基于信息-动机-行为技巧模型探讨直肠癌支架法肠转流术后患者饮食管理现状的质性研究

A qualitative study of diet management in patients with colorectal cancer after stent-based diverting technique based on information-motivation-behavioral skills model

目的探讨直肠癌支架法肠转流术后患者饮食管理现状,为制订相关护理干预策略提供依据。方法采用目的抽样法,将2023年3—7月于浙江大学医学院附属邵逸夫医院行直肠癌支架法肠转流术并已拔除转流管的15例患者作为研究对象进行半结构式访谈,基于信息-动机-行为技巧(IMB)模型设立访谈提纲,采用Colaizzi 7步分析法分析、归纳、提炼资料。结果15例患者中男10例,女5例,年龄34~76岁。根据IMB模型3个要素,将饮食管理现状归纳为9个主题,信息方面包括难以获取有效饮食指导信息、缺乏具体饮食指导内容、需要个体化饮食指导、出院后信息交流延续性欠佳;动机方面包括忽视饮食管理重要性、不喜欢口服营养制剂的味道、家庭成员支持力度薄弱;行为技巧方面包括转流管护理技能不足、缺乏实际应用口服营养制剂技能。结论直肠癌支架法肠转流术后患者饮食管理存在诸多问题,医护人员应优化直肠癌患者术后饮食宣教信息,提供多层次、多时段、多形式连续性护理,调动家属参与积极性,提高患者饮食管理动力,细化转流管护理流程,加强口服营养制剂应用指导,提升患者饮食管理能力。

Objective To investigate the current situation of diet management in patients with colorectal cancer after stent-based diverting technique,and to provide basis for formulating relevant nursing intervention strategies.Methods Objective sampling method was used to conduct semi-structured interviews on 15 patients who underwent stent-based diverting technique for colorectal cancer and had the bypass tube removed from Sir Run Run Shaw Hospital Affiliated to Medical College of Zhejiang University from March to July 2023.The interview outline was established based on information-motivation-behavioral skills(IMB)model,and the data were analyzed,summarized and extracted by Colaizzi 7-step analysis method.Results There were 10 males and 5 females,aged 34-76 years old.According to the three elements of the IMB model,the current situation of diet management was summarized into nine themes.The information included the difficulty in obtaining effective diet guidance information,the lack of specific diet guidance content,the need for individualized diet information guidance mode,and the poor continuity of information exchange after discharge.The motivations included ignoring the importance of diet management,dislike the taste of oral nutritional preparations,and weak support from family members.Behavioral skills include inadequate tube care skills and lack of oral nutrition preparation skills.Conclusions There are many problems in the diet management of patients after colorectal cancer stent-based diverting technique.Medical staff should optimize the diet education information of colorectal cancer patients after surgery,provide multi-level,multi-time and multi-form continuous care,mobilize the active participation of family members,improve the motivation of patients′diet management,refine the nursing process of the bypass tube,strengthen the application guidance of oral nutrition preparation skills,and improve patients′diet management ability.