Construction And Application Of Implementing Scheme Of ICU Diaries Based On Patient And Family Centered Care Model

Objective:1.The Objective of this study is to deeply understand the attitudes of ICU staff and family members of ICU patients towards ICU diaries and the comprehensive factors that obstruct the implementation of ICU diaries,and to provide reference recommendations for medical institutions to implement ICU diaries;2.Construct a systematic,scientific and feasible ICU diaries implementation plan based on the PFCC model,and use expert consultation to consult the specific content of the plan,and determine the weight of specific indicators based on the results of the expert correspondence to meet the needs of clinical applications;3.Under the premise of the CONSORT statement,conduct ICU diaries implementation plan based on the PFCC model in China's target population to conduct an intervening study,observe the clinical application effects,and further explore the impact of ICU diaries on early anxiety and depression and PTSD in ICU transfer patients.Explore the implementation model of localized ICU diaries.Methods:Part ?: A Qualitative Study of the factors affecting the application of ICU diariesComprehensively search domestic and foreign literature on the application of ICU diaries to determine the research content.Using a qualitative research method,semi-structured interviews were conducted with the main implements of the ICU diaries(12 ICU medical staff and 10 family members of ICU patients).After repeated discussions and revisions by the research team,the outline of the interview was determined,focusing on the attitudes of ICU medical staff and family members of ICU patients towards the ICU diary and the factors affecting the application of the ICU diary.Applying grounded theory analysis data to determine the comprehensive factors that affect the implementation of ICU diary;Part ?: Building an ICU diary implementation scheme based on the PFCC modelFully consider the factors that affect the acceptance and application of ICU diary determined by previous qualitative research,combined with the connotation of PFCC mode,and refer to the implementation methods of foreign ICU diaries,initially formulate the implementation plan of ICU diary based on PFCC mode.The expert consulting method was used to evaluate and revise the implementation plan,and finally formed an ICU diary implementation plan based on the PFCC model;Part ?: Application research of ICU diaries implementation scheme based on the PFCC modelA randomized controlled method was used to select 94 patients in a third-level general hospital ICU as the research participants,and the random number table method was used to divide the test group and the control group.Strict implementation of inclusion and exclusion criteria.The experimental group added a revised implementation plan of the ICU diary based on the PFCC model on the basis of conventional care.By comparing the two groups of subjects' IES-R scale after the 1 week and 1 month to observe the effects of ICU diary on early anxiety and depression and PTSD in ICU transfer patients.Results:1.After interviewing 12 ICU staff and 10 family members of ICU patients,the data is saturated.The data analysis shows that the factors affecting the implementation of the ICU diary include the workload of the ICU staff,the administrative status of the hospital or department,interpersonal relationships,the financial situation,the education level and personal preferences of the patient 's family.2.Apply the Delphi method to conduct two rounds of correspondence for the ICU diary implementation plan index system.Correspondence experts came from Guizhou,Guangdong,and Guangxi provinces,a total of 18 experts.Finally,ICU diary implementation plan indicators were determined,including 4 first-level indicators,16second-level indicators,and 56 third-level indicators.The authoritative coefficients of the two rounds of expert consultation are 0.870 and 0.866,and the Kendall coordination coefficients are 0.146 and 0.140.3.The participants' baseline levels in the test and control groups,before the intervention,were no significant differences in general information,diagnosis of admission,mechanical ventilation and APACHE ? scores within 24 hours after ICU admission(P>0.05).The baseline data of the two groups of patients were comparable.4.From October 2018 to September 2019,ICU medical staff and patients 'families wrote a total of 245 ICU diaries entries,including 184 entries written by medical staff,accounting for 75.1%,and patients' family wrote 61 entries,accounting for 24.9%;5.Patients in the experimental group and the control group transferred out of ICU after the first month of the IES-R(24.7 ± 10.61 vs 34.77 ± 12.70,p <0.001)and the positive performance of PTSD [24(52.17%)vs 35(81.40 %),P = 0.007] have a statistical difference,and the IES-R scale score and PTSD positive rate of patients in the experimental group are lower than those in the control group.However,the ICU patients of the two groups were transferred out of ICU after the first week there is no statistical difference between the IES-R and the positive performance of PTSD.6.The patient's education,the number of ICU diary entries,the family's financial situation,and the duration of ICU treatment are all influencing factors for the IES-R results1 month after the patient is transferred out of the ICU.Conclusions:It has been initially proved that the implementation scheme of the ICU diary based on the PFCC model is feasible and has reference significance to clinical practice,and is worthy of promotion and application.It is effective to reduce the occurrence of early anxiety,depression and PTSD in ICU patients.ICU staff should take comprehensive measures to minimize the time of patients in ICU treatment,and at the same time consider the patient's academic qualifications,appropriately select photos,text,videos and other forms to write a diary to maximize the effect of the ICU diary.