Action Research Of Feeding Shared Care Plan In Caregivers Of Patients With Diabetes Mellitus And Cerebral Stroke

ObjectivesTo understand the real situation of caregivers of patients with diabetes mellitus and cerebral stroke during feeding care.To explore the effects of feeding shared care plan on caregivers' care competence,care burden and care experience,as well as patients' feeding ability and blood glucose control.MethodsThis study was divided into two parts: 1.Qualitative research: A total of 12 caregivers of patients with diabetes mellitus and cerebral stroke in a top-three hospital in Zhenjiang were selected with objective sampling method.Semi-structured interview was used to understand the real experience of caregivers during feeding care.2.Intervention research: The patients with diabetes mellitus and cerebral stroke and their caregivers who met the standards in a top-three hospital in Zhenjiang were selected by convenience sampling method and divided into the intervention group(n=38)and the control group(n=37).The caregiver is the object of intervention.The intervention group adopted the feeding sharing care plan based on the action research method,that is,according to the spiral cycle of “plan-action-observation-reflection”,formed the service scheme of feeding sharing care plan and implemented two rounds of action intervention.Before intervention,after the first round of action,and after the second round of action,the caregivers were evaluated by Family Caregiving Competence Scale,Zarit Caregiver Burden Interview and semi-structured interview,and the patients were evaluated by Minimal Eating Observation Form,fasting blood glucose and postprandial glucose excursion.The control group received regular feeding care instruction,and the evaluation tools and time were the same as the intervention group,but no semi-structured interview was conducted.Results 1.Results of qualitative research: Through interviewing caregivers of patients with diabetes mellitus and cerebral stroke,their real experience of feeding care was understood,and the three themes of feeding care were extracted: inadequate nursing knowledge and skills,positive and negative coping,and lack of relevant support.2.Results of intervention research:(1)After the first cycle,the inter-group comparison showed that the intervention group were better than control group about caregivers' care competence,care burden and patients' feeding ability,fasting blood glucose and postprandial glucose excursion(P<0.05),except for caregivers' family cohesion and patients' feeding,energy and appetite.The intra-group comparison showed that the caregivers' care competence,care burden,and feeding ability,fasting blood glucose and postprandial glucose excursion in the intervention group were all better than those before the intervention(P<0.05).The interviews showed that caregivers' care knowledge and skills should be improved(theoretical and practical barriers to transform,inadequate interaction and communication),and caregivers' cope style should be more mature(self-efficacy improved,roles changed reasonably).According to the data analysis,we optimized the educational means and tools,adjusted the first-round plan and formed the second-round plan.(2)After the second cycle,the inter-group comparison showed that the intervention group were better than the control group about caregivers' care competence,care burden and patients' feeding ability,fasting blood glucose and postprandial glucose excursion(P<0.05).The intra-group comparison showed that the caregivers' care competence,care burden,and patients' feeding ability,fasting blood glucose,and postprandial glucose excursion in the intervention group were all better than those before the intervention,and there were interaction effects(P<0.05).The results showed that caregivers were more satisfied with their care knowledge skills,cope styles and supportive services.ConclusionQualitative interviews reveal that caregivers of patients with diabetes mellitus and cerebral stroke have inadequate care knowledge and skills,positive and negative coping,and insufficient relevant support in the process of feeding care.Adopting the action research method of “plan-action-observation-reflection” to form and implement the feeding shared care plan can improve the caregivers' care competence,care burden and care experience,as well as patients' feeding ability,fasting blood glucose and postprandial glucose excursion.