Effects Of A Home Care Mobile App On The Outcomes Of Discharged Patients With A Permanent Stoma

Objective:1.To investigate the levels of psychosocial adjustment and self-efficacy in discharged patients after ostomy,and to analyze the correlation between them as well as the influencing factors of psychosocial adjustment,the aim of which is to provide targeted nursing intervention for patients with a stoma.2.To explore the effects of a home care mobile app on the outcomes of stoma patients who discharged from hospital and in order to provide theoretical and empirical basis for the generalization and application of this transitional care service in patients and nursing staff.Methods:1.Total 168 stoma patients from 5 tertiary hospitals in Nanjing from December 2015 to July 2016 were enrolled by convenience sampling in this study.The Chinese version of Ostomy Adjustment Inventory-20(OAI-20),Stoma Self-Efficacy Scale(SSES)and the self-designed general information questionnaire were used to investigate the patients.The Pearson correlation analysis was used to explore the correlation between psychological adjustment and self-efficacy levels,and the multivariate linear stepwise regression analysis was used to analyze the factors of influencing the psychosocial adjustment level.2.203 patients with a permanent stoma in Nanjing and its surrounding areas were randomly assigned into two groups between January 2016 and November 2016.Patients in the control group(n=103)received routine discharge care.Patients in the intervention group(n=100)received home care via a mobile app besides routine care.The psychosocial adjustment level,self-efficacy scale and stoma complications incidence were measured in the follow-up period and compared between the two groups through randomized controlled trial.Data was collected at four time points: before intervention(baseline),at 1,3 and 6 months after discharge.Results:1.The average score of psychosocial adjustment in patients with a stoma was(44.53±9.52),with only 6.55% of the patients being highly adaptive.The self-efficacy was(65.78±16.73)and only 1.2% of the patients showed high efficacy.The psychosocial adjustment was positively correlated with self-efficacy significantly(r=0.768,P<0.001).The multivariate stepwise linear regression analysis showed that self-efficacy,stoma complication,gender and stoma site were the influencing factors of psychosocial adjustment(all P<0.05).2.The psychosocial adjustment level and stoma self-efficacy score of the intervention group were significantly higher than those of the control group respectively at 1,3 and 6-month follow-up(all P<0.05).The incidence of stoma complications in the intervention group were tending to reduce at 1,3 and 6 months after discharge.Conclusions:1.The discharged stoma patients need to improve their psychosocial adjustment level.Women,patients with complications and urinary tract stoma should gain more attention.Their self-efficacy may be improved with targeted intervention and transitional care which can help them get adapted to stoma and return to their home and work as soon as possible.2.The findings indicated that follow-up care at home via a mobile app can effectively improve the psychosocial adjustment level,self-efficacy scale and other related outcomes of stoma patients.It ensures the continuity of care and provides nursing guidance for the patients timely.