The Constructing Research On The Current Situation Of Discharge Readiness And Continuing Nursing Care For Cholelithiasis Patients With T-tube

ObjectiveTo explore the current situation of discharge readiness for cholelithiasis patients with T-tube and analyze the influencing factors;To understand the self-care needs of cholelithiasis patients with T-tube;To construct continuing nursing care scheme guiding by patient demand,so as to provide theoretical foundation for the formulation of continuing nursing care scheme for cholelithiasis patients with T-tube.Methods1 Cross-sectional survey: according to the method of convenient sampling,215 cholelithiasis patients with T-tube coming from a "Three-A" hospital in Qingdao from September 2020 to March 2021 were selected as research object.The discharge readiness and guidance quality were investigated.the survey results were analyzed by descriptive analysis,single factor analysis,multiple linear regression analysis and Pearson correlation analysis.The current situation and influencing factors of discharge readiness of patients with cholelithiasis with T-tube were analyzed.the relationship between discharge readiness and guidance quality were clarified.2 Semi-structured interview: according to the method of objective sampling,we conducted semi-structured interviews for 12 cholelithiasis patients with T-tube and 7family members of enrolled patients coming from a "Three-A" hospital in Qingdao from April 2021 to June 2021.the text data were analyzed with Colaizzi 7-step method.The theme of self-care needs of cholelithiasis patients with T-tube was exacted.3 Delphi expert inquiry: Based on the systematic review of relevant literature at home and abroad,the results of cross-sectional survey and semi-structured interview,a continuous nursing scheme for cholelithiasis patients with T-tube was preliminarily constructed after discussion of the research group and consulting the suggestions of experts.Delphi expert correspondence method was used to conduct two rounds of expert correspondence with 27 medical and nursing experts related to the subject of this research in seven domestic "Three-A" hospitals.Finally,the continuing nursing plan for cholelithiasis patients with T-tube was determined.Results1 Results of cross-sectional survey: the discharge readiness score of 215 cholelithiasis patients with T-tube was(90.42 ± 7.30),and the average score of each item was(7.54 ± 0.61).Univariate analysis showed that there were statistically significant differences in the scores of 10 variables,including age,marital status,education level,residence,work status,income level,medical insurance type,disease history,length of stay and BMI of patients with T-tube cholelithiasis(p< 0.05).Pearson correlation analysis showed that there was a positive correlation between discharge readiness and discharge guidance quality(r=0.453,p<0.05).Further multiple linear regression analysis showed that patients’ age,marital status,income level,BMI and discharge guidance quality were the influencing factors of discharge readiness(p<0.001),which could explain 53.1% of the total variation of the influencing factors of discharge readiness of patients with cholelithiasis with T-tube.2 Results of semi-structured interview: the semi-structured interview data from self-care needs of cholelithiasis patients and their families with T-tube were analyzed.four themes were extracted.(1)high demand for health management information,(2)demand for guidance of daily living ability about T-tube,(3)demand for T-tube nursing skills(4)demand for diversified forms of continuous nursing services.3 Results of Delphi expert correspondence: in the first round of Delphi expert correspondence,the enthusiasm of experts is 100%.The expert authority coefficient is0.85.The expert Kendall harmony coefficient is 0.278.In the second round of Delphi expert correspondence,the enthusiasm of experts was 100%.The expert authority coefficient was 0.86.The expert Kendall harmony coefficient was 0.29.After two rounds of Delphi expert consultation,the preliminary continuous care plan was modified of deleted(6 items were modified,2 items were deleted and 10 items were added),and finally the continuing care plan for cholelithiasis patients with T-tube was determined.6 primary indicators,34 secondary indicators and 81 tertiary indicators were included.Conclusions1 The discharge readiness of cholelithiasis patients with T-tube was at medium level.There was a positive correlation between the discharge readiness and the quality of discharge guidance.Medical staff should improve the contents and skills of discharge guidance,which could improve the discharge readiness of patients,help patients complete the transition from hospital to family and ensure the safety of patients.2 Cholelithiasis patients with T-tube showed high demand in obtaining health management information,improving the ability of daily living about T-tube,mastering T-tube nursing skills,and various forms of continuous nursing.3 The continuing care plan for cholelithiasis patients with T-tube constructed by the research showed scientificity and practicability.It could enrich and improve the clinical continuing care plan.Moreover,the quality of T-tube home care and the ability of daily life were effectively improved.Finally,the rehabilitation of patients were promoted.