Construction And Application Of Continuous Nursing Program For Patients With Inflammatory Bowel Disease Based On COM-B

Objective The purpose of this study was to investigate and analyze the current situation and influencing factors of discharge readiness in patients with inflammatory bowel disease(IBD),With the theoretical guidance of the COM-B model,a continuous nursing program for patients with inflammatory bowel disease was constructed,and the application effect was evaluated.Methods Using the questionnaire survey method,the discharged IBD patients in a class III grade one hospital in Qingdao from April 2020 to March 2021 were selected to conduct a discharge readiness survey,to explore the current situation of discharge readiness and analyze the influencing factors to understand the patients’ continuous nursing needs.Combined with COM-B model theory,literature analysis and guide review,continuous nursing plan for patients with IBD based on COM-B model was constructed.Delphi method was used to conduct two rounds of correspondence with 16 experts.Expert opinions was used to modify the first draft of intervention to form the final plan of continuous nursing for patients with IBD based on COM-B model.106 patients treated in the Department of Gastroenterology of a class III grade one hospital in Qingdao from March 2021 to October 2021 were selected as the research objects.They were divided into control group and intervention group according to the admission time.The control group was given routine nursing,discharge guidance and telephone follow-up;The intervention group implemented continuous nursing for patients with IBD based on COM-B model.Before and 3 months after the intervention,IBD quality of life questionnaire,IBD self-efficacy scale and Morisky medication compliance questionnaire were used to investigate the quality of life,self-efficacy and medication compliance of patients.The quality of life,self-efficacy and medication compliance of patients in the two groups were compared before and after the intervention.Results 1.The score of discharge readiness score of patients with IBD was(92.26±12.75)and the discharge guidance quality score was(140.09±31.13),both of which were at a moderate level;Multiple stepwise regression results show that the quality of discharge guidance,the payment method of patients’ medical expenses and perceived self-care ability were the main influencing factors.2.16 questionnaires were distributed in two rounds of expert Correspondence,and the effective responding rate was 100%.The authority coefficients of experts in the two rounds of correspondence are 0.92 and 0.91 respectively,and the authority of experts is high.The Kendall coordination coefficients of the two rounds of correspondence experts were 0.162 and 0.157 respectively(P<0.001).Finally,a continuous care plan for patients with IBD was formed,including 3 intervention dimension items,7 intervention function items and 57 intervention content items.3.The results of clinical application study showed that:(1)after 3 months of intervention,the score of quality of life in the intervention group was significantly higher than that in the control group(t=15.426,P<0.05).The dimensions of intestinal symptoms(t=5.237),systemic symptoms(t=5.401),emotional function(t=12.026)and social function(t=9.740)in the intervention group were higher than those in the control group,and the difference was statistically significant(P<0.05).(2)After the intervention,the score of self-efficacy in the intervention group was significantly higher than that in the control group(t=13.584,P<0.01).The dimensions of stress and emotion management(t=3.954),medical care management(t=8.239),disease management(t=14.672)and maintenance management in remission period(t=13.584)in the intervention group were significantly higher than those in the control group(P<0.05).(3)After the intervention,the medication compliance of patients in the intervention group was higher than that in the control group(t=10.997,P< 0.05).Conclusions 1.The discharge readiness and discharge guidance quality of patients with IBD are at a medium level,and the patients have continuous nursing needs.2.The continuous nursing scheme based on COM-B model constructed by Delphi method for patients with IBD is scientific and feasible.3.The empirical results confirm that COM-B continuous nursing program can help patients with IBD improve their quality of life,improve their sense of self-efficacy,improve their medication compliance,and provide a theoretical basis for clinical nurses to implement scientific continuous nursing.