Primary Development Of The Perioperative Clinical Nursing Practice Program For Elderly Breast Cancer Patients

Objective:Taking the concept of bundles of care and the model of evidence-based healthcare as the theoretical framework,to identify the items of the perioperative clinical nursing practice plan for elderly breast cancer patients.Method:On the basis of comprehensive retrieval of the relevant guidelines,a qualitative study of interviewing 32 cases of elderly breast cancer patients,caregivers and medical stuff was conducted to clarify the status quo of perioperative care and decide the focus themes.Then,the evidence related to the focus themes was retrieved and synthesized to a draft plan.Combined with the quantitative survey with Toronto Information Needs Questionnaire for Breast Cancer to adjust the health education content,the draft plan was constructed.At last,the final plan was modified and established by using Delphi,evaluating the applicability of the plan dimensions and items in the target patients.Results:(1)The domestic and foreign guidelines focused on the elderly breast cancer patients’ perioperative care were not found.13 relevant guidelines about the elderly perioperative care and breast cancer perioperative care,with quality of grade B or above were finally included and extracted the recommended items and contents related to the topic.(2)The qualitative research revealed that,the present nursing practice didn’t show the specificity in the elderly,but the obvious psychological burden caused by the fear of affecting family,the information insufficiency on treatment process,the poor rehabilitation effect,and the lack of nursing cooperation ability were shown in this population during the perioperative period.And by these results,the focus themes were determined,including psychological assessment and intervention,upper limb functional exercise plan,health education regimen and caregiver’s care ability evaluation.(3)Combined with the items extracted from guidelines,the recommendations of 22 original literatures related to the focus themes were supplemented to formulate the program,which involving the preoperative evaluation,assessment and prevention of the intra-and post-operative complications,pre-discharge assessment and health education.(4)The quantitative study showed that,the total score of the elderly group with 144 cases was 201.74±28.83,which was not statistically significantly different from that of the non-elderly group with 118 cases,but there was a difference in the content of the needs between the groups.Elderly patients paid much more attention to wound care and treatment side effects than non-elderly group(p <0.05).The needs for the information of seeking social help or support,the aim and results interpretation of examination,the development of disease,and the related medical terms examination were significantly lower than that in non-elderly patients.As the age increases,the information needs about family care demand and treatment options showed an enhanced trend.And the health education strategy in the program was modified by these result.(5)After two rounds of expert consultation,the perioperative clinical nursing practice program for elderly breast cancer patients with 5 primary indicators,13 secondary indicators and 47 tertiary indicators has been modified and established.Conclusion: Combined with the characteristics of elderly patients and the current status of the clinical care,integrating the existing evidence,and with the scientific,transparent and rigorous construct process,the study constructs the perioperative clinical nursing practice program for elderly breast cancer patients,and aims to provide instructions for the implementation of the perioperative care for this population.