Construction Of Volume Management Scheme For Patients With Cardiorenal Syndrome Type Ⅳ Undergoing Peritoneal Dialysis In The Hospital-family Transitional Period Based On "Internet + Nursing Service" Platform

Objective:Based on the theory of transtheoretical model and stages of change,construct a hospital-family transitional period volume management scheme for cardiorenal syndrome type Ⅳ patients undergoing peritoneal dialysis based on the “Internet + nursing service”platform,in order to improve patients’ volume management behavior,improve the quality of life of cardiorenal syndrome type Ⅳ patients undergoing peritoneal dialysis,and provide the basis for clinical nursing practice.Methods:1.Qualitative interview: using purpose sampling method,including cardiorenal syndrome type Ⅳ patients undergoing peritoneal dialysis for the first time and discharged from the hospital as interview subjects,explore the experience and demands of hospital-family transitional period volume management of cardiorenal syndrome type Ⅳ patients undergoing peritoneal dialysis.2.Case review: Collect the medical and home volume management records of cardiorenal syndrome type Ⅳ patients undergoing peritoneal dialysis from January 2019 to June 2020 in the nephrology department of a tertiary hospital in Nanjing,and to analyze the patients’ clinical intervention status of volume management during hospital-family transitional period.3.Literature research: According to the “6S” evidence model,we systematically searched the relevant literature on volume management of patients with cardiorenal syndrome type Ⅳ undergoing peritoneal dialysis treatment,and adopt the standards of the Australian JBI Evidence-based health care center carry out evidence classification and recommendation,so as to provide reference for the construction of the scheme.4.Delphi expert consultation: Based on the understanding of patients’ volume management needs,clinical and research status,a research group was established and the first draft of the scheme was constructed.17 experts meeting the selection criteria were invited to conduct two rounds of Delphi expert consultation.According to the expert opinions,the items were modified in combination with the theory of transtheoretical model and stages of change and clinical practice,and finally the scheme was formed.Results:1.Qualitative interview: A total of 4 themes were obtained by transcribing and analyzing the interview data.They are theme 1: insufficient understanding of the relationship between disease and volume management;Theme 2: insufficient volume self-management ability;Theme 3: hospital-family transitionability needs to be improved;Theme 4: lack of professional support.2.Case review: 45 cases about the medical and home volume management of cardiorenal syndrome type Ⅳ patients undergoing peritoneal dialysis were collected.We found that there was a significant trend of patients’ volume overload during the hospital-family transitional period,and the volume management measures of the department was insufficient.Systematic and scientific volume management planneed to be explored.3.Literature research: 12 literatures were included,including 5 guidelines,1 systematic review,3 randomized controlled trials,and 3 quasi-experimental studies.3 aspects of volume management were summarized,namely comprehensive assessment,intervention goals,and intervention strategies,including 33 items in total.4.Delphi expert consultation: In the two rounds of consultation,the positive coefficient of experts was 100% and 94% respectively,and the group authority coefficient was 0.92.The degree of concentration and coordination of opinions was good.After the integration of consultation items,the final volume management scheme was formed,which was composed of comprehensive evaluation of volume management,volume management during hospitalization and volume management after discharge.Conclusion:In this study,qualitative interview and case review were used to analyze the current situation of volume management of patients with cardiorenal syndrome type Ⅳ undergoing peritoneal dialysis during the hospital-family transition period,and literature research was conducted to review the relevant strategies of volume management at home and abroad.On this basis,Delphi expert consultation,combined with the theory of transtheoretical model and stages of change and clinical practice,has improved the volume management scheme,which is reliable and scientific,and has guiding significance for the nursing service of patients’ volume management in peritoneal dialysis center with Internet technology.