Application Of "Four Stages And Five Dimensions" Nursing Intervention Based On HBM And Orem Self-care Theory In Main Caregivers Of Children With Epilepsy

Objective:To develop the "five dimensions" scale for assessing the care needs of primary caregivers of children with epilepsy based on health belief and self-care ability: "Cognition of disease,daily care,safety protection,psychological support and self-efficacy experience",and test its reliability and validity.In the "four stages" of "the day of admission,the Middle Period of hospitalization,the day of discharge and three months after discharge," the nursing needs assessment scale for the main caregivers of children with epilepsy was used to continuously assess the nursing needs of the main caregivers of children with epilepsy,and according to each stage different nursing need,provides the targeted nursing intervention measure.To evaluate the effect of the intervention on the knowledge of epilepsy in the main caregivers of children with epilepsy and the quality of life,medication compliance,the number of seizures in the past three months,the duration of each seizure,the readmission rate of children with epilepsy.Methods:1.Based on the experience of clinical nursing experts,searching relevant literature at home and abroad,semi-structured interviews and group discussions with the parents of10 hospitalized children with epilepsy,initially determine the main caregivers of children with Epilepsy Nursing Needs Assessment Scale Alternative Entries Pool.We invited 18 experts from 11 3a hospitals in 9 provinces and cities to form the initial scale with 5dimensions and 40 items after two rounds of expert consultation;form a pre-survey scale with 5 dimensions and 38 items after purpose sampling survey 12 children with epilepsy and their caregivers.By convenience sampling of 220 hospitalized and out-patient children with epilepsy and their main caregivers,measure,collect and process date,using item distribution method,critical ratio method and correlation coefficient method to judge whether the item is deleted or not,The validity of the scale was evaluated by content validity and construct validity,and its reliability was evaluated by Cronbach’s coefficient,split-half Coefficient and retest reliability.2.Using convenience sampling method,53 main caregivers of hospitalized children with epilepsy from September to October 2020 were selected as the observation group,and 53 main caregivers of hospitalized children with epilepsy from November to December 2020 as the intervention group.Routine nursing was used in the observation group.In the intervention group,besides routine nursing care,the main caregivers of children with epilepsy were assessed with the nursing needs scale,to assess the main caregivers of children with epilepsy in the day of admission,in-hospital,the day of discharge,discharge three months of the four stages of care needs and implementation of targeted nursing intervention.Comparative the observation group and the Intervention Group of children with epilepsy main caregiver epilepsy-related knowledge of the degree,all stages of the key care needs,and the quality of life of children with epilepsy,medication compliance,the number of seizures in the past three months,the duration of each seizure,readmission rate.Results:1.Based on the experience of clinical nursing experts,literature review,two rounds of expert inquiry and clinical practice,this study developed a nursing needs assessment scale for main caregivers of children with epilepsy.The final scale includes 5 dimensions and 30 items,namely,disease cognition(9 items),daily care(5 items),safety protection(8 items),psychological support(4 items)and self-efficacy(4 items).By calculating the selection rate of each item in the scale,the selection rate of 3 items out of 3 items is less than 10%;by calculating the critical ratio of each item,the decision value of 4 items is less than 3;there are five items with a correlation Coefficient less than 0.4.After considering 5 items deleted,the Correlation Coefficient between each item score and total score was 0.405-0.906,which was greater than 0.40.After 2 exploratory factor analysis,3 items were deleted and 5 factors and 30 items were extracted,the cumulative explanatory variance was 82.99%,the construct validity of the scale is good.The S-CVI was 0.95,the I-CVI range of each item was 0.83-1,and the content validity of the scale was good.CRONBACH’s Coefficient was 0.953,split-half Coefficient was 0.881,retest reliability Coefficient was 0.967,the reliability of the scale was good.2.On the day of admission,there was no significant difference in the scores of epilepsy knowledge between the control group and the intervention group(p=0.826).On the day of discharge,the score of epilepsy knowledge in the intervention group was higher than that in the control group,the difference was statistically significant(p=0.026),both the control group and the intervention group had higher scores on the day of discharge than on the day of admission(p<0.01),and the intervention group had higher progress scores than the control group.Using analysis of variance for single-variable repeated measures design data to compare the total scores of nursing needs assessment scale of intervention group at different time points,the difference was statistically significant(p<0.01),compare scores of each time in pairs,and there were statistical differences(p<0.01).The scores of quality of life in physical function,emotional function,social function and school performance in the intervention group were higher than those in the control group,however,only the total score of quality of life,emotional function and social function in the two groups were significantly different(p<0.05).The compliance of children with epilepsy in intervention group was higher than that in control group within three months after discharge(p=0.027).There was no significant difference in the frequency and duration of seizure between the two groups(p>0.05),and the readmission rate of the intervention group was lower than that of the control group(p=0.035).Conclusion:1.The preparation of the care needs assessment tool for primary caregivers of children with epilepsy,including 5 dimensions and 30 items,which comprehensively covered the characteristics of the main caregivers of children with epilepsy.The reliability and validity of the scale are good,and the number of items is moderate,the contents are comprehensive and the pertinence is strong,it can be used as an assessment tool for assessing the nursing needs of primary caregivers of children with epilepsy.2."Four-stage five-dimensional" nursing intervention model is an effective nursing program for the main caregivers of children with epilepsy,which can improve the level of knowledge about epilepsy of the main caregivers of children with epilepsy,and improve their compliance behavior and nursing ability,in order to improve the quality of life of children with epilepsy.