基于TTM的协同护理模式在老年冠心病患者心脏康复中的应用研究

发布时间：2018-05-27 19:25

本文选题：跨理论模型 + 协同护理　；参考：《青岛大学》2017年硕士论文

【摘要】：目的本研究旨在探讨基于跨理论模型的协同护理模式对老年冠心病患者生活质量、自我效能、体适能和临床指标变化水平的影响;探讨适合老年冠心病患者运动康复训练行为改变的干预模式,评价其对老年冠心病患者心脏康复的干预效果,为进一步发展和完善心脏康复程序提供参考。方法本研究采用便利抽样的方法选取2015年12月至2016年6月在青岛某三级甲等医院心内科住院的老年冠心病患者,按照入院时间的先后顺序对患者进行统一编号,其中奇数为对照组,偶数为干预组。对照组患者采用常规护理措施,干预组患者实施基于跨理论模型的协同护理模式,根据制定的心脏康复计划给予患者与各个行为变化阶段相对应的护理干预措施。分别收集了两组患者在出院前、出院后3个月、6个月三个时间点的资料,包括一般资料、CQQC量表、自我效能量表、六分钟步行试验、行为改变阶段评估量表和Borg量表,并通过测量老年患者的体适能和生理指标的变化水平来评价其干预效果。所有数据采用SPSS17.0录入及分析,统计方法有t检验、卡方检验、秩和检验及重复方差分析。结果1老年冠心病患者的自我效能在干预后明显提升(t=-7.097,P0.05),差异具有统计学意义。CQQC量表中病情状况、一般生活、社会心理、工作情况这四个维度的得分在干预后明显增加,具有显著性差异(P0.05)。2干预组运动行为改变阶段的人数和对照组相比,差异具有统计学意义(P0.05),在干预6个月以后处于运动的行动和维持阶段的人数比例分别为45.1%和29.4%,而对照组的人数比例为18.9%和15.1%。3干预后患者的体适能指标中,运动耐力、上肢肌力、下肢肌力及身体的灵活性改善较为显著,重复方差分析显示存在交互效应(P0.05),而患者的上肢柔韧性、下肢柔韧性改善效果不明显(P0.05)。干预后患者的生理指标中,重复方差分析显示体重指数、总胆固醇、收缩压、舒张压的时间和组别之间存在着交互效应,干预组的改善情况优于对照组,差异具有统计学意义(P0.05)。4在患者的生活方式比较中,患者在干预后3个月、6个月,干预组吸烟率低于对照组,差异具有统计学意义(P0.05),在吸烟数量上,干预组在干预后的各时间点的改善情况和干预前相比较为显著。两组患者的运动参与情况、运动的频率和时间在干预后3个月、6个月均有显著性差异(P0.05),干预组的运动情况较对照组显著改善,患者的运动依从性良好。结论1基于TTM的协同护理模式和常规护理干预均有助于改善老年冠心病患者的生活质量、一般自我效能,但前者的改善效果优于后者。2基于TTM的协同护理模式保证了老年冠心病患者康复治疗的依从性,改善了患者的体适能和生理指标。3基于TTM的协同护理模式增强了患者战胜疾病的信心,提高老年冠心病患者疾病自我管理能力和疾病的应对能力,促进了患者的康复。4基于TTM的协同护理模式优于传统的常规宣教和护理,值得进一步坚持与完善。
[Abstract]:The purpose of this study is to explore the effect of the cooperative nursing mode based on the cross theoretical model on the quality of life, self-efficacy, physical fitness and the change of clinical indicators in elderly patients with coronary heart disease, and to explore the intervention mode suitable for the behavior changes of exercise rehabilitation training for elderly patients with coronary heart disease and to evaluate the intervention of the intervention on the heart rehabilitation of the elderly patients with coronary heart disease. The effect is to provide reference for further development and improvement of cardiac rehabilitation program. Methods this study adopted convenient sampling method to select the elderly patients in the Department of Cardiology of a class three grade a hospital of Qingdao from December 2015 to June 2016. The patients were numbered according to the order of admission time. The odd number was the control group. The control group was given the intervention group. The patients in the control group were treated with routine nursing measures. The patients in the intervention group carried out a cooperative nursing model based on the cross theory model. The patients were given the corresponding nursing interventions according to the established cardiac rehabilitation program. Two groups of patients were collected before discharge, 3 months after discharge, and 6 months and three months after discharge. The data, including the general data, the CQQC scale, the self-efficacy scale, the six minute walk test, the behavioral change stage assessment scale and the Borg scale, were used to evaluate the intervention effect by measuring the level of physical fitness and physiological changes of the elderly patients. All data were recorded and analyzed by SPSS17.0, and the statistical method had t test and chi square test. Results 1 the self-efficacy of 1 elderly patients with coronary heart disease increased significantly after intervention (t=-7.097, P0.05). The difference was statistically significant in the.CQQC scale, and the scores of the four dimensions of general life, social psychology and work were significantly increased after intervention, with significant difference (P0.05).2 intervention group. The number of people in the stage of exercise change was statistically significant compared with the control group (P0.05). The proportion of people in the movement and maintenance stage after 6 months of intervention was 45.1% and 29.4% respectively, while the proportion of the control group was 18.9% and the body fitness index of the patients with the prognosis of 15.1%.3, exercise endurance, upper limb muscle strength, lower limbs. The flexibility of the muscle and body was improved significantly. The repeated variance analysis showed that there was an interaction effect (P0.05), while the patient's upper limb was flexible and the lower limb flexibility improved (P0.05). In the physiological indexes of the patients after intervention, the repeated variance analysis showed that the body mass index, total cholesterol, systolic pressure, diastolic pressure time and group existed between the patients. In the interaction effect, the improvement of the intervention group was better than the control group, the difference was statistically significant (P0.05).4 in the patient's lifestyle comparison, 3 months after intervention, 6 months after intervention, the smoking rate in the intervention group was lower than the control group, the difference was statistically significant (P0.05). In the number of smoking, the intervention group was improved at each time point of the intervention. The movement participation of two groups of patients, the frequency and time of exercise were significantly different in the 3 months after intervention and 6 months after intervention (P0.05). The exercise situation in the intervention group was significantly better than that in the control group, and the compliance of the patients was good. Conclusion the cooperative nursing mode based on the TTM based cooperative nursing and the routine nursing intervention were helpful. The quality of life and general self-efficacy of elderly patients with coronary heart disease were improved, but the improvement effect of the former was better than that of the latter.2 based cooperative nursing model based on TTM, which ensured the compliance of the elderly patients with coronary heart disease, improved the physical fitness and physiological index of the patients, and enhanced the confidence of the patients to overcome the disease based on the cooperative nursing model of TTM based on.3. The ability of self management of disease and the ability to cope with disease in elderly patients with coronary heart disease have promoted the recovery of patients' rehabilitation.4 based on TTM based cooperative nursing mode, which is better than traditional routine education and nursing. It is worth further insisting and improving.
【学位授予单位】：青岛大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R473.5

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