| Objective:1.To investigate the nutritional status of patients with esophageal cancer undergoing radiotherapy,analyze the influencing factors and clinical characteristics of nutritional status;2.To construct the first draft of nutritional support nursing path for esophageal cancer patients undergoing radiotherapy through the results of current investigation and literature review;3.Revise and improve the first draft of the path through Delphi expert consultation,aiming to form a more scientific "nutritional support nursing path for esophageal cancer patients undergoing radiotherapy" to provide reference for standardizing clinical nursing practice.Method:In this study,the "nutritional support nursing path for esophageal cancer patients receiving radiotherapy" was formed through the literature review,current situation investigation and Delphi method.1.Establishment of nursing path entry pool1.1 Through one-to-one questionnaire survey of 167 patients with esophageal cancer in the Radiotherapy Department of a third grade a special hospital in Shanxi Province,the researcher understood the malnutrition status of patients with esophageal cancer and its influencing factors.1.2 Based on the literature review and the results of current investigation,the first draft of nutrition support nursing path for esophageal cancer patients undergoing radiotherapy was developed.2.Revision of nutrition support nursing path for esophageal cancer patients undergoing radiotherapy2.1 Delphi expert consultationDelphi expert consultation shall be conducted for the first draft of the path constructed in the early stage to ensure that the path constructed is scientific and operable.The 15 experts in this study are from Shanghai,Nanjing,Tianjin,Beijing and Shanxi.Through two rounds of expert consultation,we collected their opinions to revise the clinical nursing path for clinical application.2.2 Clear evaluation indexThe reliability of experts is judged by positive coefficient,authority coefficient,concentration degree and dispersion degree of experts' opinions.Selection criteria of items: the first round of expert consultation results take the full score rate > 75% as the standard judgment index.In the second round of general expert consultation,two indexes should be taken as the standard: the coefficient of variation < 0.25 and the mean value of importance assignment >3.50.3.Statistical analysisThe data were sorted out by Excel and analyzed by spss21.0.The general data of experts are expressed by frequency and composition ratio,the measurement data are expressed by mean,standard deviation and coefficient of variation,and the coordination degree of experts' opinions is tested by K-W,P< 0.05,which is statistically significant.Result:1.Literature review results:CNKI,Wanfang,VIP,PubMed,Ovid,American guide net,etc.are the main retrieval databases.The retrieval strategy uses the English key words "esophagealcancer","radiosotherapy","nutrialsupport","nursing","nursingmode / measures" and the Chinese key words "esophageal cancer","radiotherapy","nutritional support","nursing","nursing model / measures" to search the literature for nearly 10 years,forming the text content of nutritional support nursing path for esophageal cancer patients undergoing radiotherapy.In total,more than 1500 papers were found in the above database,and 900 papers,reading abstracts and keywords,81 papers,25 English papers and 29 Chinese papers were retained after reading the full text.2.Current situation investigation and research:Based on the review of the literature,this study investigated the nutritional status of 167 patients with esophageal cancer.Statistical analysis showed that there were statistically significant differences in age,occupation before the disease and tumor location among the groups(P < 0.05);there were no statistically significant differences in gender,education and residence.It can be seen that the nutritional status of patients is affected by age,pre disease occupation and tumor location.In this study,NRS 2002 and pg-sga were used to screen and evaluate the nutrition of patients with esophageal cancer radiotherapy at the same time.The results showed that kappa value was 0.569,and the consistency of the test results was moderate.The current investigation found that the incidence of malnutrition in patients with esophageal cancer radiotherapy was about 89.82%.The individual indicators were grouped by nrs2002,and the BMI,total protein,albumin and hemoglobin groups were statistically different Statistical significance,P<0.05;PG-SGA was used to group each single index,the results showed that the total protein,albumin and hemoglobin group comparison,P<0.05.according to the radiotherapy period(<10 days,10-20 days,>20 days,3stages),the total protein,albumin and hemoglobin were grouped The difference between hemoglobin groups was statistically significant,P<0.05.3.Delphi expert consultation:Through two rounds of Delphi expert consultation,the "nutritional support nursing path for esophageal cancer patients undergoing radiotherapy" was formed.There were 8 nursing experts(53.33%),5 medical experts(33.33%)and 2 nutrition experts(13.33%).There were 2 doctors(13.33%);5 Masters(33.33%);8 undergraduate(53.33%);6 senior(40.00%)and 9 intermediate(60.00%).The age of the expert was(43.87 ± 7.13)years old,and the working life of the expert was(22.00 ± 9.25)years.The recovery rate of the two rounds of expert correspondence was 100%,the effective rates were 93.33% and66.67% respectively,and the recovery rate of the two rounds was more than70%,indicating that the experts were more active.The recovery rate of the two rounds of expert correspondence was 100%,the effective rates were 93.33%and 66.67%,respectively.The recovery rate of the two rounds of expert correspondence was more than 70%,indicating that the experts were more active.The judgment coefficients of the two rounds of inquiry experts are 0.92 and 0.97 respectively,the familiarity coefficients are 0.74 and 0.83 respectively,and the authority coefficients are 0.83 and 0.90 respectively(all >0.7),indicating that the authority of the two rounds of inquiry experts is high.The coefficient of variation of the two rounds of inquiry was 0-0.138,0-0.112,Kendall's W was 0.318 and 0.357,respectively,which was statistically significant(P < 0.001)by Kendall's W test.It can be concluded that the degreeof opinion coordination of the experts was better.In the first round of correspondence,the experts put forward 8 suggestions and deleted 4 items.In the second round of inquiry,2 items were modified without deletion.Finally,a total of 123 items of nutrition support nursing path form were formed.Conclusion:According to the investigation of the current situation,the incidence of malnutrition is very high in patients receiving radiotherapy for esophageal cancer;In the middle stage of radiotherapy,i.e.the 11 th to 20 th day of radiotherapy,the malnutrition is the most serious.In this study,the nutritional support nursing path for esophageal cancer patients with radiotherapy,which was constructed by the literature review,current situation investigation and Delphi expert consultation method,was highly motivated,coordinated and concentrated by experts,which provides theoretical reference for clinical nursing practice. |
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