孕妇盆底健康自我管理教育手册的制定

发布时间：2018-01-10 12:07

本文关键词：孕妇盆底健康自我管理教育手册的制定　出处：《重庆医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:调查孕妇盆底功能障碍相关症状情况、盆底功能障碍知信行现状、盆底健康自我管理能力及相关需求,制定一套科学的《孕妇盆底健康自我管理教育手册》(以下简称《手册》),为孕妇进行妊娠期盆底主动康复的自我管理提供一个科学的工具。方法:1.采用问卷调查法对122名孕妇进行调查,内容包括:孕妇一般人口社会学资料、孕妇盆底功能障碍相关症状情况、孕妇盆底功能障碍知信行情况。2.采用半结构式访谈法,从通过问卷调查存在盆底功能障碍相关症状且知信行水平较低者中选取9例孕妇,收集其盆底健康自我管理能力及相关需求的资料并进行分析。3.在问卷调查与质性研究的基础上完成《手册》初稿,利用德尔菲法将条目化的《手册》向21名专家进行函询,最终完善《手册》。结果:1.共发放调查问卷129份,其中有效问卷122份,有效回收率为94.57%。调查对象盆底功能障碍盆腔症状:42.62%的孕妇存在盆腔坠胀感,24.63%的孕妇存在排尿不尽感,32.79%的孕妇经常体验到下腹腹压,7.38%的孕妇经常看到或感到阴道有肿物脱出,10.66%的孕妇曾经需要推压阴道或直肠周围来协助排便;肠道症状:42.62%的孕妇存在便秘症状,29.51%、9.84%和17.21%的孕妇分别存在排便不尽感、排便疼痛感和排便急迫感,13.93%的孕妇表示常不能控制肛门排气,4.92%的孕妇表示当大便松散时常无法控制排便;膀胱症状:62.30%的孕妇出现尿频症状,31.87%和20.49%的孕妇分别出现压力性尿失禁和急迫性尿失禁症状,29.51%的孕妇存在下腹或生殖道不适感。2.调查对象盆底功能障碍知信行情况:有48.36%~74.59%的孕妇不清楚盆底功能障碍相关知识;60%以上的孕妇渴望了解学习盆底功能障碍相关知识及预防措施,40.16%~45.90%的孕妇不认可盆底功能障碍相关症状可能对其日后生活质量造成不良影响且不会进行盆底肌肉锻炼;46.72%~64.75%的孕妇在孕期及产后完全做不到规律的盆底肌肉锻炼。运用结构方程模型分析结果显示,孕期盆底功能障碍相关知识对其相关态度信念有直接影响(路径系数=0.48);孕期盆底功能障碍相关知识对其预防盆底功能障碍相关行为有直接影响(路径系数=0.31),并通过影响孕期盆底功能障碍相关态度信念对其预防盆底功能障碍相关行为产生间接影响(路径系数=0.13);孕期盆底功能障碍相关态度信念对其预防盆底功能障碍相关行为有直接影响(路径系数=0.27),以上p值均小于0.01,各路径系数均有统计学意义。3.分析归纳访谈资料,共提炼出5个相关主题:女性盆底相关知识缺乏及获取途径单一;盆底健康日常行为管理能力偏低;孕期情绪波动较大且需要多方位情感支持;生活习惯管理水平有待提高;需要多途径盆底健康自我管理信息支持。4.两轮函询的专家积极系数分别为80.95%和100%,判断系数分别为0.871和0.876,熟悉程度分别为0.825和0.830,权威程度分别为0.848和0.853,协调系数分别为0.310和0.484;第一轮《手册》条目的重要性赋值均数为2.35~4.65,变异系数为0.060~0.474,第二轮的重要性赋值均数为3.53~4.65,变异系数为0.062~0.227。结论:1.孕期出现盆底功能障碍相关症状的情况较为普遍,且在不同程度上对孕妇的生活质量造成影响,医护人员应制定孕期盆底健康教育方案,帮助孕妇预防或降低相关症状的发生,减轻妊娠期不适,提高孕妇生活质量。2.孕妇普遍缺乏孕期盆底及盆底功能障碍的相关知识,行盆底主动康复的态度及行为水平较差,医护人员应加强孕期盆底健康教育工作,帮助孕妇树立盆底健康责任感,在孕期积极进行盆底主动康复。3.孕妇盆底健康自我管理存在较多问题,医护人员需要制定相关方案指导孕妇掌握盆底健康知识自我管理、盆底健康日常行为自我管理、心理调试及生活嗜好自我管理的方法与技巧,并提供多途径信息支持。4.本《手册》采用图文结合的形式且在每个管理单元后设置了不同的反馈模块,可以反馈阅读者知识掌握及行为改变的程度,为孕妇进行妊娠期盆底健康自我管理提供了一个科学的工具,同时也为相关临床护理工作者提供了一定的参考意见。
[Abstract]:Objective: To investigate the related symptoms of pregnant women with pelvic floor dysfunction, pelvic floor dysfunction KAP status, pelvic floor health self-management ability and related requirements, develop a set of scientific "maternal pelvic health self-management education (hereinafter referred to as the" manual manual > >), provide a scientific tool for self management of pregnant women during pregnancy and pelvic active rehabilitation methods: 1.. Using a questionnaire survey of 122 pregnant women included: pregnant women demographic data, symptoms of pelvic floor dysfunction in pregnant women, pregnant women with pelvic floor dysfunction KAP.2. using semi-structured interviews, selected 9 cases of pregnant women from the questionnaire exist related symptoms of pelvic floor dysfunction and knowledge for the lower level, collect the pelvic floor health self-management ability and related demand data were analyzed in.3. questionnaire survey and qualitative research base Based on the complete handbook > < draft, Delphy Fa will use the < > of manual entry inquiry to 21 experts, and ultimately improve the manual. < results: 1. a total of 129 questionnaires were issued and 122 effective questionnaires, the effective recovery rate for the 94.57%. survey of pelvic floor dysfunction symptoms: 42.62% pregnant women with pelvic pelvic bulge the sense of 24.63% pregnant women vesical tenesmus, 32.79% of pregnant women often experience abdominal abdominal pressure, 7.38% pregnant women often see or feel vaginal tumor prolapse, 10.66% of pregnant women who need to push the pressure surrounding the vagina or rectum to help defecation; intestinal symptoms: symptoms of constipation, 42.62% of pregnant women are 29.51%, 9.84% and 17.21% pregnant women are endless defecation, defecation pain and defecation urgency, 13.93% pregnant women that often cannot control the anus exhaust, 4.92% pregnant women said when loose stools often unable to control defecation; bladder disease Shape: 62.30% pregnant women had frequent symptoms, 31.87% and 20.49% of pregnant women were stress urinary incontinence and urge incontinence, 29.51% of pregnant women have lower abdominal or genital discomfort.2. survey of pelvic floor dysfunction KAP, 48.36%~74.59% pregnant women do not know the pelvic floor dysfunction related knowledge; more than 60% of pregnant women desire learn the related knowledge and prevention of pelvic floor dysfunction, 40.16%~45.90% pregnant women not recognized symptoms of pelvic floor dysfunction is likely to cause adverse effects on the quality of life and not for pelvic floor muscle training; 46.72%~64.75% of pregnant women during pregnancy and post partum to do regular pelvic floor muscle training. By using structural equation model analysis showed that, have a direct impact the pregnancy related knowledge of pelvic floor dysfunction related attitudes beliefs (R =0.48) during pregnancy; pelvic floor dysfunction Because knowledge has a direct impact on the prevention of pelvic floor dysfunction related behavior (R =0.31), and the influence of attitude belief in the prevention of pelvic floor dysfunction during pregnancy related behavior of pelvic floor dysfunction has indirect effect (R =0.13); pregnancy related attitudes of pelvic floor dysfunction beliefs have a direct effect on the prevention of pelvic floor dysfunction related behavior (path coefficient =0.27 above), P values were less than 0.01, the path coefficients were statistically significant.3. analysis of interview data, there were 5 related topics: female pelvic floor of lack of knowledge and access to a single low; pelvic floor health daily behavior management; maternal mood fluctuations and need more emotional support range; lifestyle management needs to be improved experts in many ways; pelvic health management information support.4. two rounds consultation positive coefficients were 8 0.95% and 100%, judgment coefficients were 0.871 and 0.876, respectively, 0.825 and 0.830 degree of familiarity, degree of authority were 0.848 and 0.853, the coordination coefficient were 0.310 and 0.484; the first round of the importance of the assignment Handbook > < entries are the number of 2.35~4.65, the coefficient of variation was 0.060~0.474, the importance of the second round of the assignment are the number of 3.53~4.65 conclusion: 0.062~0.227., the coefficient of variation was 1. during pregnancy related symptoms of pelvic floor dysfunction is common in pregnant women, and the quality of life impact in different degrees, the medical staff should develop health education during pregnancy, pelvic floor plan, help pregnant women to prevent or reduce the symptoms, reduce pregnancy discomfort, improve maternal quality of life.2. pregnant women generally lack the knowledge of pregnancy and pelvic pelvic floor dysfunction, pelvic floor rehabilitation active attitude and behavior level, medical personnel should strengthen the pelvic floor health during pregnancy Health education, establish a sense of responsibility to help pregnant women pelvic health during pregnancy, pelvic floor rehabilitation.3. positive active maternal pelvic health self-management problems, health care workers need to formulate relevant guidelines for pregnant women master pelvic health knowledge self management, self management of pelvic health daily actions, methods and skills of psychological adjustment and living habits of self management. And to provide information to support the way.4. < manual > the graphic combination form and in each management unit was set after the different feedback module, feedback reading knowledge and behavior change degree, provides a scientific tool during pelvic floor health self-management for pregnant women of pregnancy, but also provide a certain the reference for clinical nursing workers.

【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R473.71

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