Current Situation Of Self-Management Of Stroke Patients And The Construction Of Guided Care Model

Objectives:To investigate the condition of self-management of stroke patients and to analyze its influencing factors.In view of the condition of self-management of stroke patients,the Guided Care model is constructed to improve the self-management ability of stroke patients.It will promote the rehabilitation of stroke,and provide new methods and ideas for the rehabilitation nursing of stroke.Methods:This study was divided into 2 stages.The first stage was a cross-sectional study.The condition of self-management and the family support function of 129 stroke patients were investigated and the influencing factors were analyzed.It was the second stage that the Guided Care Model for stroke patients was built.Based on the Guided Care Model of The Johns Hopkins University,the basic framework of the model was constructed.24 experts were consulted through the 2 round by means of the Delphi Method.The data collected were analyzed by SPSS 20.0 statistical software.Statistical methods included statistical description,t test,analysis of variance(ANOVA),non-parametric test,Spearman rank correlation,and multiple stepwise regression analysis.Results:The overall score of self-management behavior of stroke patients is(186.29 ±24.231),of which the score of medication management is(20.83±2.881),the score of daily living management is(32.37±3.909),the score of social function and interpersonal management is(23.77±5.071),the score of rehabilitation exercise management is(26.65±5.017),the score of emotional management is(17.89±4.969),the score of diet management is(30.80±20.83),the score of disease management is(33.98±11.103).Family APGAR Index of stroke patients is(6.74±3.029).Personality,education level,income,main caregivers,care time,disability degree,the number of hospitalization is statistically different(P<0.05).Family APGAR Index is significantly correlated with the level of selfmanagement behavior(P<0.05).By using multiple stepwise regression analysis,it shows that the main caregivers,times of hospitalization and family care is the important factors that influence the self-management level of patients.Guided Care Model of Stroke which including 5 indexes and 33 items was constructed by using Delphi method.The 5 indicators include the purpose of the mode,the implementing agencies,the organizational structure,the duties of nurses and the content of the work.The enthusiasm of the two rounds of consultation is 92.85% and 92.31% respectively.The authority coefficient is 0.894 and the coefficient of variation(CV)is 0.08~0.17.Kendall's coefficient of concordance is 0.139,and the significance test is statistically significant(P<0.05).Conclusions:It is at the middle level in the Self-Management behaviors of stroke patients.The level of medication management and daily living management are high,and the level of disease management and diet management are the lowest.Family APGAR Index of stroke patients is in the middle range,and the whole needs to be improved.It is the important factors that affect the level of self-management of the patients with the main caregivers,the number of hospitalization and the degree of family care.It is suggested that the nurses should strengthen the management of disease and diet,and synchronous intervention with the caregivers.The Guided Care Model of stroke patients will be used for reference which the enthusiasm and authority of experts is well and the consistency of experts' opinions is better.