| Objective:To construct a phased intervention program of readiness for hospital discharge in postoperative colorectal cancer patients and to evaluate the application effect of the intervention program in patients with colorectal cancer after surgery.Methods:There were two phases in this study.Phase Ⅰ: Build the intervention.In accordance with extensive review of domestic and foreign literatures on the readiness for hospital discharge by using a documentary research method,the service program of the readiness for hospital discharge for colorectal cancer patients was preliminarily formulated based on intermediate transition/transformation theory and timing theory.Meanwhile,the intervention program was demonstrated by expert consultation.After that,a pre-experiment was carried out by selecting 10 patients.Simultaneously,SSCNS-CR was issued to understand the needs of patients at different phases of discharge,so as to improve the scientific and operative natures of the program.Phase Ⅱ: Application stage.The objects of study were patients with colorectal cancer who were hospitalized and operated in the General Surgery Department of a Class 3A Hospital in Shiyan City from June 2019 to September 2020.Using the method of self-control before and after discharge,the enrolled patients were evaluated in four phases(1 day before discharge,4 hours on the day of discharge,1 week after discharge,and 2 weeks after discharge).Meanwhile,SSCNS-CR was used to understand the needs of patients in the four phases.Furthermore,phased intervention program of the readiness for hospital discharge in postoperative colorectal cancer patients were given to each patient according to corresponding personal status,family status and social adaptation.Finally,the scores of RHDS were compared between baseline and four stages of intervention,and the scores of CD-RISC and QLQ-C30 were compared before and after discharge。Results:1.Our experiment established a phased intervention program of the readiness for hospital discharge in postoperative colorectal cancer patients with the purpose of "Take Care of Your Intestinal Health".(1)Intervention frequency: The intervention was conducted 4 times,i.e.,1 day before discharge,4 hours on the day before discharge,1week after discharge and 2 weeks after discharge.(2)Intervention content and personnel:The intervention content was divided into four themes.To be specific,the first phase was to promote the opinion expression of colorectal cancer patients freely.Patients were encouraged to freely express their views and needs for discharge.A multi-mode social support system was constructed to give emotional support.Besides,it was desired to promote self-adjustment of patient mood,make good intentions for patients discharged from hospital.It was managed by the on-the-bed doctors and nurses,"Sunshine Angel" team,enterostomal therapist and wound therapist.The second theme was "Always with You" to enable colorectal cancer patients to master discharge related knowledge and skills.It was emphasized that patients would be provided with professional medical resources through telephone and Internet after discharge,so as to eliminate the worry of "Having No Resource" after discharge.It was completed by on-the-bed nurses,"Sunshine Angel" team,enterostomal therapist and wound therapist,and nutritionists.The third part was "Ensure Intestine Unobstructed" with the purpose to ensure smooth intestinal tract after discharge and reduce complications,which was finished by the on-the-bed doctors and nurses,and psychotherapists.For the fourth phase,it was the phase of "Frequent Visit" to provide follow-up treatment and activity information,and related referral services.Through active interaction and friendly exchanges with patients,it could be useful to help patients make a smooth transition from hospital to home,which was completed by the Readiness for Hospital Discharge service team.(3)Intervention modes:One-to-one instruction and group guidance were applied in the first two phases;and"Internet+"was the major mode for the two times after discharge,such as extended service platform(telephone follow-up),We Chat interaction and online teaching.2.The phased intervention program of the readiness for hospital discharge in patients with colorectal cancer was applied to clinical practice,and the final effective sample size was 91 cases,with the exclusion of 6 cases who were lost during the process(3 cases,loss of contact;2 cases,refusal to cooperate;and 1 case,withdrawal due to change of illness).A repeated measurement analysis of variance(ANOVA)was performed focusing on the readiness for hospital discharge of colorectal cancer patients in different phases.There were significant in the total score of(RHDS)and each dimension at baseline survey,1 day before intervention,4 hours on the day of intervention,1 week after intervention and 2 weeks after intervention(P<0.05).Further pairwise comparison showed that there were no significant difference between the second intervention and the third intervention in the dimension of personal status(P>0.05),but there were significant at other time points(P<0.05).There were significant in the comparison of the five time points in the dimension of adaptive ability and the dimension of expected support(P<0.05).After intervention,there were significant in CD-RISC and various dimensions(P<0.05).After intervention,the scores of functional domain,symptom domain and overall health status in the QLQ-C30 were higher than before intervention with significance(P<0.05).But no significant in dyspnea scores after intervention compared with before intervention(P>0.05).Conclusion:In this study,a phased thematic intervention program for dealing with the readiness for hospital discharge in postoperative colorectal cancer patients is developed based on the evaluation of the actual needs of colorectal cancer patients at specific phases before and after discharge,and in accordance with literature review and theoretical basis.The proposed program can effectively improve the readiness for discharge,psychological resilience and quality of life of patients. |
PDF Full Text Request