Construction And Application Of Parastomal Hernia Prevention And Nursing Plan For Patients With Stoma

ObjectiveParastomal hernia is one of the most common long-term complications after permanent enterostomy,which aggravates the various burdens on patients.The purpose of this study is to: investigate the knowledge,attitudes and behaviors of patients with stoma about parastomal hernia prevention,and to grasp the occurrence of parastomal hernia;based on evidence-based nursing,construct case management scheme of stoma patients about parastomal hernia prevention and nursing;explore the effect of the scheme in clinical application.MethodsThis research is divided into 3 parts:1.Investigation on the knowledge,belief and behavior of patients with stoma about the prevention of parastomal hernia and Investigation on the occurrence of parastomal herniaThe convenience sampling method wasused to survey148 enterostomy patients in the stoma outpatient department of a third-class hospital in Zhenjiang on the knowledge,belief and practice of parastomal hernia prevention by a self-designed questionnaire,and to understand the incidence of parastomal hernias through physical examination.2.Construction of a case management plan for parastomal hernia prevention and nursingRetrieve the literature according to the "6S" pyramid model,and evaluate the quality of the literature,summarize the best evidence for non-surgical prevention and nursing of parastomal hernia;adopt the Delphi expert correspondence method to develop an evidence-based case management plan for parastomal hernia prevention and nursing.3.Implementation and effect evaluation of the case management planUsing a similar experimental study,in the gastrointestinal surgery department of a third-class hospital in Zhenjiang City,30 patients with permanent intestinal stoma admitted from September 2018 to March 2019 were the control group,and 30 patients with permanent intestinal stoma who were admitted from September 2019 to March2020 were the experimental group,and the parastomal hernia prevention and nursing program was implemented.The occurrence of parastomal hernia,self-care ability and self-efficacy of the two groups were compared.Results1.A 3-dimension self-developed questionnaire for the prevention of parastomal hernia in enterostomy patientsincludes knowledge(9 items),belief(6 items),behavior(5 items),the Cronbach’α coefficients of the total questionnaire and each dimension are 0.786,0.704,0.899,0.731 respectively;the half-reliability is 0.656,0.667,0.859,0.674.The patient’s total score for parastomy hernia prevention and the average scores of related knowledge,belief and behavior were 61.47±12.60 points,23.85±8.94 points,21.90±3.87 points,15.72±3.12 points,and the incidence of parastomal hernia in patients with intestinal stoma was 28.38%.Multivariate stepwise regression analysis showed that the patient’s age,education background,type of ostomy operation,occurrence of parastomal hernia and training of parastomal hernia prevention related knowledge are the influencing factors of the patient’s knowledge,belief and behavior score.2.After literature search and literature quality evaluation,a total of 10 articles were included.The expert authority coefficient(Cr)of the plan based on the literature is 0.844,the coefficient of variation of each item expert is less than 0.25,and the expert coordination coefficient is 0.269;the content of the planwith 3process indicators includes acceptance,management,and closure,and contains 3 evaluation indicators at the patient level,medical care level,and organization management level.3.In the application study of the plan,the incidence of parastomal hernia in the experimental group was lower than that in the control group(P <0.05);but the difference in the rate of medical intervention between the two groups was meaningless(P >0.05).The self-care ability of the experimental group was higher than that of the control group(P <0.05),and the self-care ability of the experimental group gradually increased over time(P <0.05).There was no significant difference in the total self-efficacy scores of the two groups(P>0.05),but the scores of social self-efficacy of the experimental group were higher than the scores of the control group,and the scores of the total self-efficacy of the experimental group increased over time(all P <0.05).Conclusions1.At present,patients with intestinal stoma have an unsatisfactory score for the prevention of parastomal hernia,and the incidence of parastomal hernia is relatively high in patients with stoma.Long-term and stable personalized education and follow-up should be carried out for patients to help patients put their knowledge and beliefs into action,so as to prevent parastomal hernia.2.This study summarized the evidence of non-surgical prevention and management of parastomal hernia,and constructed a case management plan for parastomal hernia protection.This plan was formed after two rounds of Delphi expert correspondence and has great theoretical value,and can provide a basis for the prevention and intervention of parastomal hernia in clinical practice.3.The implementation of the plan of prevention and nursing of parastomal hernia in enterostomy patients can effectively reduce the incidence of parastomal hernia in enterostomy patients,improve patients’ self-care ability and self-efficacy.