| Objective:This study aimed to investigate the current status of bowel symptoms self-management behavior after sphincter-preserving surgery among rectal cancer patients,to analyze factors related to self-management behavior of bowel symptoms;to explore the effectivenes of self-managemant ability,self-efficacy of nursing intervention based on multimedia and We Chat platform in patients with rectal cancer after sphincter-preserving surgery,thus providing a reference for self-managemant health education of patients with rectal cancer after sphincter-preserving surgery.Methods:Part one:A questionnaire survey was carried out on the patients with rectal cancer after sphincter-preserving surgery in a third grade hospital in Guizhou Province in 6-12 months2016.The questionnaire consisted of the general information,and Bowel Symptoms Self-management Behaviors Questionnaire for rectal cancer patients after sphincter-preserving surgery(BSSBQ).Part two:Based on the theory of "Self-managemant Model",combined with the needs of these patients after sphincter-preserving surgery,the change characteristics of bowel symptoms after discharge and the existing medical resources,we formulated interventions for patients to cope with bowel symptoms themselves.In 2017,patients after sphincterpreserving surgery in a hospital in Guizhou province 1-6 months received 60 patients were randomly divided into the intervention group and control group,intervention group were given nursing intervention based on multimedia and We Chat platform:(1)before discharge:(1)routine health education guidance;(2)centralized education: 1)focus on teaching that is,the multimedia courseware through a combination of text and picture phase(PPT slides)to explain to patients and their families,including the basic knowledge of colorectal cancer and intestinal symptoms self management knowledge,every 30~40 minutes;2)demonstration: small video playback operation process(Enema Glycerini,demibain),using simulation and demonstration simulation tools,And the patients were encouraged to experience;(3)“one-on-one”health guidance: in view of the low level of education,age and poor understanding of the text were in focus after the end of the education,knowledge and skills of patients mastered again explained by researchers to take one by one side of the bed to guide the way;(2)after discharge:(1)telephone: Follow up after first months of follow-up for 2 times,each time 5~10 minutes,later changed to 1 month follow-up;(2)the We Chat group interaction,namely the establishment of We Chat in patients with rectal cancer patients,the patient informed consent after the addition of We Chat,researchers and nurses regularly in We Chat group and patients interact(send text,voice chat form,voice,video call form),encourage patients to share in We Chat group in self management Inspection,real-time monitoring and management of patients self management;(3)the "one-on-one" to strengthen the guidance of chemotherapy in patients of each hospital,researchers interviewed patients in patients after chemotherapy on intestinal symptoms management of patients are targeted to strengthen guidance.The control group received routine nursing instruction:(1)before discharge: routine health education;(2)(1)telephone follow-up:same intervention group;(2)one-on-one reinforcement instruction,same intervention group.the ability of bowel symptoms self-management and self-efficacy for the two groups with sphincter-preserving surgery were evaluated before and After intervention.Results:Part one:1.140 questionnaires out of a total of 148 questionnaires were retrieved effectively with a recovery rate of 94.59%.2.The treatment management score of bowel sysptoms was 3.47±2.59 and the main factors related to the treatment management dimension scores involved age,degree of education,average monthly income of family,occupation and payment(P < 0.05);The dietetic management dimension score of bowel systoms was 8.95±3.62,and the main influencing factors included payment,degree of education,family address and average monthly income of family(P<0.05);The perianal skin management dimension score was 3.50±2.62,and the main influencing factors covered average monthly income of family,degree of education,occupation,payment and family address(P<0.05);The seeking help from others dimension score was 3.65±2.62,The main influencing factors were age,degree of education,occupation,family address,average monthly income of family(P<0.05);The self-emotion adjustment dimension score was 5.08 ± 2.66,The main influencing factors involved age,degree of education,occupation,payment,family address,average monthly income of family(P<0.05);The social management dimension score was 3.92 ±3.11,the main influencing factor covered age,degree of education,occupation,payment,family address and average monthly income of the family(P<0.05).The total self-management behavior score for bowel symptoms was 28.57±9.69.and multiple stepwise regression analysis showed that age,degree of education and average monthly income of the family of the patients was the main influencing factors of bowel symptoms self-management behavior in rectal cancer patients after sphincter-preserving surgery(P<0.05).Part two:1.There was no significant difference in baseline data of the two groups(P>0.05).2.There was no significant difference between the two groups before intervention in bowel symptoms self-management ability score and the scores of each dimension,self-efficacy score and the scores of each dimension(P>0.05);After intervention,there were significant differences in bowel symptoms self-management ability and its dimensions(P <0.05);After intervention,there were significant differences in self-efficacy score and its dimensions(P < 0.05);The intervention group before and after the intervention,there were significant differences in patients with bowel symptoms self management ability and each dimension scores,self-efficacy and the dimension scores(P < 0.05);The control group before and after intervention,there was no significant difference in patients with bowel symptoms self management ability and each dimension scores,self-efficacy and the dimension scores(P>0.05).Conclusion:1.The self-management of bowel symptoms in patients with rectal cancer after sphincterpreserving surgery was lower,and the main influencing factors involved age,degree of education and average monthly income of the family.2."centralized education" combined with "personalized health guidance" can help rectal cancer patients with sphincter-preserving surgery to master the knowledge and skills of self-management of bowel symptoms,and contribute to the cultivation of patients’ self-efficacy.3."WeChat group interaction" can shorten the distance between hospital and rectal cancer patients after sphincter-preserving surgery,and manage and monitor them in real time,so as to improve the self-management compliance of patients with bowel symptoms.4.nursing intervention based on multimedia and We Chat platform can help to cultivate the patient’s self-efficacy,and then improve the patient’s ability to manage the bowel symptoms. |
PDF Full Text Request