Investigation On Self-Management Behavior Of Patients With Myocardial Infarction After Re-Admission Based On Information-Motivation-Behavioral Skill Model

Objectives:1.To understand the current situation of home self-management of patients with myocardial infarction,as well as disease-related knowledge,self-efficacy,comprehension of social support,and quality of discharge guidance.2.To explore the weak points of home self-management behavior of patients with myocardial infarction after re-admission and related factors.3.To Explore the real experience and actual needs of patients with myocardial infarction in the process of self-management,supplement the results of influencing factors of self-management behavior of patients with myocardial infarction,and finally improve self-management programs and patients’ life quality.4.To explore effective disease self-management guidance strategies initially,in order to provide a theoretical basis for the development of high-quality and effective secondary prevention measures for hospitalized and discharged patients in clinical nursing work.Methods:This study consists of two parts: cross-sectional survey in quantitative study and phenomenological study in qualitative study.Quantitative study: This study used a convenient sampling method to select patients with myocardial infarction admitted to the Department of Cardiology of a top three hospital in Taiyuan City from December 2017 to November 2018 as the study object,and finally selected patients with myocardial infarction who met the inclusion criteria.270 questionnaires were conducted and 264 valid questionnaires were returned.The general information questionnaire,coronary heart disease knowledge and cognitive questionnaire,coronary heart disease self-efficacy energy scale,comprehension social support scale,discharge guidance quality scale,coronary heart disease self-management scale were used as investigative tools to evaluate the self-management behavior of patients admitted to hospital.Pearson related analysis and multiple linear hierarchical regression analysis were used to explore the factors affecting self-management behavior.Qualitative study : This study used the purpose sampling method to select 22 patients with myocardial infarction who were re-admitted to the Department of Cardiology of a top three hospital in Taiyuan City from July 2018 to November 2018 as in-depth semi-structured interviews.To analyze the main idea of materials by using the Colaizzi’s phenomenological 7-step analysis method.Results:1.Quantitative study results: The total score of self-management behavior of patients with myocardial infarction was 74.74±9.90,the score index was 66.79%,which was at medium level.The self-management and disease knowledge of patients with myocardial infarction was significantly positive.Correlation(r=0.534,P<0.001)was positively correlated with self-efficacy(r=0.537,P<0.001)and comprehensible social support level(r=0.455,P<0.001),and was significantly positively correlated with discharge quality.(r=0.658,P<0.001).The results of multivariate stratified regression analysis showed that after controlling the general demographic data variables,knowledge-motivation-behavior skill factor variables can explain the 31.9% of self-administration variability.And expected occupation,co-occupants,place of residence,previous admissions due to myocardial infarction,coronary heart disease awareness,self-efficacy,functional maintenance,comprehending social support,actual knowledge acquisition,and instructional skills are re-admitted significant factors influencing the self-management behavior of patients with stalks.2.Qualitative study results: The interview data of 22 patients with myocardial infarction who were admitted to hospital were summarized and repeated,and 4 topics and15 sub-themes related to the past self-care experience of such patients were extracted:(1)positive factors that promote self-management behavior: rich self-management knowledge,psychological incentives,timely attribution,and protection against comorbidities;(2)negative factors that hinder self-management behavior: lack of specific management knowledge,lack of insufficient self-action,poor self-control ability,family and social support because of overdependence of medical professional care;(3)problems in theprocess of self-management: negative emotions and psychological stress due to the disease,diversified learning pathways of selected diseases,and acquisition of acquisitions(4)new expectations for re-discharge: to get quantitative guidance on lifestyle,incorporate guidance for family members,master first-aid knowledge of heart care and disease,and rely on medical professional guidance.Conclusions:1.The self-management level of patients with myocardial infarction who are admitted to hospital is not ideal overall,especially the management level of disease medical management,including disease knowledge,treatment compliance,and emergency management.2.Complementary study combined quantitative study and qualitative interview study showed that the main factors influencing self-management behavior changes of patients with myocardial infarction coronary are heart disease knowledge and understanding level,self-efficacy,comprehension of social support level,quality of discharge guidance,negative psychological,self-control ability,overdependence on medical staff.3.Clinical health care personnel should take the knowledge,motivation and behavioral skills as the main point.Special attention should be paid to the number of times of lower education,living in rural areas,living alone,medical expenses,self-funded,and previous hospitalization frequency.More guidance,the average per capita income monthly,and the current practice of smoking,and the qualitative and negative experiences of patients in the self-management process,take appropriate comprehensive intervention measures from the actual needs of patients to improve the nursing staff’s professional quality,focus on filling the patient’s medical management knowledge gap,and take into account the effective guidance of family members,etc.,ultimately improve the patient’s self-management ability,reduce the occurrence of unexpected cardiac events,and promote the health of the whole people.