| Objective1.To explore the status quo of discharge readiness of peritoneal dialysis patients with initial catheterization and its influencing factors;2.Based on the theory of middle-level transition and behaviors change wheel,an intervention plan for the discharge readiness of peritoneal dialysis patients with initial catheterization was constructed and its intervention effect was evaluated.MethodsThis study is divided into four parts:Inventory survey:The patients who were first placed in a 3A hospital in Zhengzhou from December 2018 to March 2019 and met the inclusion criteria were selected as the survey objects,mainly including general situation questionnaire,discharge preparation measurement table,discharge guidance quality scale,coping efficacy scale and social support evaluation scale,and their influencing factors were analyzed.Based on IBM SPSS Statistics 21.0 statistical software,descriptive statistics,single factor analysis,T test and other methods are mainly used to analyze the data.The test level is ?=0.05.Qualitative research stage:This stage was based on in-depth interview data of patients with primary peritoneal dialysis,the existing problems and needs in the preparation phase of patients' discharge are analyzed and summarized.Construction of intervention plan:Combined with previous domestic and foreign literature research and quantitative research,the intervention plan for the discharge readiness of patients with primary peritoneal dialysis is preliminarily drawn up.The intervention plan is demonstrated through expert consultation and the problems existing in the intervention plan are found through pre-experiment so as to make it more scientific and operable.Intervention study:The intervention plan was evaluated by quasi-experimental research.89 patients who met the inclusion criteria and voluntarily participated in the first and second wards of nephrology department in a third-level first-class hospital in Zhengzhou were selected as the intervention objects,and the patients were divided into groups based on drawing lots with wards as the unit.45 cases were intervened in the intervention group and 44 cases in the control group.The control group received routine education such as knowledge and skills of dialysis operation and health guidance,while the intervention group implemented the intervention plan of discharge readiness based on the routine health guidance of the department:group activities were taken as the main method,and individual intervention was taken as the auxiliary method,aiming at the personal status,family status and social adaptation of patients before discharge.The intervention was carried out in batches,with each batch of patients intervening for 3 weeks with a total duration of 5 months.Patients' general data and serum creatinine level were collected before the intervention,and their discharge readiness score,discharge guidance quality score,self-care ability score and serum creatinine level were collected immediately after the intervention.Their coping efficacy score,quality of life score,serum creatinine level and unplanned readmission rate were collected 1 month and 3 months after the intervention.Based on IBM SPSS Statistics 21.0 software,chi-square test,repeated measurement analysis of variance and generalized estimation equation are mainly used to analyze the data.The test level is ?=0.05.Results1.Inventory survey:This part of the study collected 240 questionnaires and 233 valid ones,with an effective rate of 97.1%.(1)The score range of peritoneal dialysis patients with initial catheterization is 56?113,with an average score of(81.14± 12.35)and an average score of(6.76± 1.02)for items,of which the personal status dimension score is the lowest(6.29±1.21)and the predictive support dimension score is the highest(6.92±1.32);The quality score of discharge guidance was(124.82±15.34),coping efficacy score was(45.56±6.64),and social support score was(33.52±3.49).(2)Through correlation analysis,T test,Chi-square test and other statistical methods,the influencing factors of the discharge readiness of patients with primary peritoneal dialysis were analyzed.Regression analysis showed that age,number of complications,place of residence,serum creatinine level,quality of discharge guidance,social support and coping efficacy were influencing factors of discharge readiness.2.Qualitative research stage:A total of 13 patients with primary peritoneal dialysis were selected for qualitative interviews.The topics extracted were as follows:? physiological problems(physiological indexes exceeded the standard and physiological adaptability was weak);?psychological problems(negative emotions,negative coping,low self-efficacy);?weakening of family roles;?lack of family care and support;?professional support needs(disease knowledge needs,disease skills needs);peer support needs;?social function withdrawal.3.Construction of intervention plan:This study constructs an intervention plan for the discharge readiness of peritoneal dialysis patients with initial catheterization:?Intervention design:quasi-experimental study;?Intervention mode:group activities are the main and individual intervention is the auxiliary;?Intervention implementers:researchers,specialized nurses,psychologists,etc.?Intervention duration:each batch of patients was intervened for 3 weeks for 4 times.?Intervention content:The core content of the intervention is the problem of patients' transition from hospital to family.Through targeted intervention,the preparation level for discharge can be improved.? Evaluation time and indicators:before the intervention(baseline data of patients,coping efficacy score and quality of life score),immediately after the intervention(discharge readiness,discharge guidance quality,self-care ability score and serum creatinine level),1 and 3 months after the intervention(coping efficacy score,quality of life score,serum creatinine level and unplanned readmission rate).4.Intervention study:(1)The total score of discharge readiness in the intervention group and its scores in all dimensions were higher than those in the control group,and there was statistical difference between the two groups(P<0.05).The scores of the quality of discharge guidance,the dimension of knowledge actually acquired before discharge,the dimension of content difference,the dimension of discharge guidance skills and the dimension of effect in the intervention group were higher than those in the control group.there was a statistical difference between the two groups(P<0.05).there was no significant difference in the dimension of knowledge acquired before discharge between the two groups(P>0.05);The scores of self-care ability and each dimension in the intervention group were higher than those in the control group,and there was statistical difference between the two groups(P<0.05).(2)The total score of coping efficacy and the score of competency dimension of the two groups of patients before and after intervention were repeatedly measured and analyzed by variance analysis.the results showed that there were statistical differences in interaction effect,inter-group effect and time effect(P<0.05).The dimensions of cognitive level and self-confidence were analyzed by generalized estimation equation,showing that the scores of cognitive level had no statistical difference in interactive effects(P>0.05),and there were statistical differences in inter-group and time effects(P<0.05).The scores of self-confidence were statistically different in interaction,inter-group and time effects(P<0.05).(3)The total quality of life scores of the two groups of patients before and after intervention were repeatedly measured and analyzed by variance analysis.the results showed that there were statistical differences in time,inter-group and interaction effects(P<0.05).the dimensions of physiological health and mental health were analyzed by generalized estimation equation,showing that there were no statistical differences in interaction and inter-group effects of physiological health scores(P>0.05),and there were statistical differences in time effects(P<0.05).There were statistical differences in mental health scores among groups,time and interaction effects(P<0.05).(4)Objective index comparison,the blood creatinine levels of the two groups of patients before and after intervention were repeatedly measured and analyzed by variance analysis.the results showed that there were statistical differences in time effect and interaction effect(P<0.05),but there was no difference in effect between the two groups(P>0.05).Chi-square test was carried out on the unplanned readmission number of the two groups of patients,and the results showed that there was a statistical difference 1 month after the intervention(P<0.05),but there was no difference 3 months after the intervention(P>0.05).Conclusions1.The discharge readiness of peritoneal dialysis patients with primary catheter was at a moderate to lower level.Among them,the discharge readiness of patients with different age,residence,serum creatinine level and number of complications was different.The quality of patients' discharge guidance,social support and coping efficacy are the gain factors of their discharge readiness.2.Qualitative interview results of peritoneal dialysis patients with initial catheterization determine the core content of the intervention plan to make it more targeted.Expert consultation and pre-test can find the problems existing in the intervention plan and correct them in time to ensure the smooth progress of the intervention plan.3.The intervention plan for discharge readiness of peritoneal dialysis patients with initial catheterization has a positive effect on the improvement of discharge readiness,discharge guidance quality,quality of life and coping efficiency level of patients,enhance self-care ability of patients and can reduce the blood creatinine level and unplanned readmission rate of patients at the same time. |
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