Construction And Preliminary Application Of Narrative Nursing Intervention Program For Patients With Ischemic Stroke Based On COM-B Model

Objective:Based on COM-B model constructing narrative of ischemic cerebral apoplexy patients and applied to clinical nursing intervention,to explore the scheme of ischemic cerebral apoplexy patients psychological intervention effect of health and daily life ability aims to explore a new mode of clinical nursing,in order to improve the quality of life of ischemic cerebral apoplexy patients provide scientific basis and practical guidance.Methods:1.Literature analysis: domestic and foreign literature on narrative nursing and depression and anxiety was systematically reviewed,and the first draft of Narrative nursing Intervention Plan for Ischemic Stroke patients was formed by sorting and analyzing the literature.2.Delphi expert consultation: Narrative nursing intervention program for patients with Ischemic stroke was determined after 2 rounds of expert consultation.3.Application study: A quasi-experimental study design was used to conveniently select 84 patients with first ischemic stroke who were hospitalized in the Department of Neurology of a Third Grade A general hospital from July 2021 to June2022 as the research objects and were divided into the experimental group and the control group,with 42 cases in each group.The patients in the two groups were given nursing intervention for 4 weeks,the control group was given routine nursing,the experimental group was given narrative nursing on the basis of routine nursing measures.Activities of daily living and scores of depression and anxiety were collected before intervention,2 weeks and 4 weeks after intervention.The satisfaction scores of the two groups were collected at discharge.4.Statistical analysis: SPSS26.0 software was used for statistical analysis.Two-sided test showed that P<0.05 was considered statistically significant.The positive coefficient,authority coefficient and Kendall’s harmony coefficient were used to judge the reliability of the study.Using descriptive statistics,t-test,chi-square test,rank-sum test and repeated measures variance analysis applied research data,after normality test,the scores of depression and anxiety at each time point met normal distribution and homogeneity of variance,and independent sample t-test was used.Repeated measures ANOVA was used to compare the trend of scores at each time point over time,and the interaction between time and groups was analyzed.The ability of daily living and nursing satisfaction did not meet the normal distribution,and the rank sum test was used to analyze and compare.Results:1.Literature analysis: A total of 24 articles were finally included,the first draft of the narrative nursing intervention program was initially determined,including 4first-level items,16 second-level items,and 53 third-level items,including the composition requirements of intervention personnel,intervention methods,quality control and effect evaluation.2.Delphi method of expert consultation: the recovery rate of the first round and the second round of questionnaire were 88.9% and 93.8%,the rate of expert opinion was 68.8% and 20.0%,the expert authority coefficient was 0.847 and 0.853,and the Kendall coordination coefficient was statistically significant(P<0.05).3.Applied study:Barthel(BI)scores showed that there was no significant difference in the scores before intervention(P>0.05);After 2 weeks of intervention,the score of the experimental group(90.0)was higher than that of the control group(80.0).After 4weeks of intervention,the score of the experimental group(98.5)was higher than that of the control group(92.5).The difference was statistically significant(P<0.05).Scores of depression(HAMD)showed no significant statistical difference before intervention(P>0.05);2 weeks of intervention,the score of experimental group(11.93±4.59)was lower than that of control group(13.98±4.70).4 weeks of intervention,the score of experimental group(6.13±2.41)was lower than that of control group(10.68±3.15),and the difference was statistically significant(P<0.05).The results of repeated measures ANOVA showed that the time effect,intergroup effect and interaction effect of subjects in the experimental group and the control group had significant statistical significance in depression scores(P<0.05).Anxiety(HAMA)score showed that there was no significant statistical significance before intervention(P>0.05);2 weeks of intervention,the score of experimental group(8.38±3.08)was lower than that of control group(9.58±2.78).4weeks of intervention,the score of experimental group(4.25±1.51)was lower than that of control group(7.58±2.47),and the difference was statistically significant(P<0.05).The results of repeated measures ANOVA showed that in terms of anxiety score,the time effect,inter-group effect and interaction effect of subjects in the experimental group and the control group had significant statistical significance(P<0.05).Comparison of nursing satisfaction(NSNS)score: At discharge,the nursing satisfaction score of the control group(89.0)was lower than that of the experimental group(94.0),the difference was statistically significant(P<0.05).Conclusions:1.The narrative nursing intervention program for patients with ischemic stroke constructed in this study is scientific,rigorous and reliable,which can provide reference for clinical application.2.Narrative nursing intervention can effectively improve the anxiety and depression of ischemic stroke patients and reduce the occurrence of adverse reactions.3.Narrative nursing intervention can effectively improve the activities of daily living,quality of life and patient satisfaction of patients with ischemic stroke.