自我管理干预对脑卒中恢复期患者知信行及主观幸福感的影响

发布时间：2018-07-14 16:57

【摘要】：目的本研究在通过调查脑卒中恢复期患者疾病相关知识、自我效能、自我管理行为及主观幸福感的现状,分析自我管理行为的影响因素的基础上,制定并实施脑卒中恢复期患者自我管理干预方案,评价自我管理干预的效果,验证自我管理干预的可行性和有效性,为今后改善脑卒中的护理服务模式提供参考意见,帮助脑卒中恢复期患者提高其自我效能、自我管理行为水平,预防脑卒中的再复发,提高患者的生活质量和主观幸福感。方法1.脑卒中恢复期患者自我管理现状与影响因素分析,为描述流行病研究。选取2013年7月至2014年1月在江苏省盐城市某两家三级综合性医院神经内科出院的首发脑卒中恢复期患者146例作为调查对象,通过应用自行设计的患者一般资料调查表和脑卒中知识问卷、简易智力测试量表(AMT)、日常生活活动能力(ADL)量表(Barthel指数)、慢性病管理自我效能量表(SSC)、脑卒中患者自我管理行为评定量表、社会支持评定量表(SSRS)、脑卒中影响量表(SIS)、纽芬兰纪念大学幸福度量表(MUNSH),调查脑卒中恢复期患者疾病相关知识、自我效能、自我管理行为及主观幸福感的现状,分析自我管理行为的影响因素。采用SPSS20.0统计软件对所获得的数据进行统计分析,脑卒中知识、自我效能、自我管理行为、社会支持、生命质量、主观幸福感的得分采用百分比、均数和标准差进行统计描述,自我管理行为的影响因素采用单因素分析、相关性分析及多元逐步回归分析。2.自我管理干预对脑卒中恢复期患者知信行及主观幸福感的影响,为实验流行病研究。选取2014年3月至2014年9月在江苏省盐城市某两家三级综合性医院神经内科出院的首发脑卒中恢复期患者,依据纳入和排除标准,选择70例患者作为研究对象。按动态均衡随机化方法分为对照组和干预组,每组各35例。对照组患者接受神经内科脑卒中的常规治疗和护理；干预组患者除了接受神经内科脑卒中的常规治疗和护理外,出院后还参加研究者给予的为期6个月的自我管理干预,自我管理干预方案以知信行理论为基础,根据第一章脑卒中恢复期患者知识、自我效能、自我管理行为和主观幸福感的现状及自我管理行为影响因素的研究结果,结合脑卒中疾病的危险因素,运用康复功能训练知识与技能,与研究小组成员共同讨论后形成干预方案初稿,邀请神经内科护理专家及康复专家对干预方案进行修改、完善,最终形成干预方案的定稿。主要内容包括：疾病相关知识指导、安全用药指导、健康行为方式指导、日常自我监测指导、康复训练技能指导、心理指导等方面。采用脑卒中知识问卷、SSC量表、脑卒中患者自我管理行为评定量表、SIS量表、MUNSH量表,分别于干预前、干预6个月后比较两组患者的知信行、生活质量及主观幸福感,分析自我管理干预对脑卒中恢复期患者知信行、生活质量及主观幸福感的影响。结果1.脑卒中恢复期患者的脑卒中知识总分为9.52+6.35,指标得分率为48.8%,总体处于低水平,其中64.4%患者的脑卒中知识处于低水平,28.8%处于中水平,仅6.8%患者处于高水平,各维度指标得分率由高到低依次为行为方式(59.7%)、危险因素(50.9%)、先兆症状(49.4%)、安全用药(38.3%)、急救处理(35.5%)、康复知识(34.3%)；脑卒中恢复期患者的自我效能总分为5.43+1.76,其中64.4%患者的自我效能水平处于低水平,35.6%处于高水平；脑卒中恢复期患者的自我管理行为总分为150.55±37.11,指标得分率为59.0%,总体处于中等偏低水平,其中44.5%患者的自我管理行为水平处于差水平,51.4%处于中等水平,仅4.1%患者处于良好水平,各维度指标得分率由高到低依次为：安全用药管理(71.8%)、饮食管理(65.4%)、日常生活起居管理(64.7%)、情绪管理(64.0%)、社会功能和人际管理(59.7%)、康复锻炼管理(57.2%)、疾病管理(42.5%)。2.脑卒中恢复期患者的社会支持总分为39.78±10.60,客观支持得分为12.03±3.75,主观支持得分为20.44±5.58,对支持的利用度得分为7.51±1.79,得分均低于国内常模,差异均有统计学意义(P0.05,P0.01)；脑卒中恢复期患者的生活质量总分为206.47±34.13,指标得分率为69.99%,总体处于中等水平,各维度指标得分率由高到低依次为：交流能力(86.3%)、记忆与思维(80.9%)、力气(78.8%)、手功能(76.4%)、情绪(72.85%)、行动能力(62.8%)、日常生活(60.9%)、社会参与(54.2%)；脑卒中恢复期患者的SWB总分为29.47±4.87,处于中等水平,正性情感得分为6.26±1.19,负性情感得分为4.61±1.31,正性体验得分为8.25±1.75,负性体验得分为4.43±1.43,其中正性情感、正性体验及总分得分低于国内常模,负性情感、负性体验得分高于国内常模,差异均有统计学意义(P0.01)3.单因素分析结果显示,脑卒中恢复期患者自我管理行为总分在不同年龄、职业状况、文化程度、医疗付费方式、人均月经济收入、合并疾病、Barthel指数上有统计学意义(P0.01)；相关性分析结果显示,脑卒中恢复期患者脑卒中知识(r=0.579,P0.01)、自我效能(r=0.405,P0.01)、社会支持(r=0.312,P0.01)、生活质量(r=0.567,P0.01)、主观幸福感(r=0.358,P0.01)与自我管理行为总分均呈正相关。脑卒中恢复期患者脑卒中知识(r=0.511-0.579,P0.01))、自我效能(r=0.314～0.434,P0.01)、社会支持(r=0.239-0.382,P0.01)、生活质量(r=0.468-0.598,P0.01)、主观幸福感(r=0.289～0.368,P0.01)与自我管理行为各维度(疾病管理、安全用药管理、饮食管理、日常生活起居管理、情绪管理、社会功能和人际管理、康复锻炼管理)也均呈正相关；多元逐步回归分析结果显示,文化程度、脑卒中知识、社会支持、自我效能、生活质量是脑卒中恢复期患者自我管理行为的主要影响因素。4.对照组干预前后比较：知信行方面,在脑卒中知识总分、安全用药管理、饮食管理、日常生活起居管理、情绪管理、自我管理行为总分方面得分,差异均有统计学意义(P0.05或P0.01),而在脑卒中知识各维度得分、自我效能总分、疾病管理、社会功能和人际管理及康复锻炼管理方面得分,差异均无统计学意义(P0.05)；生活质量方面,在力气、记忆与思维、日常活动、行动能力、手功能、社会参与及生活质量总分方面,差异均有统计学意义(P0.05或P0.01),而在情绪、交流能力方面,差异无统计学意义(P0.05)；主观幸福感方面,主观幸福感总分及各维度得分,差异均无统计学意义(P0.05)。5.干预组干预前后比较：知信行、生活质量的总分及各维度得分,均较干预前明显提高,差异有统计学意义(P0.01)；主观幸福感方面,正性情感、正性体验得分及主观幸福感总分,均较干预前明显提高,差异有统计学意义(P0.01),而负性情感、负性体验得分,均较干预前明显下降,差异有统计学意义(P0.01)。6.干预后两组患者间的比较：干预组的知信行、生活质量的总分及各维度得分,均高于对照组,差异有统计学意义(P0.05或P0.01)；主观幸福感方面,干预组的正性情感、正性体验得分及主观幸福感总分,均高于对照组,差异有统计学意义(P0.01),而负性情感、负性体验得分,均低于对照组,差异有统计学意义(P0.01)。结论1.脑卒中恢复期患者的脑卒中知识处于低水平；脑卒中恢复期患者自我效能水平不佳,64.4%患者的自我效能水平处于低水平；脑卒中恢复期患者的自我管理行为总体处于中等偏低水平。2.脑卒中恢复期患者的社会支持总分及各维度得分均低于国内常模；脑卒中恢复期患者的生活质量、主观幸福感处于中等水平。3.文化程度、脑卒中知识、社会支持、自我效能、生活质量是脑卒中恢复期患者自我管理行为的主要影响因素。4.自我管理干预措施有效地提高了患者的脑卒中知识水平,增强了患者疾病自我管理的自信心,促进了患者有效自我管理行为的建立,有利于提高患者的生活质量及主观幸福感。
[Abstract]:Objective To study the effect of self - management intervention on patients with stroke recovery period , to evaluate the effect of self - management intervention , to evaluate the effect of self - management intervention and to improve the quality of life and subjective well - being of stroke patients .
Results 1 . The knowledge of stroke knowledge , self - efficacy , self - management behavior and subjective well - being and the influence factors of self - management were analyzed .
The self - efficacy of patients with stroke recovery was 5.43 + 1.76 , of which 64.4 % had a low level of self - efficacy and 36.6 % were at a high level ;
The self - management behavior of patients with stroke recovery period was 150 . 55 卤 37.11 , and the index score was 59.0 % . The overall level of self - management behavior in 44.5 % was at low level .
The quality of life of patients with stroke recovery period was 206 . 47 卤 34.13 , the score of index was 69.99 % , the overall level was middle level , the score of each dimension index was from high to low in order : communication ability ( 86.3 % ) , memory and thought ( 80.9 % ) , strength gas ( 78.8 % ) , hand function ( 76.4 % ) , emotion ( 72.85 % ) , action ability ( 62.8 % ) , daily life ( 60.9 % ) , social participation ( 54.2 % ) ;
The total score of SWB in stroke recovery period was 29.47 卤 4.87 , the positive emotion score was 6.26 卤 1.19 , negative emotion score was 4.61 卤 1.21 , positive emotion score was 8.25 卤 1.75 , negative experience score was lower than that of domestic norm , negative emotion , negative experience score higher than that of domestic norm , negative emotion , negative experience score higher than that of domestic norm , negative emotion , negative experience score higher than domestic norm , negative emotion , negative experience score higher than domestic norm , negative emotion , negative experience score higher than the domestic norm , the difference is statistically significant ( P0.01 ) 3 . Single factor analysis result shows that the total score of patients ' self - management behavior is statistically significant ( P0.01 ) .
Correlation analysis showed that stroke knowledge ( r = 0.579 , P0.01 ) , self - efficacy ( r = 0.312 , P0.01 ) , social support ( r = 0.312 , P0.01 ) , social support ( r = 0.239 - 0.382 , P0.01 ) , social support ( r = 0.239 - 0.368 , P0.01 ) , subjective well - being ( r = 0.289 - 0.368 , P0.01 ) , subjective well - being ( r = 0.289 - 0.368 , P0.01 ) , subjective well - being ( r = 0.289 - 0.368 , P0.01 ) .
Multivariate stepwise regression analysis showed that the degree of culture , knowledge of stroke , social support , self - efficacy and quality of life were the main influencing factors of self - management behavior in patients with stroke recovery .
In terms of quality of life , the difference was statistically significant ( P0.05 or P0.01 ) in the aspects of strength , memory and thinking , daily activity , action ability , hand function , social participation and quality of life , but there was no significant difference in emotion and communication ability ( P0.05 ) ;
The scores of subjective well - being , subjective well - being and scores of each dimension were not statistically significant ( P0.05 ) .
Subjective well - being , positive emotion , positive experience score and subjective well - being were significantly improved before intervention ( P0.01 ) , while negative emotion and negative experience score decreased significantly before intervention ( P0.01 ) .
The positive emotion , positive experience score and subjective well - being of intervention group were higher than those in the control group ( P0.01 ) .
The self - efficacy level of patients with stroke recovery period was poor , and the self - efficacy level of 64.4 % patients was at a low level ;
The self - management behavior of patients with stroke recovery period was generally at a moderate level . 2 . The total score of social support and the scores of each dimension in stroke recovery period were lower than that of domestic norm ;
4 . Self - management intervention measures effectively improve the knowledge level of stroke knowledge of patients , enhance the self - confidence of patients ' self - management , promote the establishment of effective self - management behavior of patients , and help to improve the quality of life and subjective well - being of patients .
【学位授予单位】：东南大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R473.74

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