Milko Zanini. Authors: Annamaria Bagnasco, Milko Zanini, Gennaro Rocco, Loredana Sasso

Transcription

1 RCN 2014 Annual International Nursing Research Conference April 2014, Glasgow, Scotland, UK Milko Zanini Authors: Annamaria Bagnasco, Milko Zanini, Gennaro Rocco, Loredana Sasso

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3 There is evidence that nursing documentation is often weak, and in particular it lacks of a consistent and standardized approach towards educational diagnosis. Practical preoperative stoma training and motivation are essential to improve recovery and reduce the length of hospital stay.

4 Therapeutic patient education (TPE) imposes a radical change in the nurse-patient relationship (Schweyer & Thore, 2012). Whenever the nurse encounters a patient or a patient's family, there is a transfer of information that is expected to be incorporated into the patient's overall outcome (Krau, 2011) A shared definition of patient education has not yet been realized, we have variable results in outcomes measures that were used for the evaluation (Boyde, Turner, Thompson, & Stewart, 2011). little research has been conducted regarding patient benefit (Cotterill-Walker, 2012)

5 The literature currently identifies at least three risk factors in wrongly addressed entero-stoma patients: peri-stomal skin maceration and lesions (80% of stoma patients) (Burch, 2012); ; special dietary requirements (Rollins, 2010); an inadequate stoma device (Williams,2012) Italy counts a stoma population of upwards of 60,000 units.

6 attempt a more systematic and uniform approach to nurse assessment of educational needs in stoma care. develop a format for the identification of education needs in patients validate Motivation of the enterostoma patients needs (MEPN)

7 This research project allowed for the development of an educational diagnosis tool addressing the needs of stoma patients and their care-givers The following steps were taken to assess the MEPN chart: Defining a set of indicators for the educational diagnosis of Motivation Developing and piloting an MEPN diagnostic chart contents Validating the MEPN diagnostic chart

8 Data were entered into a 20.0 version SPSS analysis database for principal components analysis (PCA) with varimax rotation to investigate if the data could be reduced to fewer underlying dimensions. By using Monte Carlo PCA for parallel analysis, it was estimated that a three-factor solution would be appropriate

9 Through factor analysis we identified 3 factors Item Communality First principal unrotated component Factor 1 autonomy Factor 2 Social interactions Cronbach s alpha Factor 3 empowerment

10 factor 1was labelled Autonomy and included: How much do you trust in your ability to manage embarrassing situations? How important is physical activity for you?. Factor 2 was labelled Social interaction; and included: Do you feel the need to talk with other people who have the same problem? Do you think you are able to manage your life habits now that you have a stoma?. Factor 3 was labelled empowerment and included: How much do you trust in the support of the family members? How much do you trust in other people s support? The internal consistency of factors 1 and 2 was acceptable and for factor 3 it was low

11 Mokken scaling of the Questionnaire (n=104) Two items did not scale and were excluded from the analysis but the automated item selection procedure; two scales were former, one with 11 items and one with four items; only the first scale was considered here as the one with four items was not considered useful. A moderately strong Mokken scale (scalability coefficient H > 0.40) with moderately strong invariant item ordering (HT > 0.40) was derived Item Label Mean Hi SE 4 How important is physical activity for you? How much will you be able to 14 accept your stoma? How important is it for you to 2 resume your previous sexual activity? How good do you think you are 10 at handling sensitive/embarassing situations? How important is it for you to 8 resume working? How good do you think you are 9 at dealing with your stoma / condition autonomously? Do you think you can deal with 17 daily life now that you have a stoma? How good do you think you are 12 at handling sensitive/embarassing situations? Do you think you will be able to 16 choose the most appropriate device for you? How important is it for you to 3 maintain your level of autonomy? * How important is it for you not to be a burden for the family members? H = 0.47; Rho = 0.88; H T =0.41; *-item does not show IIO; SE

12 The sample size here was quite small for Mokken scaling, based Kuijpers et al (2013) using marginal models to establish the utility of standard errors and confidence intervals for scalability coefficients, we used the standard errors of the item scalability coefficients (Hi) and the standard errors of the scalability coefficients for item pairs (Hij) to calculate the 95% confidence intervals for each

13 104 diagnosis checklists validated by a pattern with 300 patient/caregivers involvement during three months Three sites for outpatients stoma treatment services The compliance assessment form had been carried out by nurses within 72 hours before discharge of patients. Definition of, at least, three educational diagnosis for patient and caregiver for each nurse Fill out and evaluation form at the end of the six evaluation on diagnosis

14 Educational diagnosys for PATIENTS: 47% of Patients are autonomous in their foods choice 33.7% are autonomous for medical devices choice 61.5% of the sample is dependent on appropriate behavior for inflammation management. 34.6% of patient sample is passive on appropriate behavior for the treatment of peristome skin. 52,9% are autonomous on clothing 35.6% is autonomous for the recognition of complications

15 Educational diagnosys for CAREGIVERS: 89,4% are active and autonomous in foods choice for patients 76% are active and autonomous for medical devices choice 36.5% of the sample did not answer on appropriate behavior for inflammation management for patient are active and autonomous for the treatment of peristome skin. 52,9% are autonomous on clothing 37.5% of sample answers Active and 39.4% autonomous

16 we evaluated the concordance between autonomy and dependence patient and caregiver significantly agree on the choice of the medical device (K =.717) and discreetly agree on appropriate behavior for irritation (K =.549). We evaluated the correlation between active and passive Patient and caregiver on appropriate behavior for inflammation (K =.632). For the other variables the patient and the caregiver do not agree

17 we found that no evidence of the TPE outcome were released to patient, because the checklist was too long to be evaluated during nurses intervention, we defined an MS excel based check list to evaluate the results of TPE program on patients. We also defined a cross-related table showing the outcomes of each section on a diagnosis tool and defined a cumulative index to evaluate performance outcomes

18 questions DISSAL Dipartimento di Scienze della Salute evaluation sections DESCRIPTION (STOMA SHEET) (PUT "X IN THE APPROPRIATE POSITION: A,B,C,NO,NAP) 1 educational diagnosis-observable behavior YE S 1 NO 2 A B C 1 the attitude of the patient in their choice of foods is active and autonomous? x 2 the patient's attitude about choosing appropriate devices is active and autonomous? x 3 the patient's attitude about the behavior for irrigation is active and autonomous? x 4 the attitude of the patient on the proper treatment of skin peristome is active and autonomous? x 5 the attitude of the patient in the selection of clothing is active and autonomous? x 6 the attitude of the patient on the recognition of complications is active and autonomous? x NAP 3 1 educational diagnosis-observable behavior not applicable questions 0 Positive responses (A) 3 Positive responses (B) 2 Positive responses (C) 1 negative responses 0 outcome positive score 4,25 70,83% educational diagnosis observable behavior next goal 6 A= full B = average C = minimum NO= not reached

19 This tool can better explain on a visual paper what is going on for patients and can demonstrate the value of their effort to better manage their condition. This tool allows the evaluation of the level of compliance with the educational information provided by nurses, with a three leve positive score or a single negative score. Analysis of levels of positivity or negativity achieved by the patient in relation to the defined objectives allows the expression of an outcome of the therapeutic patient education path Our tool also allows to make an evidence of the performance score of every step of educational path, giving to nurses and patient a visive match with their goals on therapeutic education

20 Reorganization of health care processes by inserting educational diagnosis Board in the assessment of the patient: introduction of an integrated educational diagnosis into nursing documentation. Introduction of training projects "on the job" for the continuous update on the review of the documentation. allow nurses to give an immediate feedback to patients that take part of the TPE program, with a report that summarize results and patient outcomes.