| ObjectiveTo construct a self-management intervention program for renal stone patients after ESWL based on symptom management theory;and apply the proposed plan to the clinic,aiming to evaluate its impact on the clinical efficacy,symptom management effect,self-management ability and quality of life of patients with kidney stones.Methods1.Construction of a self-management program for patients with renal stones after ESWLBased on the literature search,we screened the entries related to symptom management and self-management of renal stone patients after ESWL,and formed the first draft of the self-management program for renal stone patients after ESWL with symptom management theory as the framework through discussion among group members,and formed the revised draft after discussing and revising the expert opinions through two rounds of Delphi method correspondence;the final draft was formed after pre-experimentation.2.Application of the self-management program for patients with renal stones after ESWLUsing a randomized controlled study,162 kidney stone patients who underwent ESWL treatment at the Urology Lithotripsy Center of a hospital in Nanjing from Feb.2022 to Dec.2022 were selected as the intervention subjects of this study,and were randomly divided into a control group(81 cases)and a test group(81 cases)using the closed envelope method;the control group took conventional treatment and nursing measures,and the test group took the control group on the basis of The final draft of the self-management intervention program constructed on the basis of symptom management theory was adopted in the test group,and the intervention period was 3 months.The patients’general data and disease-related data were collected,and the abdominal plain film was reexamined two weeks after the intervention to clarify the discharge of stone fragments,and the symptom management effect was measured by symptom management score before and 7 days after the intervention.The data were collected and statistically analyzed using SPSS26.0 software,and the difference was considered statistically significant at P<0.05.Results1.Construction of a self-management program for patients with renal stones after ESWL(1)Literature study:By searching the literature related to self-management of renal stone patients after ESWL in Chinese and English databases,a total of 662 relevant literature were obtained.The content research method was applied to the retrieved literature for initial and refined screening,and a total of 12 pieces of literature meeting the requirements were finally included.The evidence was synthesized by the group members on the basis of group discussion,and the first draft of the intervention program was constructed using symptom management theory as the framework.(2)Expert consultation:A total of 15 experts were included in this study to conduct two rounds of expert consultation on the first draft of the intervention program,and the return rate of the questionnaires in the two rounds was 75%and 100%,indicating that the positive coefficient of experts was high.In addition,the authority coefficient of the experts consulted was 0.86,which is a high authority.The mean values of the rationality of the entries in the two rounds of correspondence questionnaires were 4.60 and 4.81,respectively,implying a good concentration of experts’opinions.The mean value of CV of entries at all levels in this study was<0.25,W fluctuated between 0.22-0.33,andχ~2test showed P<0.01,indicating a high degree of credibility of expert opinions.The final criteria for approval of entries at all levels were the mean number of plausibility assignments≥4 and the coefficient of variation<0.25,and entries that met both conditions were retained;those that met only one of the conditions were revised by the group after discussion,and then a second round of expert correspondence was conducted,and then a revised draft was formed after the completion of the two rounds of correspondence.(3)Pre-experimentation:12 cases meeting the criteria of nadir were pre-experim-ented,and the intervention plan was adjusted from the consideration of safety and feasibility in the implementation process to form the final draft.2.Clinical application of self-management program for patients with renal stones after ESWL(1)There was no statistically significant difference between the two groups of patients in terms of general information such as gender,age,marital status,education level,medical payment method,per capita monthly household income,and residence status(P>0.05).(2)Comparison of disease-related data between the two groups:no statistically significant differences in BMI,stone size and location,and past medical history(P>0.05).(3)Comparison of symptom management between the two groups:there was no statistically significant difference in the symptom scores between the two groups before the intervention(P>0.05),and all the symptom scores of the two groups decreased after the intervention(P<0.05);the comparison between the two groups showed that the reduction of the symptom scores was more significant in the experimental group(P<0.05).(4)Comparison of clinical stone removal effect between the two groups:Among 162patients with kidney stones treated with ESWL,18 cases in the control group were cured,49cases were clinically improved and 14 cases were not cured;among 81 cases in the trial group,39 cases were cured,35 cases were improved and 7 cases were not cured.The data of the two groups were statistically compared,and the difference was statistically significant(P<0.05).(5)Comparison of self-management ability between the two groups:before the intervention,there was no statistically significant difference between the two groups in the five index scores of diet control,proper exercise,emotional management,medication compliance and regular follow-up(P>0.05),but after the intervention,the self-management level of the two groups was significantly higher than that of the same group before the intervention,and the difference was statistically significant(P<0.05);and after the intervention,the test group showed a higher The difference was statistically significant(P<0.05).(6)Comparison of patients’quality of life between the two groups:before the intervention,there was no statistically significant difference between the two groups in the eight indicators for judging the quality of life(P>0.05),but three months after the intervention,the self-management level of both groups improved compared with that before the intervention,and the difference was statistically significant(P<0.05);and the test group showed a higher quality of life compared with the control group after three months of intervention,and the difference was statistically significant(P<0.05).Conclusions(1)The results of this study show that the self-management program for kidney stone patients based on symptom management theory is scientific,reasonable and feasible,and can provide evidence for the construction of the self-management program for kidney stone patients after ESWL surgery.(2)The self-management intervention program based on symptom management theory can improve the rate of stone fragment expulsion,reduce the severity and duration of postoperative symptoms,and improve self-management ability and patients’quality of life. |
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