management scheme for the rehabilitation of patients with bladder cancer with cutaneous ureterostomy;to explore the effect of self-management intervention on the self-management ability,stoma adaptation level,stoma complications and quality of life of patients with bladder cancer with cutaneous ureterostomy after operation;to clarify the application value of self-management intervention for the rehabilitation of patients with cutaneous ureterostomy after hospital,so as to provide clinical and community benefits and provide the reference for continuous nursing service of self-management intervention after hospitalization for patients with cutaneous ureterostomy.Methods1.From September 2017 to May 2018,106 patients were selected as the study subjects who successfully underwent radical cystectomy and cutaneous ureterostomy at the Urology Department of a tertiary general hospital in Zhengzhou.After signing the informed consent,the patients who met the inclusion criteria were numbered according to the sequence of cutaneous ureterostomy.The patients were randomly divided into observation group and control group by random number table.The patients in the control group received routine nursing measures after operation,including health education,routine health education materials,teaching urostomy nursing methods and receiving telephone consultation;the patients in the intervention group received self-management intervention on the basis of routine nursing,mainly including self-management training of patients with stable condition after operation by members of the research group.The self-management handbook for patients with cutaneous ureterostomy,which was designed by the research group after Delphi expert consultation.After the patient's condition was stable,the self-management intervention was carried out from 3 aspects:self-management of the stoma,management of daily life of the stoma,self-assessment and monitoring of the self-condition.After the hospital,the regular telephone call and Wechat follow-up for six months was made every two weeks by a specialized person.2.Patients'demographic data and disease-related data were mastered by patient general situation questionnaire before and after intervention.Patients'stoma self-management ability was assessed by Urostomy Patient Self-Management Scale and the complications of stoma were countedat at the time of discharge,3 months and6 months after discharge,and patients'stoma adaptation level was assessed by stoma Patient Adaptation Scale;patients'stoma adaptation level was assessed by Chinese version of Stoma Patient Adaptation Scale.The quality of life scale(QOL)was used to evaluate the effect of QOL intervention 3 months and 6 months after discharge.3.SPSS22.0 statistical software was used for data analysis.Descriptive statistical analysis,two independent samples t-test,chi-square test,rank sum test and repeated measurement variance analysis were used to analyze the collected data.Results1.106 patients with cutaneous ureterostomy were enrolled in this study.Four of them were exfoliated.The sample loss rate was 3.77%.There were 50 cases in the intervention group and 52 cases in the control group.Among 102 patients,79(77.45%)were males and 23(22.55%)were females;the average age of patients was(66.32±5.82)year;those with junior high school education or above 66(64.71%);27(26.47%)were divorced or widowed;73(71.57%)were living in cities;47(46.08%)were complicated with hypertension and diabetes;the average hospitalization time of patients was(13.32±4.67)days;there was no significant difference in general data between the two groups(P>0.05).2.Self-management of patients with cutaneous ureterostomy:There was no significant difference in the total score of self-management between the two groups before intervention(t=0.179,P=0.858).The difference in the total score of self-management intervention between the two groups at 3 months and 6 months after intervention was statistically significant(P<0.05).The total score of self-management of the two groups changed with time and group.The total score of self-management intervention in the intervention group gradually changed from(39.68±11.82)to(50.45±10.13)and(65.25±12.17),indicating that the change trend of the total score of self-management intervention in the two groups was different with time and group,and the instant effect and grouping effect were statistically significant(P<0.05).The total score of self-management intervention in the control group were changed from(40.12±12.97)to(45.72±9.14)and(50.41±9.45).The total score of self-management intervention of patients was affected by group factor(F=97.625,P<0.001),time factor(F=252.314,P<0.001).There was a interaction between the time effect and grouping effect of the two groups(F=37.271,P<0.001).3.The score of stoma adaptation of patients with cutaneous ureterostomy:the score of intervention group was(41.86±12.70)at discharge,and that of control group was(43.02±10.91).There was no significant difference between the two groups(t=0.495,P=0.621),which was comparable.The score of intervention group was(53.67±8.87)at the third months after discharge,and that of control group was(47.27±11.13).The difference between the two groups was statistically significant(t=-3.204,P=0.002).Six months after discharge,the score of the intervention group was(65.05±9.47)and the control group were(50.41±8.35).There was significant difference in the scores between the two groups(t=-8.290,P<0.001).The scores of two groups at different time points were analyzed by repeated measures of variance.The adaptation level of patients was affected by group factor(F=7.225,P<0.001),time factor(F=65.014,P<0.001).There was interaction between the time effect and grouping effect of the two groups(F=19.291,P<0.001).4.The incidence of stoma-related complications:The incidence of stoma-related complications of the two groups at discharge were 8%and 5.8%respectively.The incidence of complications in the intervention group was 30.0%at 3 months after discharge and 50.0%in the control group.The difference between the two groups was statistically significant(P=0.046).At 6 months after discharge,the incidence of complications in the intervention group was 12.0%,the control group was 38.5%.There was a significant difference between the two groups(?~2=9.398,P=0.002).Urinary infection and irritative dermatitis around the stoma were the main complications.5.Quality of life scores of patients with cutaneous ureterostomy after operation:The total scores of quality of life of patients in intervention group and control group after self-management intervention after 3 months were(5.25±2.74)and(4.07±2.12)respectively.The total scores in two groups after 3 months were statistically significant by Mann-Whitney U rank test(Z=-1.228,P=0.027).The total scores of the two groups after 6 months intervention were(6.67±3.12)and(5.01±2.45)respectively.Statistical analysis showed that there were significant differences in the total scores of the two groups at 6 months(t=-2.995,P=0.003<0.05).The scores of the two groups at different time points were analyzed by repeated measures of variance.The results showed that there were significant differences between the two groups.The quality of life score was influenced by group factors(F=47.285,P<0.001),time factors(F=169.147,P<0.001).There was a interaction between the time effect and grouping effect of patients'quality of life score(F=15.691,P<0.001).ConclusionSelf-management intervention is a safe and effective nursing intervention mode suitable for patients with cutaneous ureterostomy.It can effectively enhance the mastery of disease-related knowledge and skills of patients with cutaneous ureterostomy,improve the adaptation level of patients with post-hospital stoma,reduce the occurrence of stoma-related complications,and improve the self-management ability and quality of life of patients after hospital. |
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