Construction And Implementation Of The Transitional Care Program For Patient With Intermittent Catheterization After Radical Hysterectomy Of Cervical Cancer

Objective:In order to acquire the current situation of transitional care for patients with intermittent catheterization after radical hysterectomy of cervical cancer and patient's experience and requirements.This research combined guideline reviewing and Delphi method to construct a transitional care program for patients with intermittent catheterization after radical hysterectomy of cervical cancer.Evidence-based,scientific and normative program is expected to promote outcome of patients with intermittent catheterization after radical hysterectomy of cervical cancer.Method:1 In order to understand the current situation of transitional care for patients with intermittent catheterization after radical hysterectomy of cervical cancer,doctors and nurses of Gynecology department were selected as objects of the study with the approach of semi-structured interview of qualitative research in the idea of purposive sampling;Patient's experience and requirements were got with the same way.The research was attempted to make proper supplements and lay a foundation of constructing the program.2 Systematic retrieval and evaluation of clinical practice guidelines related to intermittent catheterization,and summarize the high-quality guideline recommendations.And through the expert meeting method to demonstrate the applicability of the recommendations,select and formulate recommendations suitable for clinical practice.3 Following the transitional care model and omaha classification system,the draft of transitional care program for patients with intermittent catheterization after radical hysterectomy of cervical cancer was formed on the basis of qualitative research and guideline reviewing.2 rounds of expert consultation were organized to make amendments and form text of the program.4 A non-randomized controlled trail was conducted to assess clinical effectiveness of the program.Objective of the study were eligible patients who underwent Gynecology department in one grade-? general hospital from April 2019 to December 2019.Patients were divided into two groups.Patients who underwent Gynecology department from April 2019 to July2019 were assigned to the controlled group which received usual care,while patients from August 2019 to December 2019 to the intervention group.The outcome fell into 5 domains:(1)urinary tract complication;(2)patient compliance;(3)the quality of life;(4)health service utility: the number of hospital readmission,emergency visits,and outpatient visits;(5)patient satisfaction: patient satisfaction separately with hospital care and discharge care.IBM SPSS Statistics Version 23.0 was used to perform statistical analysis,when a p-value of <0.05 was considered statistically significant.The data were analyzed with methods as descriptive statistic or non-parametric test;Chi-square test was used for comparison of constituent ratio or rate.Results:1 Qualitative research of gynecology staff was extract four related topics while patients' s experience and requirement three related topics,respectively.2 According to the guideline reviewing,seven guidelines were included,for overall quality,3 guidelines were evaluated as level A,3 were level B and 1 was level C.Twenty-seven recommendations were synthesized and categorized into 4 aspects of assessment,practice,education and management.An experts meeting was organized to make amendments of the twenty-seven recommendations.3 Experts' response rates both were 100% in the two rounds,experts' authority coefficient were 0.920 and 0.926,and the Kendall's W values were 0.334 and 0.306 respectively(P<0.001).The program contained two parts,the nursing evaluation form of intermittent catheterization andtransitional care implementation program of intermittent catheterization,totally 8 first-level ones,51 second-level ones and 77 third-level ones.4 The comparison between intervention group and control group showed the effect of intervention group is more notable in the rate of urinary complications,the total score of compliance with discharge recommendation(t=5.868,P=0.000)and the four compliance item of standard operation(t=2.928,P=0.007),drinking water plan(t=2.646,P=0.013),catheterization diary(t=3.347,P=0.002),and referral follow-up(t=3.162,P=0.004),the quality of life(t=4.551,P=0.000),the emergency visits(?2=16.133,P=0.000),the outpatient visits(?2=19.400,P=0.000),and the patient satisfaction with discharge care(t=0.100,P=0.000)of the two groups(P<0.05).Conclusion:1 Following the transitional care model and omaha classification system,the transitional care program for patients with intermittent catheterization after radical hysterectomy of cervical cancer was formed on the basis of qualitative research,guideline reviewing and 2 rounds of expert consultation.The program contained two parts,the nursing evaluation form of intermittent catheterization and transitional care implementation program of intermittent catheterization,totally 8 first-level ones,51second-level ones and 77 third-level ones.2 The effect of the program for patients with intermittentcatheterization after radical hysterectomy of cervical cancer was testified under quasi-experiment,proving the positive effects in patients' urinary complication,compliance,quality of life,the emergency visits,the outpatient visits,and the satisfaction with discharge care.The conclusion showed that the constructed program was mostly consistent with the design purpose.