| Objective:1.Compile the continuous care demand scale of patients with permanent enterostomy and test the reliability and validity.2.To determine the changing trend of continuous care needs and quality of life of patients with permanent enterostomy over time.3.Analyze the relationship between the continuous nursing needs and quality of life of patients with permanent enterostomy at different time points after discharge.Methods:1.Formation of the scale entry pool: In April 2018,15 permanent enterostomy patients admitted to the wound stomy clinic of a grade III first-class hospital in Taiyuan city were selected as interviewees by the method of objective sampling,and semi-structured interviews were conducted according to the interview outline.In-depth analysis of the recording data,combined with relevant literature and group discussion results,to form a scale item pool.2.Formation of the first draft of the scale: from May 2018 to July 2018,20 international stomatological therapists and clinical experts from 13 grade-a hospitals in China were selected for 3 rounds of consultation.Revise the items according to the expert opinions and item selection criteria to form the first draft of the scale.3.Pre-survey of the scale: In August 2018,20 permanent enterostomy patients with the same characteristics as the formal investigation were selected for a small sample test to detect whether there were too many items in the scale and whether the statements were easy to understand and unambiguous.The scale was modified according to the patients' opinions.4.Formal survey of the scale: from September to December 2018,219 permanententerostomy patients from 3 grade a hospitals in taiyuan city were selected by convenient sampling.Relevant data were collected,and items were selected by critical ratio method,correlation coefficient method,homogeneity test and factor analysis.Validity of the scale was evaluated by structure validity and content validity,and reliability of the scale was evaluated by Cronbach's coefficient,partial reliability coefficient and retuning reliability coefficient.5.Permanent continuity of intestinal colostomy patients care needs and QOL of longitudinal research: using convenient sampling method,the selection of August 2018-December 2018 in taiyuan city 5 first-class ternary hospitals for the first time for colorectal cancer line permanent enterostomy and been discharged from hospital,89 patients as the research object,USES the general information questionnaire,permanent continuity of intestinal colostomy patients nursing demand scale,colostomy patients quality of life scale in patients discharged from hospital after 1 month,3 months,6 months,12 months follow-up survey.Results:1.Semi-structured interview results: the interview data were analyzed to summarize five topics of continuous nursing needs of patients with permanent intestinal stoma:physiological distress,insufficient stoma nursing skills,limited daily activities,negative emotional coping,and desire for external support.According to the semi-structured interview results and related literature,the group discussion resulted in the formation of a scale item pool with 43 items in 5 dimensions.2.Results of expert letter consultation: the effective recovery rate of 3 rounds of expert letter consultation was 100%.The expert authority coefficient(Cr)was 0.899,0.901 and0.929,respectively.The Kendall coordination coefficient(W)was 0.169,0.216 and 0.253(P < 0.001),respectively.According to the expert opinions and item selection criteria,the item expression was improved,2 items were merged,9 items were deleted,and the first draft of the scale containing 33 items in 5 dimensions was formed.3.Preliminary survey results: it took 5 ~ 12 min for 20 patients to complete the scale.The patients indicated that each item was unambiguous and easy to understand,and the scale was not modified.4.Official survey results: after item analysis,two items were deleted.The total Cronbach's coefficient of the scale was 0.938,and the Cronbach's coefficient of each dimension was 0.806 ~ 0.923.The overall half-reliability coefficient of the scale is 0.746,and the half-reliability coefficient of each dimension is 0.771 ~ 0.911.The total retest reliability coefficient of the scale is 0.879,and the retest reliability coefficient of each dimension is 0.790 ~ 0.872.I-cvi is between 0.80 and 1.00,and s-cvi is 0.95.The correlation coefficient R between each dimension and the total table is 0.758,0.781,0.701,0.749 and 0.748 respectively.5.Longitudinal research results: the patients with different measurement time points after discharge continuity care needs total score and each dimension score difference was statistically significant(P < 0.05),the continuity of care needs a score and physiology,colostomy care dimension scores a downward trend after rising first,daily activities,psychological and social support needs dimension scores showed a trend of rising;After discharge,the differences in the total QOL scores and scores of each dimension were statistically significant.The total QOL scores and scores of psychological,social and mental health dimensions all showed a downward trend,while the scores of physiological health dimensions showed an upward trend.The continuous nursing needs of patients at different evaluation points after discharge were negatively correlated with QOL.Conclusion:1.The continuous care needs scale of patients with permanent intestinal stoma has good reliability and validity,which can be used as a tool to assess the level of continuous care needs of such patients;2.The continuous nursing needs and QOL of patients with permanent enterostomy show a dynamic change.At different evaluation time points after discharge,the nursing needs of patients are unmet,and the quality of life is at a medium or lower level.Medical staff should scientifically assess the unmet needs of patients at different time points andcarry out targeted health care to improve patients' QOL. |
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