Role of remote extension management based on Roy's adaptive theory for secondary prevention in patients with coronary heart disease

LI,Lijun,GAO,Ruiying*

General practice department,The Affiliated Hospital of Inner Mongolia Medical University,Hohhot Inner Mongolia 010050,China

【Abstract】Objective:To construct and evaluate the application effectiveness of remote extension management for coronary heart disease under Roy's adaptive theory field of view.Methods:The enrolled 210 eligible CHD patients were pided into two groups(experimental and control)according to a randomized double-blind approach,in which both groups received standardized treatment and care during hospital,based on the fact that the control group(n=105)received routine discharge instructions from responsible nurses and routine out of hospital health while the experimental group(n=105)was supported by Roy's adaptive theory,Rational multimodal CHD long-term management model was constructed with team collaboration.The continuous follow-up observation was conducted for 1 year,and the rates of readmission,major adverse cardiovascular events,and complications after 1 year of discharge in both groups were recorded and observed,and the quality of life,self-health management status of the patients in both groups were tracked and evaluated using the Seattle Angina survey scale specific for coronary heart disease,the coronary self management behavior scale.Results:The rates of rehospitalization with recurrent coronary heart disease,major adverse cardiovascular events,and complications in the experimental group at out of hospital(after 1 year)were significantly lower than those in the control group(P<0.05;Meanwhile,the scores of each factor and the total score of Seattle Angina survey scale and coronary self management behavior scale in the two groups were significantly different(P<0.05),and the quality of life and self-management behavior of the experimental group were better than those of the control group.Conclusions:Remote extension management based on Roy's adaptive theory is an effective method for innovative long-term management of CHD and has great application to normalize the effectiveness of out of hospital secondary prevention strategies for CHD.

【Key words】Roy adaptive theory;Multimodal extension administration;Coronary heart disease;Secondary prevention

Evidence based medical evidence confirms that high-quality secondary prevention of coronary heart disease can delay and/or reverse the process of coronary atherosclerosis and prevent the occurrence of cardiovascular adverse events after PCI[1].For patients with coronary heart disease,the implementation of a series of continuous nursing plans to ensure the improvement of the secondary prevention effect outside the hospital is extremely critical.However,most of the existing long-term extended management schemes for coronary heart disease remain in the development of remote monitoring of medical resources,and the multi-agent optimization task in telemedicine has not formed a mature supporting method."Roy's adaptive theory"was put forward by Roy,an American nursing expert.This concept is based on the overall needs of the patient's body and mind,and emphasizes the appropriate adjustment of the inpidual's adaptive ability and ruminant meditation level[2].This theory is a new theory in the overall health management of the medical system and the promotion of the adaptability of patients with chronic diseases.It has the essence of forward-looking group prevention and health care.This study applies this theory to the remote extended management of coronary heart disease.This paper will study the management characteristics and application effects,aiming to help improve the long-term management and upgrading of coronary heart disease.The specific report is as follows:

1 Data and methods

1.1 Case data

Using the cluster sampling method,210 patients with coronary heart disease who were treated in the Department of Cardiology and Geriatrics of the Affiliated Hospital of Inner Mongolia Medical University from October 2019 to February 2021 were selected as the study subjects,including 126 males and 84 females,aged 45 to 80 years,with an average age of(59.3±10.5)years and a body mass index of(22.8±3.5)kg/m2.

1.2 Research methods

1.2.1 Grouping

The above 210 selected subjects were randomly pided into two groups according to the double-blind principle,namely,the experimental group(n=105 cases)and the control group(n=105 cases).Both groups received standardized treatment and nursing during the hospital period.On this basis,the control group received the routine discharge guidance of the responsible nurse and routine out-of-hospital health.The experimental group was supported by Roy's adaptive theory and built a reasonable long-term management model of remote coronary heart disease under team cooperation.The demographic data,coronary heart disease type and course of disease and other general data of the two groups were compared,and the difference was not statistically significant(P>0.05),which was comparable.

1.2.2 Remote extended management strategy of coronary heart disease in the perspective of Roy's adaptive theory

1.2.2.1 System construction and organization preparation

With the goal of"providing long-term care,rehabilitation support and health education for patients with coronary heart disease",according to the characteristics of the standard secondary prevention task of coronary heart disease,and taking the project time as the framework,build a remote extended management system of coronary heart disease under the framework of Roy's adaptive theory and make good organizational preparations.

1.2.2.2 Remote extension management task process supported by Roy's adaptive theory

①When the patient is discharged from the hospital,the responsible nurse will issue the discharge manual and give detailed discharge guidance such as medication,self-inspection and reexamination,and explain the management plan of coronary heart disease in the community and at home;Improve the patient file information on the chronic disease management network platform,register the personal account of the network platform for the patient,explain the function module of the platform,and make the patient or family familiar with the health education class and telemedicine arrangement.②The patient or family member is required to log in to the program interface regularly or irregularly,and the responsible nurse is required to log in to the network platform regularly to verify the patient's condition,and check and verify the patient's various independent physical examination values(such as blood pressure,heart rate,blood sugar,blood lipids,daily urine volume,BMI,etc.).Randomly and regularly carry out online coronary heart disease awareness education courses and patient club exchanges to answer patients'questions,so as to facilitate the summary of patients'self-disease management experience and the sharing of patients'experience;In addition,the follow-up records of the patients were randomly fed back to the family caregivers to urge their family caregiver status to assist the patients in home self-management.

1.2.2.3 Evidence-based practice intervention of Roy's adaptive theory

In remote extended management,according to Roy's adaptive theory,we can reasonably establish nurse-patient communication and trust according to four ways of inpidual adaptation adjustment,namely,physiological/physical way,self-concept/group identity way,role function way,and interdependence way,so that patients can better participate in management actions.Specifically,in the early stage,it is mainly combined with the group disease symptoms and psychological state at the time of discharge to find out the patient's earliest change and the most sensitive self-concept awareness.Through communication with the patient,it can help the patient master the basic knowledge of the secondary prevention and intervention mechanism of coronary heart disease and the home-based treatment plan in the way of group identity,improve the self-concept awareness of rehabilitation treatment,and provide a good basis for the next step to establish confidence in overcoming the disease and make cognitive decisions.

1.2.3 Effect evaluation

(1)The main intervention effects of secondary prevention of coronary heart disease in the two groups were observed through regular outpatient review,follow-up and evaluation records of remote interactive platform.(2)The quality of life and self-health management status of patients in the two groups were tracked and evaluated using the Seattle Angina Pectoris Survey and Coronary Heart Disease Self-Management Behavior Scale(CSMS)for coronary heart disease[3-4].

1.3 Statistical methods

All data were entered into Epidata3.5 database and processed by SPSS16.0 software.Quantitative data were expressed as mean±standard deviation(x±s).The comparison of quantitative data before and after implementation was conducted by paired t-test,and the comparison of counting data was conducted by chi-square test,with the test level of P=0.05.

2 Results

2.1 Comparison of secondary prevention effects between two groups

A total of 210 patients participated in the study.The whole follow-up period was uninterrupted,and there were no patients who were out of prevention.After one year of follow-up observation,the relapse and readmission rate of coronary heart disease,major adverse cardiovascular events and complications in the experimental group were significantly lower than those in the control group,with a statistically significant difference(P<0.05).

2.2 Comparison of quality of life between the two groups

The difference between the two groups in the factor scores and total scores of the Seattle Angina Questionnaire was statistically significant(P<0.05),suggesting that the quality of life of the experimental group was better than that of the control group;See Table 1.

Table 1 Comparison of the total score of quality of life and scores of each dimension between the two groups after 1 year of follow-up(score,x±s)

item	Control group(n=105)	Experimental group(n=105)	t	P
Degree of activity restriction	70.31±17.56	84.08±17.30	15.732	<0.05
Stability of angina pectoris	71.60±20.24	85.07±15.27	14.104	<0.05
Angina attack	82.45±21.50	90.32±20.08	10.251	<0.05
Treatment satisfaction	78.28±20.41	89.47±18.10	13.047	<0.05
Subjective feeling of disease	65.29±18.77	72.10±15.90	11.003	<0.05
total points	74.27±21.56	84.13±14.50	11.729	<0.05

2.3 Comparison of self-management behaviors of coronary heart disease between the two groups

The difference between the two groups in each factor score of coronary heart disease self-management behavior scale(CSMS)was statistically significant(P<0.05),suggesting that the self-management behavior of the experimental group was better than that of the control group;See Table 2.

Table 2 Comparison of each factor score of coronary heart disease self-management behavior between the two groups(score,x±s)

dimension	Control group(n=105)	Experimental group(n=105)	t	P
Bad hobbies	10.31±3.70	14.31±2.32	8.043	<0.05
General lifestyle	11.60±3.18	15.07±2.15	7.505	<0.05
symptom	10.27±1.36	13.27±2.59	5.824	<0.05
Disease cognition	11.15±2.06	15.47±3.64	7.971	<0.05
Treatment compliance	7.29±1.20	8.10±1.32	4.002	<0.05
give first aid treatment	9.37±2.40	11.19±2.37	5.270	<0.05
Emotional management	12.40±2.35	15.70±2.44	6.532	<0.05

3 Discussion

At present,the prevalence and mortality of coronary heart disease in China are increasing significantly,which has become a major public health problem seriously affecting public health.Coronary heart disease is a lifelong disease,which is highly related to lifestyle.Even if the short-term effect of percutaneous coronary intervention is good,its long-term prognosis still depends on the realization of the secondary prevention goal of coronary heart disease.The secondary prevention of coronary heart disease is mainly to intervene multiple risk factors,reduce complications and adverse cardiovascular events,and improve the quality of life[5]by implementing comprehensive treatment for patients with coronary heart disease.Long-term clinical practice has proved that extended management under the remote monitoring platform system is one of the important ways to improve the effect of out-of-hospital rehabilitation of patients with chronic diseases.Especially for people with cardiovascular diseases such as coronary heart disease,extended management has changed the pattern of traditional medical services and become a key link to effectively achieve the relevant secondary prevention goals.However,previous research shows that at present,the current remote extension management procedures of most medical institutions are still lack of pertinence and cannot meet the needs of patients[6,7].It is mainly reflected in the fact that the matching effectiveness of management means in the specific monitoring process is not strong,and the degree of refinement is not high,which can not really drive the intrinsic enthusiasm of patients'self-health management at home[8].The above problems greatly affect the actual effect of the extended management of secondary prevention of coronary heart disease.

In recent years,with the in-depth study of basic management theory in the medical field,the nursing theory in the relevant chronic disease management model has made great progress."Roy's adaptive theory"was gradually put forward by foreign nursing expert Carlista Roy according to the role played by nurses in disease prevention,medical management,rehabilitation promotion and health education.In this theory,Roy defined people as a whole of biological,psychological and social attributes,and believed that the life course of an inpidual is a dynamic process of constantly adapting to internal and external stimuli and continuously improving health level[2,9].From the perspective of international research trends,some scholars believe that Roy's adaptive theory is based on the overall needs of the patient's body and mind,emphasizing the appropriate stimulation and adjustment of the inpidual in health promotion and health education,so that it can reach the best adaptive state of the environment,thus enhancing the patient's adaptability to the disease[10].

On the basis of the above research,this study focuses on the two themes of integration and adaptation,and proposes the construction of remote extended management of coronary heart disease in the perspective of Roy's adaptive theory,with a view to providing more high-quality remote extended management services for patients with coronary heart disease at home.Roy's adaptive model,as a nursing intervention model,is first used as a management system to help patients adapt to their roles in receiving health education and guidance.The Roy adaptive model,which is the main link in the extended nursing process implemented in this study,is the specific implementation of the four adaptation models of this theory.By sharing information related to secondary prevention knowledge and combining with the evolution game of the main stimulus and related stimulus of information in health management,patients can truly participate in clinical diagnosis and treatment,make the best decision reasonably,and improve treatment compliance.

From the results of this experiment,this study is of great significance in improving the connotation of the means of extended management services for coronary heart disease.The results of this paper fully prove that remote extended management based on Roy's adaptive theory is an effective method for innovating long-term management of coronary heart disease,and has important application value in standardizing the effectiveness of secondary prevention strategies outside the hospital for coronary heart disease.Due to the relatively short development of the experimental study,the proposed path and steps of the extension management involved in this study still have defects and deficiencies.The solution of the above problems requires more theoretical research and management practice with a larger sample size in the future.

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【Funding project】Natural Science Foundation of Inner Mongolia(2019ms08143)

Corresponding author:GAO Ruiying