Application Of Nursing Intervention Based On IMB Model In Caregivers Of Enterostomy Patients

Objective:1.Through the combination of qualitative interviews and questionnaires,we can understand the current situation and influencing factors of the care burden of caregivers of patients with enterostomy,and provide a reference for formulating corresponding nursing intervention programs.2.To explore the application effect of nursing intervention based on IMB model in changing the coping style,improving the care ability and reducing the care burden of caregivers of patients with enterostomy.Methods:1.Qualitative interview,13 caregivers of patients with enterostomy who were admitted to the colorectal and anal surgery ward of a tertiary hospital in Shanxi Province from October 2021 to January 2022 were selected as the research objects by the method of purpose sampling.The data were collected by face-to-face semi-structured interview.With the help of NVivo 11.0 software,Colaizzi seven-step analysis method was used to analyze the data and refine the theme,so as to preliminarily understand the burden experience of caregivers in the process of care.2.Cross-sectional survey,using convenient sampling method,selected from April2022 to June 2022 in Shanxi Province.The caregivers of patients with enterostomy in the colorectal and anal surgery ward and stoma clinic of the third-grade class-A hospital were taken as the research objects.According to the Kendall sample size estimation method and considering 15% of the invalid questionnaires,the sample size of 163 cases was finally determined.The general information questionnaire,the simple coping style scale(SCSQ),the family caregiver care ability scale(FCTI)and the family caregiver burden scale for cancer patients(CBS-CP)were used to conduct a questionnaire survey to further analyze the caregiver burden level and its influencing factors.3.Randomized controlled trials were selected from July to September 2022 in the Department of Colorectal and Anal Surgery ward of a tertiary hospital in Shanxi Province.The caregivers of patients with enterostomy in the ward were taken as the research objects.The caregivers were randomly divided into the experimental group and the control group by coin tossing method.According to the comparison formula of the two sample mean and the pre-experimental results,and considering the 20% sample loss rate,the sample size of each group was finally determined.Both groups received routine nursing education in colorectal and anal surgery.On the basis of routine nursing,the experimental group implemented nursing intervention based on IMB model.SCSQ,FCTI,CBS-CP and stoma complication assessment tools were used to evaluate the effects of the two groups before and three months after intervention.Results:1.Qualitative research topic analysis results :The burden experience of caregivers of enterostomy patients in the care process can be summarized into five themes : insufficient psychological preparation(difficulty in stoma acceptance,lack of confidence in care),lack of care knowledge and skills,impaired health,high economic pressure(expensive stoma products,insufficient reimbursement)and changed pace of life.2.Cross-sectional study results show that :(1)The total score of care burden of 163 caregivers of enterostomy patients was(63.83 ± 13.24)points,including 65 cases of mild burden(39.88 %),87 cases of moderate burden(53.37 %)and 11 cases of severe burden(6.75 %).The overall care burden was moderate.(2)Univariate analysis showed that there were significant differences in the care burden scores of caregivers of patients with enterostomy in terms of education level,working status,family per capita monthly income,understanding of enterostomy,daily care time and self-care ability(P < 0.05).(3)Pearson correlation analysis showed that there was a negative correlation between the total score of care burden and the score of positive coping style and the total score of care ability(r = 0.437,0.464,P < 0.05),and a positive correlation with the score of negative coping style(r = 0.348,P < 0.05).(4)Multivariate linear regression showed that the working status,family per capita monthly income,positive coping style,negative coping style and care ability of caregivers of patients with enterostomy were the influencing factors of care burden(P < 0.05).These variables can explain 45.3 % of the total variation of care burden.3.Results of randomized controlled trials :(1)Before intervention,there was no significant difference in baseline data between the two groups(P > 0.05).(2)Intervention effect comparison :(1)SCSQ score : The positive coping score of the experimental group was higher than that of the control group,and the negative coping score was lower than that of the control group.(2)FCTI score : The total score of care ability in the experimental group was lower than that in the control group.There were statistically significant differences in the total score of care ability and scores of each dimension between the two groups(P < 0.05).(3)CBS-CP score : The total score of care burden in the experimental group was lower than that in the control group.There were significant differences in the total score of care burden and the scores of physiological,psychological,social and disease dimensions between the two groups(P < 0.05).Although there was no significant difference in the economic burden dimension between the two groups,the score of the economic burden dimension in the experimental group was lower than that in the control group.(4)Incidence of enterostomy complications : The incidence of enterostomy complications in the experimental group was lower than that in the control group,and the difference between the two groups was statistically significant.Conclusion:(1)In the process of caring for patients,caregivers of patients with enterostomy have diversified care burdens.Psychological status,self-health,economic pressure and social interaction are all important sources of their burden experience.Medical staff should comprehensively consider the above factors when intervening in caregivers,and propose targeted management countermeasures to alleviate the burden of care.(2)The burden of caregivers of patients with enterostomy is generally above the middle level.Care burden is related to coping style and care ability.The emergence and development of care burden are affected by factors such as caregivers ’ working status,family per capita monthly income,coping style and care ability.Medical staff should provide psychological support and skill guidance according to the individual situation of caregivers,strive to change the coping style of caregivers,improve their care ability,and then reduce their care burden.(3)The nursing intervention based on IMB model can change the coping style of caregivers of patients with enterostomy,improve the care ability,reduce the incidence of complications of enterostomy,and finally achieve the purpose of reducing the burden of care through the combination of information,motivation and skill training.It has certain guiding significance for improving the quality of care and improving the health outcomes of patients.