糖尿病护理门诊患者失访原因和赋能教育应用效果研究

发布时间：2018-06-08 04:10

本文选题：糖尿病 + 护理门诊　；参考：《天津医科大学》2014年硕士论文

【摘要】：目的 1调查糖尿病护理门诊患者失访的原因,分析可能造成失访结局的相关影响因素。 2将赋能教育应用于失访患者,确定其应用效果和推广价值。方法 1采用病例对照研究分析造成失访的相关因素。将2010年1月至2011年5月期间出院的糖尿病患者根据失访与否进行分组,随机抽取失访和非失访患者各180例。根据预留联系方式对两组患者进行电话联系。采取开放式提问,了解两组患者对随访的态度、现状,另外向失访患者提问失访的原因；收集患者病历资料：包括性别、年龄、病程、家族史、受教育情况,工作状况、医保、定点医疗、治疗方式、用药情况、并发症严重程度等。将两组患者的资料进行对照,并作回归分析。 2作为补充试验,探讨不同随访频率与失访结局的关联性：重新抽取自2011年11月起新出院糖尿病患者240人,随机分为三组开展随访健康教育。教育内容完全一致,但三组随访教育频率分别为：每周1次、每2周1次和每月1次。教育周期均为3个月,之后改为每月1次门诊随访。在3个月和1年后进行监测,应用卡方检验和重复测量方差分析法分析随访频率与失访、血糖控制的关系。 3应用赋能教育对失访患者进行干预：电话联系失访患者,征得患者和家属同意后对其中80例患者实施3个月的糖尿病赋能教育。期间应用中文版糖尿病赋能量表(CM-DES)进行评估,并按照赋能教育5个步骤实施以患者为主导的赋能教育,于干预前、干预6个月和1年时进行效果监测。结果 1患者对随访的主观态度不重视(OR=I.60)、独自随访能力降低(OR=2.53)、在岗工作(OR=I.90)、未出现严重并发症(OR=2.17)与失访存在相关性,是造成失访的危险性因素。而患者性别、年龄、病程、家族史、受教育程度、医保、定点医疗、治疗方式、社会支持与失访未发现明显相关(p0.05)。 2不同随访频率设置组中失访的发生率(χ2=1.96)不存在显著性差异(p=0.375),可认为其不是造成失访的原因。随访干预后,各组患者糖化血红蛋白(F=37.63)、空腹血糖(F=21.68)和餐后2小时血糖(F=199.44)均显著下降(p0.05)。三组之间血糖水平相当(p0.05),不同随访频率对患者血糖控制效果一致。 3失访患者通过赋能教育指导,1年内失访率同普通患者基线水平相当,为21.5%。通过赋能教育,患者自我护理行为得到显著改善：其中饮食(F=38.22)、运动(F=89.39)、血糖监测(F=50.7)、足部护理(F=20.63)和平均吸烟情况(F=9.43)显著改善(p0.05),然而用药情况(F=3.45)在赋能教育前后无显著差异(p0.05)。患者自我效能(F=122.16)和赋能得分(F=127.53)较之前显著提高。结论 1造成患者失访的因素是多方面的。患者主观对于随访的重视程度,自身行动能力、是否在岗工作以及并发症的程度是影响随访的重要原因。 2不同随访频率设置不会造成失访,可结合患者自身情况合理设置。护士需要在工作中对于容易失访的患者予以重视,尽可能提高随访出席率。 3赋能教育是帮助患者发现自身内在的能力以控制自身疾病的有效方法,通过强调患者的自我管理,激发患者主观的动力以促进行为改变。对失访人群进行赋能教育,可促使失访患者回归随访,增强自我效能和自我管理能力,使血糖水平得到更好地控制,从而改善预后。
[Abstract]:objective
1 to investigate the causes of missed visits in diabetes outpatients, and analyze the related factors that may cause the outcome of missed visits.
2 apply empowerment education to patients who lost their visit, and determine their application effect and promotion value.
Method
1 a case-control study was used to analyze the related factors that caused the loss of visits. The diabetic patients discharged from January 2010 to May 2011 were divided into groups according to the loss of visits, and 180 cases of the patients who were lost and non lost were randomly selected. The two groups of patients were contacted by telephone according to the way of reservation. Open questions were taken to understand the two groups of patients. The attitude of the visit, the status quo, and the reasons for the loss of the patients who have lost the interview, and collect the patient's medical records, including sex, age, course of disease, family history, education, work condition, medical insurance, fixed-point medical treatment, treatment, medication, and the severity of complications. The data of the two groups of patients were compared, and a regression analysis was made.
2 as a supplementary trial, the relevance of different follow-up frequencies and unvisited outcomes was investigated: 240 newly discharged diabetic patients were re selected from November 2011, randomly divided into three groups to carry out follow-up health education. The education content was completely consistent, but the three groups of follow-up education frequencies were 1 times a week, 1 times every 2 weeks and 1 times a month. The educational cycle was 3. It was followed up to 1 visits per month and followed up for 3 months and 1 years after 3 months and 1 years. The relationship between the frequency of follow-up and the control of blood glucose control was analyzed with chi square test and repeated measurement of variance analysis.
3 the intervention of the disabled patients: the telephone contact with the patients who lost the patients and the consent of the patients and their families to carry out the education of 80 patients for 3 months of diabetes empowerment. During the period, the Chinese version of the diabetes empowerment table (CM-DES) was applied to the assessment, and the patient oriented education was carried out in accordance with the 5 steps of the education. Before intervention, the effect was monitored for 6 months and 1 years.
Result
1 the subjective attitude of follow-up was not attached to the subjective attitude (OR=I.60), the ability to follow up (OR=2.53), working (OR=I.90), no serious complications (OR=2.17) and the loss of visits were related to the loss of visits. The sex, age, course of illness, family history, education, medical insurance, fixed-point medical treatment, treatment, social support No significant correlation was found between the loss of visits (P0.05).
2 there was no significant difference (p=0.375) in the incidence of loss of visits (2=1.96) in the setting group of different follow-up frequencies (p=0.375). It was considered that it was not the cause of the loss of visits. After the follow-up, the glycated hemoglobin (F=37.63), fasting blood glucose (F=21.68) and postprandial blood glucose (F=199.44) were significantly decreased (P0.05). The level of blood glucose between the three groups was equal (p0. 05) the frequency of blood glucose control was consistent with the frequency of follow-up.
The rate of loss of visits within 1 years was equal to the baseline level of the ordinary patients through the instruction of the education of 3 lost visits. The self-care behavior of the patients was significantly improved by the education of 21.5%., including diet (F=38.22), exercise (F=89.39), blood glucose monitoring (F=50.7), foot Nursing (F=20.63) and average smoking (F=9.43), however, the use of P0.05 was significantly improved (P0.05). There was no significant difference in drug status (F=3.45) before and after empowerment education (P0.05). Patients' self-efficacy (F=122.16) and empowerment score (F=127.53) were significantly higher than before.
conclusion
1 the factors that cause the patient's loss of visits are multifaceted. The degree of attention to the follow-up, the ability to act, the work on duty, and the degree of complications are the important factors that affect the follow-up.
2 the setting of different follow-up frequency will not cause the loss of visits. It can be reasonably set up with the patient's own situation. Nurses need to pay attention to the patients who are easy to lose the visit in the work, and improve the attendance rate as much as possible.
3 enforced education is an effective way to help patients find their own inherent ability to control their own diseases. By emphasizing the self management of the patients and stimulating the subjective motivation of the patients to promote the change of behavior, the education of the disabled people can encourage the patients to return to the follow-up, strengthen their self-efficacy and self-management ability, and make the blood sugar level. Better control is achieved to improve the prognosis.
【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R473.5

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