| Objcetive:The purpose of this study is to explore the supportive care needs of ischemic stroke(ischemic stroke,IS)patients,based on this and combined with Delphi expert consultation to build a comprehensive supportive care program for patients with ischemic stroke to meet their dynamic needs.Methods:This research consists of three parts:1.Quantitative study of supportive care needs in patients with ischemic strokeUsing the "Supporting Care Needs Scale for Stroke Patients" as a research tool,166,165,and 164 patients with ischemic stroke were selected for acute care,rehabilitation,and long-term recovery survey through convenient sampling to investigate the needs for supportive care,and to obtain the characteristics of supportive care needs at different stages of the disease.2.A qualitative study of longitudinal changes in supportive care needs in patients with ischemic strokeSelecting 14 patients with ischemic stroke for the first time under the construction of descriptive research methods to explore the dynamic experience of ischemic stroke patients in the acute phase(acute onset,in-hospital stable phase),rehabilitation(initial rehabilitation,continuous rehabilitation)and long-term recovery(adaptation period,functional role adjustment period),so as to clarify the characteristics of the dynamic changes in its supportive care needs.3.Construction of a comprehensive supportive care program for patients with ischemic strokeUnder the guidance of supportive care framework and based on the above results,the quantitative and qualitative research results are integrated to initially establish the content of a comprehensive supportive care program for patients with ischemic stroke;The content of the preliminary program was revised by Delphi expert consultation method selecting 15 experts,finally form a comprehensive disease care program for patients with ischemic stroke based on supportive care framework.Results:1.Quantitative research on supportive care needs of IS patients(1)The level of supportive care needs in patients with IS at different stagesThe standardized total score for supportive care needs of IS patients in the acute stage was(2.18±0.37)points,of which the disease-related information needs score was(2.75±0.40)points;the standardized total score for supportive care needs of IS patients in the rehabilitation stage was(2.24±0.38)points,disease-related information needs(2.85±0.41),social support needs(2.56±0.30),and rehabilitation care needs(2.28±0.63)are the top three;the standardization score of supportive care needs for IS patients with long-term recovery is(1.90±0.31)points,of which social support needs score is(2.62±0.3 6)points.(2)Comparison of the degree of supportive care needs of patients with IS at different stages of the diseaseThe standardized score of supportive care needs of IS patients in acute stage is higher than that of long-term recovery IS patients(P<0.001),and the standardized score of supportive care needs of IS patients in rehabilitation stage is higher than that of IS patients in long-term recovery(P<0.001).(3)Unmet needs for supportive care at all stages of IS diseaseThe proportion of acute IS patients with disease-related information needs not met is 75%,psychological care needs not met is 36.7%;rehabilitation IS patients with disease-related information needs not met is 77.6%,social support needs not met is 61.8%,rehabilitation care needs not met is 39.3%,psychological care needs not met is 32.7%;long-term recovery IS patients with disease-related information needs not met is 53.7%,social support needs unmet is 65.2%.2.A qualitative study of the dynamic changes of supportive care needs of IS patientsThere are 22 themes from the longitudinal qualitative study of the full supportive care needs of IS patients for disease throughout the six phases:① acute onset(disease-related information,early social support,emotional support,assistance with daily activities,management of impaired function,early functional rehabilitation);② stable period in the hospital(mainly discharge guidance);③initial rehabilitation(information on rehabilitation prognosis,initial rehabilitation guidance,continuous communication and support,psychological support,symptom management);④ continuous rehabilitation(secondary prevention,continuous Functional rehabilitation,psychological counseling);⑤adaptation period(long-term social support,psychological adjustment,long-term rehabilitation guidance,daily life guidance,long-term symptom management,cognitive adjustment);⑥role function adjustment period(functional role adjustment).3.Construction of a comprehensive supportive care plan for IS patientsThe questionnaire recovery rate for both rounds of expert consultation was 100%;in the first round of expert consultation,the coefficient of variation of one third-level indicator was>0.25 and the mean was<3.5;The second round of expert consultation,the indicators at all levels meet the coefficient of variation≤0.25 and the mean ≥ 3.5.In the first round of expert consultation,one indicator was deleted,two were modified,and four were added.The second round of expert consultation was not modified.Supportive care programs for patients with ischemic stroke include 6 primary indicators,25 secondary indicators,and 67 tertiary indicators.Conclusions:1.Quantitative research on supportive care needs of IS patientsThe demand for supportive care in the acute phase is at a medium to high level,with disease-related information being the highest.The demand for supportive care during the rehabilitation period is at a medium to high level,and the top three are the needs for disease-related information,social support and rehabilitation care.The need for supportive care during the long-term recovery phase is at a medium level,with social support being the highest.2.Study on vertical changes in the content of supportive care needs of IS patientsIS patients have a variety of supportive care needs at all stages of the disease.At each stage of the disease,the main supportive care needs is different and presents a dynamic characteristic.Supportive care should be provided in accordance with the needs of each stage to promote the better adaptation of chronically ill patients with IS.3.Construction of a comprehensive supportive care plan for IS patientsThe supportive care program based on supportive care framework for the patients with ischemic stroke is highly motivated and authoritative.All levels of indicators are important.Expert opinions tend to be consistent.It has certain scientificity and feasibility,which can meet IS patients’ supportive care needs throughout their illness. |
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