| Objective1.Conduct a thorough investigation into the current state of discharge readiness among patients who have undergone double-J stent placement surgery for urinary system calculi,and explore the factors that may be affecting it.2.Utilizing the Transtheoretical Model and the Behavior Change Wheel(BCW)theory,develop an intervention plan aimed at improving the discharge readiness of patients who have undergone double-J stent placement surgery for urinary system calculi.Implement the plan and assess its effectiveness through evaluation.MethodsThe study consisted of four phases.1.Status investigation phasePatients with indwelling double J-tubes after urological stone surgery,who were planned for discharge from a tertiary care hospital in Zhengzhou from December 2021 to March 2022,were selected as the study population.They were assessed using various questionnaires,including the general condition questionnaire,urology indwelling double J-tube patient discharge readiness questionnaire,discharge instruction quality scale,and social support rating scale,to analyze the factors influencing discharge readiness.The data were analyzed using IBM SPSS Statistics 25.0 and statistical methods such as t-test,one-way ANOVA,and multiple linear regression analysis,with a test level of α=0.05.2.Phase of qualitative researchProblems and needs of patients in the discharge preparation phase were analyzed and summarized based on the in-depth interview data of patients with indwelling double J-tubes after urinary calculi surgery,as part of the qualitative study phase.3.Intervention scheme construction stageThe intervention program was initially developed in combination with the preliminary study,and experts were consulted to identify problems and revise the intervention program accordingly.The final draft was formed after pretesting.4.Intervention program implementation phaseThe experimental study was conducted to evaluate the intervention program.A total of 64 eligible patients who voluntarily participated from the first and second wards of the urology department in a tertiary care hospital in Zhengzhou were selected as intervention subjects.They were divided into intervention and control groups using the lottery method,with 32 cases in each group,and were respectively provided with the discharge readiness intervention program and routine discharge instruction education.The data were analyzed using SPSS25.0 statistical software.Results1.Status investigation phaseThis study gathered a total of 201 questionnaires,from which 6 invalid ones were excluded.The remaining 195 questionnaires were deemed valid,resulting in a high validity rate of 97.01%.(1)urinary calculi patients with postoperative indwelling double J tube discharge readiness score range 119-171,the average score was(141.62±10.74)points and items are divided into(5.90±0.45),the response capacity dimension scored lowest(5.42±0.38),The score of emotional support was the highest(6.56±0.85).The score of discharge guidance quality was(142.22±12.61),and the score of social support was(37.98±7.70).(2)Multiple linear regression analysis was conducted with discharge readiness as the dependent variable and age,gender,marital status,working status,education level,monthly income,payment method of medical expenses,length of stay,type of medication taken,discharge guidance quality score and social support score as the independent variables.Results Gender,working status,education level,length of stay,quality of discharge guidance and social support were the influencing factors of discharge readiness2.Phase of qualitative researchA total of 11 patients with indwelling double J-tube after operation of urinary calculi were selected for qualitative interview,and the extracted themes were successively as follows:(1)disease uncertainty,(2)self care ability defects(symptom management ability insufficiency,the double J tubes related insufficient knowledge and ability to regulate emotions),(3)availability of support system is not perfect,lack of social support,insufficient medical support,emotional support),(4)the psychological problems,guilt,anxiety,fear3.Intervention scheme construction stageThe initial intervention plan,developed based on both the Transition Theory and BCW Theory,was refined after consulting with experts and conducting pre-experiments.During the expert consultation,a total of 11 questionnaires were distributed,all of which were valid with a valid recovery rate of 100%,and an authority coefficient of 0.915.The intervention plan aimed to improve the readiness of patients with indwelling double-J tubes following urologic stone surgery,and it was developed as follows:①Intervention design:Quasi-experimental study;②Intervention method:Combination of group and individual;③Intervention personnel:Researchers,responsible nurses,psychological counselors,etc;④Number of interventions:Four times in total;⑤Intervention content:Based on previous studies,various intervention themes were identified,including knowledge of caring for double-J tubes,methods to cope with complications,attention to daily life,improvement of social support,and regulation of psychological issues.The final intervention themes were "Preparing to embark on the ’J’ journey together," "Improving self-care and coexistence with the ’J’," "Comprehensive support for physical and mental comfort," and "Safe discharge and continued care.";⑥Evaluation time and indicators:Before the intervention(patient baseline data,discharge readiness,discharge guidance quality,and self-care ability),immediately after the intervention(discharge readiness,discharge guidance quality,and self-care ability),and one month after the intervention(complication incidence and unplanned readmission rate).4.Intervention program implementation phaseFollowing the intervention,the intervention group demonstrated higher scores in the total discharge readiness and all dimensions compared to the control group,with statistical differences observed between the two groups(P<0.05).Specifically,the intervention group had superior scores in the dimensions of discharge guidance quality,knowledge acquisition before discharge,content difference,discharge guidance skills,and effect.Nonetheless,there were no significant differences between the two groups in the dimension of knowledge acquisition before discharge(P>0.05).Moreover,the intervention group exhibited higher scores in self-care ability and various dimensions compared to the control group,with statistical differences observed between the two groups(P<0.05).Furthermore,the complication rate was significantly higher in the intervention group(31%)than the control group(9%)(P<0.05),and the rate of unplanned readmission was also significantly lower in the intervention group(6%)compared to the control group(25%)(P<0.05).Conclusions1.In this study,the discharge readiness of patients with indwelling double J tube after urinary calculi operation was at a lower than medium level,and gender,working status,educational level,length of stay,quality of discharge guidance and social support were influencing factors of discharge readiness.2.The intervention plan for discharge readiness of patients with double J-tube indwell after urinary calculi operation can improve the discharge readiness,discharge guidance quality,self-care ability of patients with double-J-tube indwell after urinary calculi operation and reduce the incidence of complications and unplanned readmission rate. |
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