Application of continuous nursing based on EMS management mode in preschool children with wheezing diseases

doi:10.3969/j.issn.1674-8115.2024.02.009

Abstract

Abstract:

Objective ·To explore the effect of continuous nursing based on EMS [environment management (E), medicine direction (M) and self monitoring (S)] management mode on the preschool children with asthmatic diseases. Methods ·A total of 67 children aged 0 to 6 years with asthmatic diseases admitted to the Department of Respiratory Medicine, Shanghai Children's Hospital, Shanghai Jiao Tong University School of Medicine from December 2019 to November 2020 were selected and divided into observation group (33 cases) and control group (34 cases) according to the random number table method, with 3 cases lost, and finally 32 cases in each group. The observation group received continuous nursing care based on EMS management mode, while the control group received routine care and discharge follow-up through the telephone. The children in the two groups were followed up at 1, 3, and 6 months after discharge to evaluate the results of Test for Respiratory and Asthma Control in Kids (TRACK) and wheezing recurrence; Medication Adherence Report Scale for Asthma (MARS-A) and Nursing Job Satisfaction Questionnaire were used to evaluate medication adherence and nursing job satisfaction 6 months after discharge. Results ·There was no significant difference in demographic characteristics and clinical baseline characteristics between the two groups. Repeated measures analysis of variance showed that effects of time, groups and the interaction of groups×time on the total score of TRACK were statistically significant. The total scores of TRACK in the observation group were significantly higher than those in the control group at 1, 3, and 6 months after discharge (P=0.000). The total scores of TRACK in the two groups gradually increased with time (P=0.000). The recurrence rates of wheezing in the observation group were 25.0%, 18.7%, and 9.4% at 1, 3, and 6 months after discharge, which were significantly lower than those in the control group (50.0%, 43.7%, and 31.3%, respectively, P<0.05). Generalized estimating equation analysis showed that there was a statistically significant difference between the two groups (P=0.013), and the intervention effect of the observation group was better than that of the control group (OR=0.292). The MARS-A score of the observation group was 4.519±0.395 at 6 months after discharge, which was significantly higher than that of the control group (3.994±0.739, P=0.001). The nursing job satisfaction of the observation group was significantly higher than that of the control group (P=0.000). There was a moderate positive correlation between the MARS-A score and the nursing job satisfaction (r=0.389, P=0.001). Conclusion ·Continuous nursing based on EMS management mode can significantly improve the medication compliance and wheezing control level of the preschool children with asthmatic diseases, significantly reduce the recurrence rate of wheezing, and improve the nursing satisfaction.

Key words: EMS management mode, continuous nursing, preschool child, asthmatic disease

CLC Number:

R725.6

JIANG Yunli, LI Aiqiu, XIAO Yanshang, LI Tiantian, HU Yachen, ZHANG Xiaoxiao, WU Beirong. Application of continuous nursing based on EMS management mode in preschool children with wheezing diseases[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2024, 44(2): 228-236.

Figures/Tables 4

TrendMD

References 36

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Item	Observation group (n=32)	Control group (n=32)	Z/t/χ² value	P value
Age/month	12.1 (5.4, 35.5)	14.5 (4.6, 27.9)	-0.752	0.452
Gender/n(%)			1.871	0.171
Male	20 (62.5)	25 (78.1)
Female	12 (37.5)	7 (21.9)
Resident area/n(%)			3.473	0.062
Living in city	25 (78.1)	18 (56.3)
Living in suburbs/village	7 (21.9)	14 (43.7)
Combined with allergic diseases/n(%)			1.362	0.741
No allergic diseases	26 (81.2)	25 (78.1)
Allergic rhinitis	3 (9.4)	4 (12.5)
Allergic conjunctivitis	1 (3.1)	0 (0)
Allergic dermatitis	2 (6.3)	3 (9.4)
Bronchiolitis history/n(%)			0.080	0.777
No	24 (75.0)	23 (71.9)
Yes	8 (25.0)	9 (28.1)
Diagnosed as asthma/n(%)			0.064	0.800
No	19 (59.4)	18 (56.3)
Yes	13 (40.6)	14 (43.7)
Seasonal factor/n(%)			0.674	0.412
No	21 (65.6)	24 (75.0)
Yes	11 (34.4)	8 (25.0)
Passive smoking/n(%)			0.000	1.000
No	6 (18.8)	6 (18.8)
Yes	26 (81.2)	26 (81.2)
Production mode/n(%)			0.251	0.616
Eutocia	16 (50.0)	18 (56.3)
Caesarean	16 (50.0)	14 (43.7)
Premature delivery/n(%)			0.087	0.768
No	8 (25.0)	7 (21.9)
Yes	24 (75.0)	25 (78.1)
Feeding history/n(%)			1.476	0.478
Breast feeding	26 (81.2)	22 (68.7)
Artificial feeding	3 (9.4)	6 (18.8)
Mixed feeding	3 (9.4)	4 (12.5)
Paternal age/n(%)			0.068	0.794
≥35 years old	12 (37.5)	11 (34.4)
<35 years old	20 (62.5)	21 (65.6)
Maternal age/n(%)			0.638	0.424
≥35 years old	12 (37.5)	9 (28.1)
<35 years old	20 (62.5)	23 (71.9)
Paternal education level/n(%)			0.481	0.786
Technical secondary school or below	6 (18.8)	4 (12.5)
Junior college	9 (28.1)	10 (31.2)
Bachelor degree or above	17 (53.1)	18 (56.3)
Maternal education level/n(%)			0.136	0.934
Technical secondary school or below	9 (28.1)	8 (25.0)
Junior college	6 (18.8)	7 (21.9)
Bachelor degree or above	17 (53.1)	17 (53.1)
Paternal history of allergic diseases/n(%)			0.110	0.740
Yes	5 (15.6)	6 (18.8)
No	27 (84.4)	26 (81.2)
Maternal history of allergic diseases/n(%)			0.000	1.000
Yes	28 (87.5)	28 (87.5)
No	4 (12.5)	4 (12.5)

Item	Observation group (n=32)	Control group (n=32)	Z/t/χ² value	P value
Age/month	12.1 (5.4, 35.5)	14.5 (4.6, 27.9)	-0.752	0.452
Gender/n(%)			1.871	0.171
Male	20 (62.5)	25 (78.1)
Female	12 (37.5)	7 (21.9)
Resident area/n(%)			3.473	0.062
Living in city	25 (78.1)	18 (56.3)
Living in suburbs/village	7 (21.9)	14 (43.7)
Combined with allergic diseases/n(%)			1.362	0.741
No allergic diseases	26 (81.2)	25 (78.1)
Allergic rhinitis	3 (9.4)	4 (12.5)
Allergic conjunctivitis	1 (3.1)	0 (0)
Allergic dermatitis	2 (6.3)	3 (9.4)
Bronchiolitis history/n(%)			0.080	0.777
No	24 (75.0)	23 (71.9)
Yes	8 (25.0)	9 (28.1)
Diagnosed as asthma/n(%)			0.064	0.800
No	19 (59.4)	18 (56.3)
Yes	13 (40.6)	14 (43.7)
Seasonal factor/n(%)			0.674	0.412
No	21 (65.6)	24 (75.0)
Yes	11 (34.4)	8 (25.0)
Passive smoking/n(%)			0.000	1.000
No	6 (18.8)	6 (18.8)
Yes	26 (81.2)	26 (81.2)
Production mode/n(%)			0.251	0.616
Eutocia	16 (50.0)	18 (56.3)
Caesarean	16 (50.0)	14 (43.7)
Premature delivery/n(%)			0.087	0.768
No	8 (25.0)	7 (21.9)
Yes	24 (75.0)	25 (78.1)
Feeding history/n(%)			1.476	0.478
Breast feeding	26 (81.2)	22 (68.7)
Artificial feeding	3 (9.4)	6 (18.8)
Mixed feeding	3 (9.4)	4 (12.5)
Paternal age/n(%)			0.068	0.794
≥35 years old	12 (37.5)	11 (34.4)
<35 years old	20 (62.5)	21 (65.6)
Maternal age/n(%)			0.638	0.424
≥35 years old	12 (37.5)	9 (28.1)
<35 years old	20 (62.5)	23 (71.9)
Paternal education level/n(%)			0.481	0.786
Technical secondary school or below	6 (18.8)	4 (12.5)
Junior college	9 (28.1)	10 (31.2)
Bachelor degree or above	17 (53.1)	18 (56.3)
Maternal education level/n(%)			0.136	0.934
Technical secondary school or below	9 (28.1)	8 (25.0)
Junior college	6 (18.8)	7 (21.9)
Bachelor degree or above	17 (53.1)	17 (53.1)
Paternal history of allergic diseases/n(%)			0.110	0.740
Yes	5 (15.6)	6 (18.8)
No	27 (84.4)	26 (81.2)
Maternal history of allergic diseases/n(%)			0.000	1.000
Yes	28 (87.5)	28 (87.5)
No	4 (12.5)	4 (12.5)

Time	TRACK score/point		F value	P value
Time	Observation group (n=32)	Control group (n=32)	F value	P value
Before intervention	40.00±24.82	42.03±26.36	0.101	0.752
Follow-up at 1 month	81.09±11.69^①	63.44±17.89^①	21.842	0.000
Follow-up at 3 months	90.78±5.84^①②	76.72±11.26^①②	39.345	0.000
Follow-up at 6 months	96.56±3.22^①②③	83.91±9.73^①②③	48.763	0.000
F value	50.757	35.677
P value	0.000	0.000

Time	TRACK score/point		F value	P value
Time	Observation group (n=32)	Control group (n=32)	F value	P value
Before intervention	40.00±24.82	42.03±26.36	0.101	0.752
Follow-up at 1 month	81.09±11.69^①	63.44±17.89^①	21.842	0.000
Follow-up at 3 months	90.78±5.84^①②	76.72±11.26^①②	39.345	0.000
Follow-up at 6 months	96.56±3.22^①②③	83.91±9.73^①②③	48.763	0.000
F value	50.757	35.677
P value	0.000	0.000

Item	Observation group (n=32)	Control group (n=32)	χ²/t value	P value
Wheezing recurring during 1 month/n(%)			4.267	0.039
No	24 (75.0)	16 (50.0)
Yes	8 (25.0)	16 (50.0)
Wheezing recurring during 1-3 months/n(%)			4.655	0.031
No	26 (81.3)	18 (56.3)
Yes	6 (18.7)	14 (43.7)
Wheezing recurring during 3-6 months/n(%)			4.730	0.030
No	29 (90.6)	22 (68.7)
Yes	3 (9.4)	10 (31.3)
MARS-A score/point	4.519±0.395	3.994±0.739	-3.546	0.001
Satisfaction with nursing work/%
Total score	96.1±3.1	92.4±4.3	-3.926	0.000
Nursing communication	95.9±4.3	92.6±4.2	-3.108	0.003
Nursing health education	97.1±3.6	93.4±4.7	-3.477	0.001
Nursing care services	94.6±3.9	89.8±6.1	-3.759	0.000
Nursing Environment	97.7±4.0	94.7±4.4	-2.824	0.006