Establishment Of An Index System Of Home Care Needs For Children With Long Arm Cast

ObjectivesTo establish a set of scientific and systematic home care needs index system for pre-school children(3-6 years old)after long arm cast immobilization,so as to provide guidance and basis for better development of continuous home care for related children.Methods1.Qualitative research:Through systematic literature search,the outline of interviews with family members and medical personnel of the children was drawn up.By using objective sampling method,10 parents of children in pre-school age who were immobilized with long arm cast in a third-class A hospital in Jinan,Shandong Province,and 7 experts in pediatric orthopaedic medicine,nursing and rehabilitation from Jinan,Liaocheng and Xi’an were selected as interview subjects for semi-structured interviews.The traditional content analysis method was used to analyze and sort out the data,and extract the theme,so as to provide the basis for the establishment of all levels of items in the home nursing needs index.2.The first draft of the index system for home care needs of pre-school children after long arm cast immobilization:Based on the bio-psycho-social medical model proposed by Engel,professor of psychiatry and internal medicine at the University of Rochester,New York,USA,the problems and needs of children after upper limb fracture were summarized according to the qualitative research results,and the literature related to the continuous home care methods and status of children after fracture was retrieved by the literature synthesis analysis system.The first draft of an indicator system for home care services was established.3.Delphi expert letter consultation:Using the Delphi expert letter consultation method,20 experts in pediatric orthopaedic medicine,nursing and rehabilitation of children were invited to conduct letter consultation.According to the expert opinions,entries at all levels of the draft were modified,improved and optimized,and finally an indicator system of home care needs for pre-school children after long arm cast immobilization was formed.Results1.A total of 10 fathers or mothers of 3-6 years old children with long arm cast after upper limb fracture were interviewed,and 4 themes of home care needs was extracted,which were:symptom experience and physical change needs,information needs,co-existence of negative and positive psychological experience and social needs.Symptom experience and physical change needs included eight sub-topics,which were:pain assessment and management,swelling assessment and management,itching assessment and management,finger blood supply assessment,plaster tightness assessment,skin appearance improvement,assistance in activities of daily living and clothing change needs.Information needs include 6 sub-topics,which were:knowledge of fracture causes,knowledge of fracture treatment,drug and diet information,knowledge of functional exercise,activities of daily life,and demand for selecting media for information acquisition.The coexistence of negative and positive psychological experiences included 12 sub-topics,which were:fear and complaint,irritability and anger,avoidance and self-protection,loneliness,worry,doubt,regret and frustration,resistance,dependence,strength,positive optimism and fluke psychology.Social needs include 7 sub-topics:needs for medical staff,needs for parents,needs for schools and teachers,needs for peers,needs for other family members besides parents,needs for communication with other relevant personnel and needs for improvement of the surrounding environment.2.Interviewed 7 experts in medical,nursing and rehabilitation fields,and extracted 4 themes,which were:response to the possible symptom experience and physical changes,choose the type and location of functional exercise,deal with possible psychological problems and deal with possible social problems of children at home.Response to the possible symptom experience and physical changes included 10 sub-topics:pain and swelling assessment,muscle contracture and joint stiffness,decreased sensory ability,obesity,placement of fractured limbs,peripheral blood transport observation,local hygiene,skin itching,secondary disasters and limitations in activities of daily living.Choose the type and location of functional exercise included 2 sub-topics:the choice of functional exercise methods and the choice of functional exercise parts.Deal with possible psychological problems include 4 sub-topics:irritability and depression,anxiety and fear,overdependence and low self-esteem.Deal with possible social problems include 8 sub-topics:the impact on schooling,the impact on children’s social interaction,the limitation of playing with toys,the family burden,the expectations of the children,the expectations of the family,the expectations of the school and the expectations of the medical staff.3.Based on the real care experience of primary caregivers of children in pre-school age during home care after long arm cast immobilization for upper limb fractures and the qualitative interview results of relevant medical professionals,the problems and needs of children after long arm cast immobilization for upper limb fractures are summarized by taking the bio-psycho-social medical model proposed by Engel as the theoretical framework.Based on the method and current situation of continuous home care for children after fracture retrieved systematically,the first draft of home care needs index service system was established,including 6 first-level items,50 second-level items and 85 third-level items.4.The questionnaire recovery rates of the two rounds of Delphi expert letter consultation were 90%and 89%,respectively,and the effective rates were 100%.The authority coefficients of the two rounds of correspondence consultation were 0.879 and 0.800,respectively.The selection criteria for each item in the two rounds of correspondence consultation should meet the importance>3.5,coefficient of variation<0.25,and full score rate>20%at the same time.After the first round of consultation,some items were deleted,modified and added to form the second round of expert correspondence consultation table with 5 first-level items,26 second-level items and 36 third-level items.The results of the second round of correspondence showed that all items met the screening criteria,and no experts put forward suggestions for modification.After two rounds of expert correspondence consultation,the average value of importance assigned to each item is 4.38～5.00,the coefficient of variation is 0.00～0.20,and the coordination degree of the three-level items is 0.275,0.207 and 0.253,respectively,which reflects the unity of expert opinions.Finally,a home care needs index system covering five aspects of children’s physiological,functional exercise,psychological,social and information,including 5 first-level items,26 second-level items and 36 third-level items,was formed for preschool children with upper limb fracture and long arm cast immobilization.ConclusionsIn this study,the bio-psycho-social medical model as the theoretical framework,literature analysis combined with the needs and suggestions of both the supply and demand,through Delphi expert letter consultation method to improve and screen items,formed a scientific system of home care needs index system of pre-school children after long arm cast immobilization,to provide reference for further development of home care practice of related groups and diseases.