Application Of Continuous Care Base On Protective Motivation Theory In Self-health Management Of Patients Undergoing Mechanical Heart Valve Replacement

Objective To understand the self-health management needs of patients undergoing Mechanical Heart Valve Replacement（MHVR）.To explore the influence of continuous nursing guided by Protective Motivation Theory（PMT）on self-efficacy,self-health management ability,quality of life and the occurrence of complications in MHVR patients.To provide reference for self-health management intervention of MHVR patients.Methods The method of descriptive qualitative and quantitative research was adopted in this study.1.Descriptive qualitative research stage:11 patients who underwent MHVR surgery in a Grade III Grade A general hospital of Zhuhai City from March to April 2020 were selected as the research objects by phenomenological research method and purpose-oriented sample selection.Based on the theory of protective motivation,an interview outline was prepared and a semi-structured interview was conducted with the research subjects.Colaizzi analysis method was used to analyze the data,and the theme of self-health management needs was obtained,which provided a basis for the development of continuing care intervention plan for MHVR patients.2.Quantitative research stage:A total of 72 patients receiving MHVR after operation in a Grade A general hospital of Zhuhai City from April2020 to December 2020 were randomly divided into control group（36cases）and intervention group（36 cases）with convenient sampling method.The control group was given routine nursing,and the intervention group was given continuous nursing intervention program based on the theory of protective motivation.The general information questionnaire,MHVR postoperative self-management scale,general self-efficacy scale,and SF-12 laboratory coagulation indicator（International Normalized Ratio（INR））were used for evaluation.At the end of 1 month and 3 months after discharge,self-management ability,self-efficacy,quality of life and anticoagulant effect of patients in the two groups were evaluated,and the incidence of complications after discharge was compared between the two groups.SPSS 18.0 statistical software was used for descriptive analysis,t test,χ²test and repeated measurement analysis of variance.Result1.Qualitative research results:Colaizzi analysis method was used to analyze the data,and five self-health management needs of MHVR patients were extracted.They include lack of knowledge of self-health management,factors threatening self-health management,desire for professional information support from medical staff to improve coping ability,desire for self-actualization,need for family and social support.2.Quantitative research results（1）.Self-management status of MHVR patients:Before intervention,the total self-management of postoperative MHVR patients in the two groups were divided into:intervention group 85.64±12.12,control group84.66±7.74;（P>0.05）.The total average score of general self-efficacy was24.67±4.74 in the intervention group and 24.09±4.03 in the control group.Quality of life status:The concise health status questionnaire（SF-12）of patients after MHVR in the two groups was divided into:intervention group 496.06±55.14,control group 501.09±60.67;Current situation of coagulation index INR reaching the standard:81.8%of the intervention group and 87.5%of the control group reached the standard.The above differences were not statistically significant（P>0.05）.Before intervention,there were no statistically significant differences in the basic information and related health behaviors between 2 groups（P>0.05）.（2）.At the end of 1 month and 3 months after discharge,the total mean score of self-management amount of patients after MHVR in the intervention group was 96.00±2.12 and 101.94±11.22,respectively,which were both higher than those in the control group 87.06±14.17 and88.63±11.09.The difference was statistically significant(t _{at the end of 1 month after}discharge=2.823,t at the end of 3 months after discharge=4.811,P<0.05).The results of two-way repeated-measures ANOVA showed that the F values of intervention effect,time effect,interaction effect of time and intervention in the self-management scale of patients in two groups were 23.862,11.769and 8.882,respectively,and the differences were significant（P<0.05）.（3）.At the end of 1 month after discharge,there was no statistical significance in the general self-efficacy scores of the intervention group（P>0.05）.At the end of 3 months after discharge,the average score of general self-efficacy in the intervention group was 31.88±6.62,higher than24.13±5.77 in the control group,and the difference was statistically significant（t=3.145,P<0.05）.The results of two-way repeated-measure ANOVA showed that the F values of time effect,intervention effect,time-intervention interaction effect in the general self-efficacy scale of patients in 2 groups were 28.303,4.614 and 3.572,respectively,and the results were all different（P<0.05）.（4）.During the intervention,1 case of complication thrombosis and 1case of skin and mucosal hemorrhage occurred in the intervention group.In the control group,1 case of wound infection,1 case of cerebral hemorrhage and 3 cases of skin and mucosal hemorrhage occurred.The difference was statistically significant（χ²=81.096,P<0.001）.（5）.Laboratory coagulation indicators:International Normalized Ratio（INR）.At the end of one month after discharge,there were 23 patients in the intervention group and 17 patients in the control group,with no statistically significant difference（χ²=1.886,P=0.170）.At the end of 3months after discharge,30 cases in the intervention group and 19 cases in the control group reached the standard INR,the difference was statistically significant（χ²=8.706,P=0.003）.（6）.At the end of 1 month and 3 months after discharge,the average scores of SF-12 questionnaire in the intervention group were 569.85±79.28and 624.55±61.55,respectively,higher than those in the control group525.31±49.45 and 559.84±66.14.The difference was statistically significant （tat the end of 1 month after discharge=2.708,tat the end of 3 months after discharge=4.084,P<0.05）.The results of two-way repeated-measure ANOVA showed that the F values corresponding to the time effect,intervention effect,interaction effect of time and intervention in the Short-Form Quality of Life Questionnaire-12 were 45.250,10.634 and 6.644,respectively,and the results were different between the two groups（P<0.05）.Conclusion1.Patients undergoing mechanical heart valve replacement have five self-health management needs after discharge:improving the cognition of self-health management;Joint decision making between doctors,nurses and patients;multiple sources of information;family and social support;improve the ability to take care of oneself.2.Continuing nursing based on the theory of protective motivation can improve the self-health management ability and self-efficacy of MHVR patients,help to reduce the incidence of complications after discharge,and help to improve their quality of life.