Construction And Application Of Symptom Management Scheme For Patients With Urinary Ostomy

Objective:Develop a symptom management plan for patients with urinary ostomy and evaluate its application effect in patients.Specific goals:?Investigate the longitudinal changes of symptom clusters in patients undergoing total bladder ureterostomy;?Develop a symptom management plan for urethral stoma patients based on the results of longitudinal investigation of symptom groups and evidence-based nursing concepts,and implement ureterostomy for clinical patients Symptom management provides the theoretical basis;? Evaluate the effect of the application of symptom management schemes in patients with urethral stoma;?Eventually achieve to improve the patient's stoma adaptation level,reduce the incidence of stoma-related complications,and improve the quality of life of patients.To formulate a symptom management scheme for patients with urethral stoma and evaluate its application effect in patients with urethral stoma.Method:This study consists of three parts.Part I:Longitudinal study of symptom groups in patients with urethral stoma.To investigate the general demographic and clinical data of patients undergoing radical cystectomy and ureterostomy in our hospital from December 2018 to June 2019,and used in patients 1 week,1 month and 3 months.The Chinese version of the Anderson Symptom Inventory(MDASI)was used to investigate symptoms.Data analysis was performed using SPSS 23.0.Statistical demographic methods were used to analyze general demographic data,and exploratory factor analysis was used to analyze patient symptom cluassters.Part ?:Establishing a symptom management plan for patients with bladder total ureterostomy.According to the results of the first part of the symptom clusters survey,formulate a symptom management plan from the literature review and Delphi expert consultation,and review relevant clinical practice guidelines in this field.?Literature review and evaluation:search Chinese and English databases and related guide websites.English search terms include continuous of nursing/care,continuous nursing/care,continuous nursing/care,transitional nursing/care,follow-up care/nursing,care/nursing after discharge,post-discharge nursing/care,telephone,home/family visit,teleursing/telecare,management,symptoms,symptom clusters,Urban stoma,Bladder cancer stoma,ostomy,Best Practice Guideline,Clinical Practice Guideline,Chinese search terms include stoma,Urostomy,continuous care,symptom management,best practice guidelines,clinical practice guidelines.The search is based on a combination of subject words and free words.The search period is up to May 2019.? Delphi expert consultation method:Combining the results of the symptom group survey and the literature search results,a questionnaire for the management of symptoms of bladder total ureterostomy patients was compiled,and two rounds of experts were conducted for 15 clinical stoma care experts in and outside the province.Correspondence to improve the plan.Part ?:Preliminary application of symptom management scheme for patients with bladder total ureterostomy.Select our hospital for urology admission from August 2019 to January 2020,and explain to patients after meeting the inclusion criteria.Patients who are willing to participate in this study are numbered according to the admission order and grouped against a random number table.The corresponding random numbers are even.The intervention group,the odd number is the control group.Finally,76 cases were collected,and 38 cases in the control group,using conventional health education methods;38 cases in the intervention group,on the basis of conventional health education,using pre-established symptom management programs to intervene patients,encouraging patients to participate in the week A"stomato sunlight lecture hall".The quality of life,stoma adaptability,and complications around the stoma were evaluated at the time of discharge and 1 month after surgery.Results:Part 1:A total of 59 patients who completed an effective survey.Exploratory factor analysis showed that there were 4 symptom clusters at 1 week after operation.Factor 1 was named as a stoma-related symptom group,,including 4 items:sadness,distress,sleepiness,and stoma.Management,factor 2 is named as pain-related symptom group,including 3 items:pain,fatigue,lack of sleep,factor 3 is named as gastrointestinal symptom group,including 2 items:nausea,poor appetite,and factor 4 is named as somatic symptom group,Including 2 entries:dry mouth,forgetfulness;3 symptom clusters presented in January postoperatively,factor 1 was named stoma-related symptom cluster,including 3 entries:sadness,stoma management,insufficient sleep,and factor 2 was named pain Related symptom groups,including 4 items:pain,fatigue,distress,drowsiness,factor 3 is named somatic symptom group,including 3 items:forgetfulness,numbness,and poor appetite;3 symptom clusters are presented in 3 months after operation,factor 1 For the stoma-related symptom group,it includes 3 items:sadness,drowsiness,and stoma management.Factor 2 is named as the pain-related symptom group,which includes 3 items:pain,fatigue,lack of sleep,and distress.3 designated groups somatic symptoms,including two entries:forgetfulness,poor appetite.Part 2:Include 4 guides after searching and evaluation.They are "Ostomy care and management" published by the Canadian Association of Registered Nurses of Ontario(RNAO)in 2009,and "International Ostomy" published by the World Association of Osteopaths(WCET)in 2014 Guideline,Discharge Planning for a Patient With a New Ostomy,released by the American Wound and Incontinence Association(WOCN)in 2015,and Management of the Adult Patient With a Fecal,released by the American Wound and Incontinence Association(WOCN)in 2018 or Urinary Ostomy-An Executive Summary."Based on the results of the symptom group survey and the screening opinions of the guideline,a "symptom management plan for patients with total bladder resection and ureterostomy" was constructed,and two rounds of expert consultations were completed.The two rounds of expert consultation positive coefficients are 100%,the judgment coefficient Ca is 0.57 and 0.66,the familiarity Cs is 0.89 and 0.92,and the expert authority coefficient Cr is 0.73 and 0.79,respectively.After the second round of consultations,the coordination coefficients of the first-level indicator,the second-level indicator and the third-level indicator were 0.506,0.190,and 0.104,respectively,indicating that there were fewer experts' differences,the opinions tended to be consistent,and the consensus degree of the item indicators was higher.Experts give suggestions for amendments to the article,and based on expert opinions,establish a symptom management plan for patients with bladder total resection and ureterostomy.Part 3:38 cases were included in the intervention group and 38 cases were in the control group.There were no cases of lost follow-up during the period from discharge to 1 month after surgery.There were 76 effective cases with an effective rate of 100%,1.Quality of life:There was no statistical difference in the scores between the intervention group and the control group before discharge(P>0.05).Patients in the intervention group had physical function(PHD),psychological function(PSD),and social function(SOD)1 month after surgery.),Specific module(SPD),and total(TOT)scores were higher than the control group,the difference was statistically significant(P<0.05).The intervention group scores in all areas were higher than those before discharge from hospital,and the differences were statistically significant.Significance(P<0.05).Physical function(PHD),social function(SOD),common symptoms and side effects(SSD),and total(TOT)scores in the control group at 1 month after operation were higher than those before discharge.The intentional module(SPD)was less than 1 month after discharge,and the difference was statistically significant(P<0.05);2.Stoma adaptability level:there was no significant difference in scores between the two groups of patients before discharge(P>0.05),The score of the intervention group was significantly higher than that of the control group at 1 month after operation,and the difference was statistically significant(P<0.05).3.Incidence of ostomy complications:The incidence of ostomy-related complications was different between the two groups of patients.No statistical significance(P>0.05),and the incidence of complications in the intervention group at 1 month after surgery Significantly lower than the control group,two groups of patients the incidence of complications and the difference was statistically significant(P<0.05),urinary tract infection and wherein around the stoma skin irritation inflammation major complication.Conclusion:Nursing staff should continue to pay attention to patients with bladder total urethral stoma,especially during the period from the patient's discharge to 1 month after surgery.The patient lacks the knowledge and skills of stoma nursing,lacks awareness of stoma complications,and is afraid of stoma care.Symptom management plan for patients with bladder total ureterostomy provides patients with knowledge and information on disease management,role management and emotional management to ensure the effective continuation of relevant information after-discharge,combined with regular telephone follow-up and WeChat health knowledge.The form of push and outpatient follow-up,continuously pay attention to the patient's post-hospital symptoms,give the patient proper guidance and encouragement,reduce the patient's negative emotions,improve the post-hospital adaptation level of urostomy patients,improve the quality of life of patients and the nurse's Work efficiency provides a reference for clinical and community-based postoperative continuous nursing services for patients with urethral stoma.