Construction And Application Of Home Self-management Scheme For T2DM Patients Based On The Omaha Problem Classification System

Objective:In this study,a home self-management scheme for T2DM patients was constructed based on the Omaha problem classification System,and the effect of this scheme on home-based blood glucose control and self-management ability of T2DM patients was examined.In order to provide scientific,objective and effective theoretical basis and practical reference for home self-management of T2DM patients,promote the realization of efficient home self-management,so as to improve the level of after-hospital blood glucose management,and provide guidance for clinical nursing and health education.Methods:1.Based on the Omaha Problem Classification System as the theoretical basis,combined with the pathological and physiological characteristics of T2DM patients,the evaluation scale of home self-management care problems for T2DM patients based on the Omaha problem classification System was preliminatively developed through literature review and group discussion,and the final evaluation scale was determined by two rounds of expert consultation.2.Based on the Omaha Problem Classification System T2DM patients home self-management care problems assessment scale as the main basis,the initial scheme was formed through literature research,according to relevant guidelines,combined with self-management theory,goal management theory and Orem self-care theory,and the final scheme based on Omaha Problem Classification System T2DM patients home self-management was formed through expert meeting method.3.Pre-discharged T2DM patients from the endocrinology department of a Grade-III hospital in Changchun were selected as subjects by convenience sampling method from August to October 2022.All patients met the inclusion and exclusion criteria and signed informed consent.A total of 149 patients were enrolled in this study and randomly selected into observation group and control group by random number extraction method,with 75 cases in observation group and 74 cases in control group.The control group was given routine discharge guidance and follow-up by the responsible nurse,and was followed up by phone or wechat once a week after discharge.In the observation group,on the basis of the control group,the members of the research group used the assessment scale formed in this study to evaluate the patients at the time of pre-discharge.According to the assessment results,the corresponding guidance was given according to the home-based self-management plan,the home-based self-management goals were determined with the patients,and a one-week individualized self-management plan was formulated.During the stay at home,telephone or wechat follow-up was also conducted with the above method every week.Follow-up observation time of both groups was 12 weeks.After intervention,the differences of glycated hemoglobin,fasting plasma glucose and 2-hour postprandial blood glucose in venous plasma between the two groups were compared at pre-discharge and 12 weeks after discharge.The difference of the fasting plasma glucose compliance rate and the 2-hour postprandial blood glucose compliance rate by self-monitoring at home between the two groups at 1～4 weeks,>4～8 weeks and>8～12 weeks.The knowledge,attitude and DSMQ scores of diabetes self-management were compared between the two groups at pre-discharge and 12 weeks after discharge.Results:1.Based on the Omaha Problem Classification System as the theoretical framework,the home care problems assessment scale for T2DM patients based on the Omaha Problem Classification System was formed with the field of health-related behaviors as the main research content,including 8 nursing problems and 24 symptoms/signs.2.A home-based self-management scheme for T2DM patients based on the Omaha Problem Classification System was developed,which included the assessment scale,intervention content and self-management goals.3.Application of the scheme(1)After intervention,fasting plasma glucose、2-hour postprandial blood glucose and glycated hemoglobin in the two groups at 12 weeks were significantly better in the observation group than in the control group,and the difference was statistically significant(P<0.05).(2)After intervention,the self-monitored fasting blood glucose compliance rate and the 2-hour postprandial blood glucose compliance rate at 2 hours after meals were compared at 1～4 weeks,>4～8 weeks and>8～12 weeks,the observation group was significantly better than the control group,the difference was statistically significant(P<0.05).(3)After intervention,the knowledge of diabetes self-management,attitude and scores of DSMQ scales in the observation group were significantly higher than those in the control group at the 12th week,with statistical significance(P<0.05).Conclusion:In this study,home self-management scheme for T2DM patients was constructed based on Omaha Problem Classification System,which was scientific,feasible and effective.The practical application proved that the scheme can effectively improve the blood glucose control level of patients and improve the self-management ability of patients.