专项在职培训对社区护士痴呆相关知识及态度的影响研究

发布时间：2018-05-25 16:15

本文选题：痴呆 + 护士培训　；参考：《第三军医大学》2017年硕士论文

【摘要】：目的:伴随着老龄化问题的加剧老年痴呆病人正逐年增多,其应对形势变得日趋严峻。世界阿尔茨海默病协会近年来多次在其年度报告中呼吁全世界关注痴呆的早期筛查、风险控制和消除歧视等问题,并指出社区将是痴呆预防及干预的主战场。社区护士在痴呆早期筛查、诊断及痴呆病人的照护中均扮演着重要角色,但多数人并没有通过正规课程学习掌握相关的技能,护士们不知道如何协助医生开展痴呆高风险人群的早期筛查诊断工作和协助指导家庭照护者为痴呆病人提供更好的照护。特别是在我国老年护理专业课程体系建设尚不完善的情形下,这一情况尤为突出并亟待改善。本研究拟设计一项适用于本地区社区护士的痴呆护理专项培训项目,评估其对社区护士的痴呆相关知识、态度和早期筛查诊断意识的影响。方法:以随机数字法的抽样方式从重庆市沙坪坝区23个社区卫生服务,中心选取4个社区,随机分为对照组和干预组并实施干预培训。干预组接受痴呆护理专项培训,对照组接受其他护理知识的面授培训。分别于干预前(T1)、干预后2周(T2)和干预后3个月(T3)对两组进行测评。研究对象的痴呆相关知识测评采用阿尔茨海默病知识量表(Alzheimer's Disease Knowledge Scale,ADKS)和痴呆知识量表(Dementia Knowledge Assessment Tool Version 2,DKAT2);研究对象的痴呆相关态度测评采用痴呆态度量表(Dementia Attitudes Scale,DAS);以自设的一个半开放式问题在干预前(T1)和干预后3个月(T3)测评研究对象对痴呆高风险人群的早期筛查诊断意识;在干预后2周(T2)和干预后3个月(T3)运用自制满意度问卷测评干预组对培训的满意度,并以一个开放式问题测评干预组对培训的评价和改进建议。采用SPSS 19.0对数据进行描述性分析、?2检验、独立样本t检验、非参数Mann-Whitney U秩和检验和重复测量方差分析。检验水准为P㩳0.05。结果:本研究初始共入组社区护士115人,失访了14人,最终有效人数101例,有效率87.8%,其中干预组49人,对照组52人。1.社区护士痴呆相关知识、态度和痴呆早期筛查诊断意识的现状101名护士的ADKS得分为(19.36±2.40)分,得分较低的维度是“症状”、“痴呆照料”和“危险因素”,分别为(2.16±1.00)分、(2.77±0.94)分、(3.57±1.10)分。DKAT2得分为(15.17±2.57)分。DAS得分为(88.78±12.75)分,其分维度“社会舒适度”和“痴呆知识”得分分别为(37.52±8.11)分、(51.26±10.76)分。对主观记忆抱怨人群的处理方式中,有33.7%的护士选择“建议找专科医生会诊”,有27.7%和13.9%的护士选择“建议做简易认知筛查”和“为病人做简易认知筛查”,有高达24.8%的护士选择“安慰病人”和“忽视/转移话题”。两组人员在痴呆相关知识、态度和痴呆,早期筛查诊断意识方面的得分差异,无统计学意义(P0.05)。2.痴呆护理专项在职培训的效果评价(1)采用重复测量方差分析显示,干预组ADKS得分高于对照组,其差异有统计学意义(F=96.10,P0.001),两组对象的ADKS得分随时间变化的差异有统计学意义(F=81.61,P0.001),分组和,时间,两因素有交互作用(F=48.95,P0.001)。两组的ADKS基线值得分不存在统计学差异(P㧐0.05),但干预后进一步进行t检验显示在T2和T3时间点,干预组ADKS得分高于对照组(t=11.80,P0.001;t=10.09,P0.001)。采用重复测量方差分析显示,干预组DKAT2得分高于对照组,其差异有统计学意义(F=47.10,P0.001),两组对象的DKAT2得分随时间变化的差异有统计学意义(F=19.87,P0.001),分组和时间,两因素有交互作用(F=16.52,P0.001)。两组的DKAT2基线值得分不存在统计学差异(P㧐0.05),但干预后进一步进行t检验显示在T2和T3时间点,干预组DKAT2得分高于对照组(t=7.79,P0.001;t=6.77,P0.001)。(2)采用重复测量方差分析显示,干预组DAS得分高于对照组,其差异有统计学意义(F=52.40,P0.001),两组对象的DAS得分随时间变化的差异有统计学意义(F=25.07,P0.001),分组和时间两因素有交互作用(F=26.05,P0.001)。两组的DAS基线值得分不存在统计学差异(P㧐0.05),但干预后进一步进行t检验显示在T2和T3时间点,干预组DAS得分高于对照组(t=7.90,P0.001;t=7.91,P0.001)。(3)培训干预前,两组对象的痴呆早期筛查诊断意识无显著性差异(P㧐0.05),干预后3个月经独立样本t检验显示,两组人员处理主观记忆抱怨人群时,干预组选择“建议病人进行认知筛查”或“为病人进行认知筛查”的比率多于对照组,组间差异具有统计学意义(P=0.044;P=0.004)。(4)培训后,干预组对本项目的满意度较高,干预后2周对问卷各条目的满意度均超过91.8%;干预后3个月对问卷各条目的满意度均超过89.8%。结论:本研究显示,痴呆护理专项培训可以有效改善社区护士痴呆相关知识和态度,并且可以提高其对痴呆高风险人群的早期筛查诊断意识。除此之外,社区护士对本项目的满意度较高,表明本项目具有一定的可行性并且接受度较高。
[Abstract]:Objective: the increase of Alzheimer's disease is increasing year by year with the aging problem, and its response to the situation is becoming increasingly severe. In recent years, the world Alzheimer's Association has repeatedly called for worldwide attention to the early screening of dementia, risk control and elimination of discrimination, and points out that the community will be the prevention and intervention of dementia. Community nurses play an important role in early dementia screening, diagnosis and care for dementia patients, but most people do not learn the related skills through regular courses. Nurses don't know how to assist doctors in early screening and diagnosis of high risk dementia people and help guide family caregivers to be dementia. This situation is particularly prominent and urgent to improve. This study intends to design a special training program for dementia care for community nurses in the region to assess the knowledge, attitude and early screening of dementia in community nurses. Methods: 23 community health services in Shapingba District of Chongqing were selected by random number method, and 4 communities were selected from the center of Chongqing city. The control group was randomly divided into control group and intervention group, and intervention training was carried out. The intervention group received special training for dementia nursing and the control group received other nursing knowledge training. T1), 2 weeks (T2) and 3 months after intervention (T3) were used to evaluate the two groups. The dementia related knowledge of the subjects was evaluated by the Alzheimer's disease knowledge scale (Alzheimer's Disease Knowledge Scale, ADKS) and the dementia knowledge scale (Dementia Knowledge Assessment Tool 2). The Dementia Attitudes Scale (DAS) was used to examine the early screening diagnostic awareness of the subjects with high risk of dementia before the 1.5 open questions (T1) and 3 months after intervention (T3), and the intervention group was assessed by the self-made satisfaction questionnaire after 2 weeks of intervention (T2) and 3 months after intervention (T3). The evaluation and improvement proposal of the intervention group on an open question. The data were analyzed with SPSS 19, 2 test, independent sample t test, non parameter Mann-Whitney U rank sum test and repeated measurement variance analysis. The test level was P? 0.05. results: 115 community nurses in the initial co entry group were lost to visit. 14, the final effective number of 101 cases, the effective 87.8%, 49 of the intervention group, the control group of 52.1. community nurses with dementia related knowledge, attitude and the status of early screening diagnosis of dementia in 101 nurses score (19.36 + 2.40) scores, the lower scores are "symptoms", "dementia care" and "risk factors", respectively (2). The score of.16 + 1), (2.77 + 0.94), (3.57 + 1.10) and (15.17 + 2.57) score was (15.17 + 2.57).DAS score (88.78 + 12.75), and the scores of "social comfort" and "dementia knowledge" were (37.52 + 8.11) scores, respectively (37.52 + 8.11), and (51.26 + 10.76) points. 27.7% and 13.9% of the nurses chose "simple cognitive screening" and "simple cognitive screening for patients". Up to 24.8% of the nurses chose "comfort patients" and "neglect / transfer topics". The two groups had differences in dementia related knowledge, attitude and dementia, and early screening diagnostic awareness. Evaluation of the effect of P0.05.2. dementia nursing special on-the-job training (1) repeated measurement of variance analysis showed that the score of ADKS in the intervention group was higher than that of the control group, and the difference was statistically significant (F=96.10, P0.001). The difference of the ADKS score with time was statistically significant (F=81.61, P0.001), group and time, and two factors had two factors. Interaction (F=48.95, P0.001). The ADKS baseline of the two groups was worth no statistical difference (P? 0.05), but further t test showed that the score of ADKS in the intervention group was higher than that of the control group (t=11.80, P0.001; t=10.09, P0.001). The difference between the intervention group and the control group was higher than that of the control group. The difference between the intervention group and the control group was higher than the control group. There were statistically significant (F=47.10, P0.001), the DKAT2 scores of the two groups were statistically significant (F=19.87, P0.001), group and time, and the two factors had interaction (F=16.52, P0.001). The two groups of DKAT2 baselines were worthy of no statistical difference (P? 0.05), but further t test showed in T2 and T3 time points, The score of DKAT2 in the intervention group was higher than that of the control group (t=7.79, P0.001; t=6.77, P0.001). (2) the repeated measurement of variance analysis showed that the score of DAS in the intervention group was higher than that of the control group, and the difference was statistically significant (F=52.40, P0.001). The difference of the DAS score of the two groups was statistically significant (F=25.07, P0.001), and the two factors of grouping and time were interactive. The effect (F=26.05, P0.001). The DAS baseline of the two groups was worth no statistical difference (P? 0.05), but further t test showed that the score of DAS in the intervention group was higher than that of the control group (t=7.90, P0.001; t=7.91, P0.001). (3) before the training intervention, there was no significant difference in the awareness of the early diagnosis of dementia in the two groups (0.05). After the intervention, the t test of 3 menstrual independent samples showed that the ratio of the intervention group was more than the control group when the two groups were dealing with the subjective memory complaints. The difference was statistically significant (P=0.044; P=0.004). (4) after training, the intervention group was satisfied with the project. The degree of satisfaction of all the items of the questionnaire over 2 weeks was more than 91.8%, and the satisfaction of all the items in the 3 months after the intervention was more than 89.8%. conclusion: This study showed that the special training of dementia nursing can effectively improve the knowledge and attitude of dementia in community nurses and can improve their early screening for people with high risk of dementia. Apart from this, the satisfaction of community nurses to this project is higher, indicating that this project is feasible and acceptable.
【学位授予单位】：第三军医大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R473.2

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