Construction Of Nursing Sensitivity Outcome Index System For PICC Discharged Patients And Its Application In Continuing Nursing

Objective:1.Establish a nursing sensitivity outcome index system for patients discharged from PICC with tube through Delphi method,and provide a reference for the next step of personalized continuing care;2.To explore the effect of continuous nursing based on nursing outcomes in patients discharged from PICC with tube.Methods:1.Delphi method was used to determine the nursing sensitivity outcome index of patients discharged from PICC with tube.According to the Omaha problem classification system,guided by the nursing outcome,28 experts were selected by Delphi method for 2rounds of correspondence.2.Clinical application of continuous nursing intervention program for patients discharged from PICC with tube based on nursing sensitivity outcome indicators.The convenient sampling method selected 45 patients who were discharged from PICC with a tube for the first time from April to July 2019 as the control group for routine discharge care,and 47 patients from August to November 2019 for the observation group to implement the Omaha-based system based on the nursing outcome.Guided Continuing Care.The evaluation time is the end of the first chemotherapy,the second chemotherapy,and the first outpatient maintenance after the third chemotherapy.The targeted nursing measures are developed based on the "PICC Outpatient Index System for Nursing Sensitivity Outcome",and the observations are evaluated and observed.The nursing problems and the scores of cognition(K),behavior(B),and status(S)before and after the intervention in the group;evaluation of the self-management ability of the patients in the 2 groups;statistics on the incidence of complications in the 2 groups of patients during the 3 chemotherapy cycles.3.The main statistical methods are as follows: the positive coefficient is expressed by the opinion extraction rate and the effective recovery rate of the questionnaire;the reliability of the research results is expressed by the expert authority coefficient(Cr);the coordination degree of expert opinion is expressed by the coordination coefficient(Kendall's W)and the coefficient of variation(CV);the weight analysis is carried out by analytic hierarchy process and the reliability and validity are tested.T-test,chi-square or Fisher exact probability method,repeated measurement analysis of variance and Mann-Whitney U test were used to analyze the intervention effect.Results:1.Delphi correspondence results: 28 experts from 21 tertiary hospitals in 10 provinces and cities completed 2 rounds of effective correspondence.The effective recovery rate of the second round of questionnaires was 90% and 100%,the revised opinion submission rates were 50% and 11%,and the authority levels were 0.861 and0.894.The importance of each index in the second round was 3.54 ? 5.00,and the coefficient of variation was 0.000 ? 0.245,the perfect score is 0.21 to 1.00,and the coordination coefficients of all levels are 0.344 to 0.359.Finally,4 major areas including13 primary indicators,28 secondary indicators,and 76 tertiary indicators were discharged from the PICC.The nursing sensitivity outcome index system shows that the results of this study are scientific and reliable.Determine the weights of all levels of indicators through the analytic hierarchy process,the first-level indicators of health(0.099),contact community resources(0.064),infection status(0.175)and awareness(0.152),physical activity(0.099)and personal care and care supervision(0.099)at the forefront of their field;the top two of the secondary indicators are knowledge:infection prevention(0.175),knowledge:PICC catheter maintenance(0.127).2.The results of the experimental study showed that there was no significant difference in general information between the two groups of patients(P>0.05).Patients in the observation group had 13 nursing problems in 4 major areas: income,health,contact with community resources,social,mental health,skin and catheter,neuro-muscular-skeletal function,circulation,infection,cognition,physical activity,Personal care and care supervision and drug treatment programs,the KBS scores of different nursing problems at different time points were statistically different(P<0.05).The total score of the self-management ability of the two groups was analyzed by two-factor repeated measurement analysis of variance: the difference between the groups was statistically significant(F=38.497,P<0.05),and the difference between the two groups at different time points was statistically significant(F=424.882,P<0.05),and there was an interaction effect between time and groups(P<0.05).Among the dimensions,except for the scores of the 3rd assessment of "catheter management confidence" and the3 rd assessment of "maintaining compliance",there was no significant difference in the scores of the 2 groups(P>0.05).The differences in the other dimensions were statistically significant.Significance(P<0.05).The incidence of complications in the observation group was significantly improved after intervention,and the difference was statistically significant(P<0.05).Conclusion:1.The PICC patient sensitive discharge outcome index constructed in this study provides a theoretical basis for continuing nursing work.2.Based on the Omaha system,the nursing outcome-oriented continuous nursing model integrates assessment,intervention,and evaluation,which can reflect common nursing problems during discharge,dynamically monitor patient outcomes,and improve self-management of PICC discharged patients.Capabilities provide effective intervention programs.