A Study On Application Of Case Management Model Based On Omaha System In Hemodialysis Patients

【 Objective 】(1)In the framework of the Omaha System,Knowledge-Attitude-Practice Model,Case Management,Holistic Nursing Theory and nursing theory as the support,to establish the hemodialysis patients case management mode based on Omaha system;(2)the model was applied to patients with Maintenance Hemodialysis in assessment,intervention,evaluation of effect,To compare influence of patients’ Knowledge – Behavioral-Status(K-B-S),nutrition,calcium phosphorus metabolism,dialysis adequacy,the quality of life.【Method】(1)Reviewing literature,in the framework of the Omaha system,in combination with disease characteristic of End-Stage Renal Disease in patients with Maintenance Hemodialysis,build up the Maintenance Hemodialysis case management assessment-intervention-evaluation form.revise according to thefeedback of expert consultation.And conduct preliminary tests.Finally,a case management record of hemodialysis patients based on Omaha system was completed,and the patients problems were graded by Likert5 method from three aspects: cognition,behavior and condition.(2)included 88 patients who match Inclusion criteria and conduct Maintenance hemodialysis in the blood purification department From June 2016 to October 2017.they were Randomly divided into the intervention group and the control group,each group of 44 people.Control group given the conventional treatment and care of blood purification,while intervention group was given case management Based on the Omaha system.Evaluation of patients health problems K-B-S score,nutrition indicators,residual kidney function,,calcium and phosphorus metabolism,dialysis adequacy,diet and water intake compliance,Health related quality of life before and after the intervention.【 Results 】(1)the incidence ≥25% health problems among Maintenance hemodialysis patients were total of 15: Urinary function(97.7),nutrition problems(93.2%),digestive(90.9%),skin(65.9%),circulation(61.4%),the nerve-muscle-bone(56.8%),physical activity(52.3%),mental health(43.2%),facial features/oral cavity(43.2%),sleep(38.6%)and income(36.4%),health care(36.4%),drug therapy(34.1%),catheter/ Vascular access(31.2%),resources/information(27.3%).(2)Analysis the improvement of commen 15 health problems,Results show that,the change in situation grade of income and facial features/oral cavity nostatistical significance(P > 0.05),there were no statistical significance(P >0.05)in the change of Behavioral-Status of circulation function and Urinary function.The k-b-s scores of other major nursing problems were improved when compared with those in the group,and the difference was statistically significant(P < 0.05).(3)Before the intervention,the differences in serum albumin,hemoglobin and c-reactive protein,i PTH,serum calcium,serum phosphorus,serum potassium,creatinine,uric acid,Bu N,Kt/V,IDWG,systolic blood pressure,diastolic blood pressure,NT-pro BNP in the two groups were not statistically significant(P >0.05).After 6 months,the differences in creatinine,uric acid,Bu N,Kt/V,IDWG,systolic blood pressure,diastolic blood pressure,NT-pro BNP in the two groups were statistically significant(P < 0.05).There was no significant difference in serum potassium,Bu N,Kt/V and systolic blood pressure(P>0.05).intergroup comparison shows that albumin,hemoglobin,serum calcium,Kt/V of patients from intervention group were all increased,while the control group were decrease.The i PTH,serum phosphorus,creatinine,and uric acid in intervention group were decreased,and changes in serum potassium and Bu N were not statistically significant(P>0.05).(4)Before intervention,there was no statistically significant difference between the two groups in the score of 18 items in the KDQOL-SFTM scale(P >0.05).After the intervention,the comparison of the two groups showed that KDQOL-SFTM total score and physical function,general health,vitality,social function,mental health,symptoms/problem,cognitive function,sleep,social support,patient satisfaction score difference of the 10 projects has statistical significance(P < 0.05).in Intervention group,the total score of KDQOL-SF,,body function,body pain,general health,vitality,emotional function,symptoms/problem,cognitive function,sleep,patient satisfaction were better than before(P <0.05).statistically significant differences between before and after intervention(P< 0.05),There was no significant difference in the scores of all the items in the control group before and after intervention(P>0.05).(5)After intervention,the Dietary adherence and water intake adherence in the Intervention group were better than before,the difference was statistically significant(P < 0.05).【Conclusions】(1)There are many health problems in patients with end-stage renal disease,and they live with poor quality of life.(2)The Omaha System,as a community-based,simplified nursing program,is useful for evaluating health problem of maintenance hemodialysis;Case management can improve the Knowledge-Behavioral-Status of patients with hemodialysis.The case management model based on Omaha system can help improve the nutritional status of patients,improve the calcium and phosphorus metabolism,improve the compliance of diet and water intake,and alleviate the volume overload.The case management model based on Omaha system can improve the quality of life of patients with maintenance hemodialysis.