跨理论模型的心理护理对妊娠期糖尿病患者妊娠压力的干预研究
发布时间：2018-09-17 20:14
【摘要】：目的:评估妊娠期糖尿病(GDM)患者妊娠压力水平及其影响因素;评价跨理论模型(TTM)的心理护理对GDM患者妊娠压力、应对方式、血糖水平和妊娠结局的干预效果,以寻求适合GDM患者压力管理行为改变的干预模式,为完善GDM患者健康促进行为提供实践依据。方法:本研究分两部分进行。一部分为GDM患者妊娠压力现状及其影响因素的研究(简称为“研究一”),采用目的性抽样,于2016年2月~7月对承德市某三甲医院产科门诊的15例GDM患者妊娠压力的情况及原因进行半结构式、深入访谈,收集资料后采用Colaizzi分析法进行分析并提炼主题。另一部分为TTM的心理护理干预的研究(简称为“研究二”),采用便利性抽样,于2016年2月~7月在知情同意的基础上,选取承德市某三甲医院产科门诊常规产检的86例GDM患者为研究对象,按随机数字表法分为实验组(n=43例)和对照组(n=43例);对照组实施常规护理,实验组在常规护理的基础上实施跨理论模型的心理护理,两组干预时间均持续3个月;分别于干预前、干预1个月后、干预3个月后,采用妊娠压力量表、行为改变阶段问卷、简易应对方式问卷(SCSQ)、新生儿及产妇观察指标对2组患者进行数据的收集,数据采用SPSS22.0统计软件进行统计学分析。结果:研究一Colaizzi分析法共提炼8个主题:(1)负性情绪;(2)胎儿健康方面;(3)妊娠结局方面;(4)知识获取方面;(5)未来生活方面;(6)血糖控制方面;(7)工作、社交方面;(8)家庭方面。研究二TTM的心理护理干预结果:1.基线资料显示:(1)2组患者在年龄、职业、居住地、文化程度、家庭人均月收入、医疗费用支付方式、孕产次数、有无糖尿病家族史及不良孕产史方面比较,差异均无统计学意义(p0.05);(2)gdm患者妊娠压力总分为(47.05±5.11)分,得分指标为52.51%;(3)2组患者在妊娠压力得分[(0.52±0.05)vs(0.53±0.06),t=-0.842]、行为变化阶段(χ2=3.248)及应对方式[积极应对:(16.83±2.97)vs(15.51±2.68),t=-1.696;消极应对:(9.88±1.69)vs(10.02±1.37),t=1.634]得分进行比较,差异均无统计学意义(p0.05),具有可比性。2.干预后结果显示:(1)对干预前、干预1个月后、干预3个月后,2组患者的妊娠压力总分进行重复测量方差分析,结果显示,2组患者妊娠压力总分在时间效应、干预效应及其交互效应均有统计学意义(f时间效应=930.459,f干预效应=20.831,f交互效应=90.086,p均0.01);干预1个月后2组患者妊娠压力总分比较[(0.43±0.47)vs(0.48±0.06),t=-4.323],干预3个月后2组患者妊娠压力总分比较[(0.35±0.04)vs(0.44±0.06),t=-8.403],差异均有统计学意义(p均0.01);在不同时间点上,实验组妊娠压力总分比较(f实=607.241),对照组妊娠压力总分比较(f对=323.332),差异均有统计学意义(p均0.01);2组患者妊娠压力总分在各时间点的两两比较差异均有统计学意义(p均0.05)。(2)对干预前、干预1个月后、干预3个月后,2组患者的scsq得分进行重复测量方差分析,结果显示,2组患者的积极应对方式得分的时间效应、干预效应及其交互效应均有统计学意义(f时间效应=232.522,f干预效应=12.280,f交互效应=4.246,p均0.01);实验组和对照组患者在干预1个月后积极应对方式得分比较[(18.02±2.69)vs(16.42±2.60),t=2.814]、干预3个月后积极应对方式得分比较[(22.12±2.54)vs(19.53±2.81),t=-3.232],差异均有统计学意义(p均0.05);不同时间点上,实验组患者积极应对方式得分比较(f实=107.013),对照组患者积极应对方式得分比较(f对=144.906),差异均有统计学意义(p均0.01);实验组和对照组患者积极应对方式得分在各时间点上的两两比较,差异均有统计学意义(p均0.01)。2组患者的消极应对方式得分的时间效应、干预效应均无统计学意义(f时间效应=0.584,f干预效应=2.126,p均0.05);实验组和对照组患者干预1个月后消极应对方式得分比较[(9.44±1.59)VS(10.26±1.36),t=-2.545],差异有统计学意义(P0.05);不同时间点实验组患者消极应对方式得分比较(F实=5.064),对照组消极应对方式得分比较(F对=4.226),差异均有统计学意义(P均0.05);实验组和对照组患者消极应对方式得分在各时间点上的两两比较,结果显示2组患者干预前与干预1个月后比较差异有统计学意义(P0.05),2组患者其余时间点之间比较差异均无统计学意义(P均0.05)。(3)实验组和对照组患者在不同时间点上妊娠压力行为变化阶段的组内、组间比较结果显示,实验组和对照组患者在干预1个月后、干预3个月后的行为变化阶段进行组间比较(χ21个月=22.928,χ23个月=24.952),差异均有统计学意义(P均0.01);不同时间点上实验组和对照组患者行为变化阶段进行组内比较(χ2实=84.488,χ2对=37.360),差异均有统计学意义(P均0.01)。(5)实验组和对照组患者血糖水平及妊娠结局的比较,结果显示,实验组患者三餐后2小时血糖值均显著低于对照组[(5.41±0.55)VS(6.00±0.77),t早餐=-3.132;(6.31±0.29)VS(6.96±0.89),t中餐=-2.248;(6.23±0.26)VS(7.21±0.67),t晚餐=-2.030],差异均有统计学意义(P均0.05);实验组患者的剖宫产、新生儿并发症以及产妇并发症发生率均显著低于对照组[χ2剖=5.296,χ2新=5.780,χ2产=7.026],差异有统计学意义(P均0.05)。结论:1.GDM患者的妊娠压力处于中等水平,需要及时评估并给予有针对性的心理护理干预;2.TTM应用于GDM患者的妊娠压力干预,能有效降低患者的压力水平,促使患者采取积极的应对方式,使行为变化阶段明显向前发展;3.TTM能促进GDM患者自我管理,使患者意识到行为改变对控制血糖的好处,最终改善妊娠结局。
[Abstract]:Objective: To evaluate the pregnancy stress level and its influencing factors in patients with gestational diabetes mellitus (GDM), and to evaluate the intervention effect of psychological nursing across theoretical model (TTM) on pregnancy stress, coping style, blood glucose level and pregnancy outcome in GDM patients, so as to find a suitable intervention model for the change of stress management behavior in GDM patients, and to improve the health of GDM patients. Methods: This study is divided into two parts. One part is the study on the pregnancy pressure status and its influencing factors of GDM patients (study 1). From February to July, 2016, 15 cases of GDM patients in the obstetric clinic of a third-class hospital in Chengde were selected by purposeful sampling. Colaizzi analysis method was used to analyze and refine the subject. Another part was the study of psychological nursing intervention of TTM (study 2). Based on informed consent from February to July, 2016, 86 patients with GDM were selected as subjects. The subjects were divided into experimental group (n = 43 cases) and control group (n = 43 cases) according to random number table method; the control group was given routine nursing, and the experimental group was given cross-theoretical model psychological nursing on the basis of routine nursing. The intervening time of the two groups lasted for three months; before intervention, after intervention for one month, after intervention for three months, the pregnancy pressure scale and behavior were adopted. Results: A Colaizzi analysis method was used to extract 8 topics: (1) negative emotions; (2) fetal health; (3) pregnancy outcomes; (4) knowledge acquisition. (5) Future life; (6) Blood glucose control; (7) Work, social aspects; (8) Family aspects. Study 2 TTM psychological nursing intervention results: 1. Baseline data showed: (1) 2 groups of patients in age, occupation, residence, education level, family per capita monthly income, medical expenses payment, times of pregnancy and childbirth, family history of diabetes and adverse. There was no significant difference in pregnancy and childbirth history (p0.05); (2) the total score of gestational stress in GDM patients was (47.05 + 5.11) and the score index was 52.51%; (3) the score of gestational stress in the two groups was (0.52 + 0.05) vs (0.53 + 0.06), t = - 0.842], the stage of behavior change (2 = 3.248) and coping style [positive coping: (16.83 + 2.97) vs (15.51 + 2.68), t = - 1.696; Negative coping: (9.88 + 1.69) vs (10.02 + 1.37), t = 1.634] scores were compared, the differences were not statistically significant (p0.05), with comparability. 2. After intervention, the results showed: (1) Before intervention, 1 month after intervention, 3 months after intervention, the total score of pregnancy pressure in the two groups were repeated measurement of variance analysis, the results showed that the total score of pregnancy pressure in the two groups was in Time effect, intervention effect and interaction effect were statistically significant (f-time effect = 930.459, f-intervention effect = 20.831, f-interaction effect = 90.086, P 0.01); after 1 month intervention, the total score of pregnancy pressure in the two groups was compared [(0.43 + 0.47) vs (0.48 + 0.06), t = - 4.323]; after 3 months intervention, the total score of pregnancy pressure in the two groups was compared [(0.35 + 0.04) vs (0.44 + 0.44]. 0.06, t = - 8.403], the difference was statistically significant (p 0.01); at different time points, the experimental group pregnancy pressure total score comparison (f = 607.241), the control group pregnancy pressure total score comparison (f = 323.332), the difference was statistically significant (p 0.01); two groups of pregnancy pressure total score at each time point were statistically significant (p 0.01); (2) Before intervention, one month after intervention, and three months after intervention, the SCSQ scores of the two groups were analyzed by repeated measures of variance. The results showed that the time effect, intervention effect and interaction effect of the two groups were statistically significant (f-time effect = 232.522, f-intervention effect = 12.280, f-interaction effect = 4.246, P 0). The scores of positive coping style in the experimental group and the control group were compared after 1 month of intervention [(18.02 (+ 2.69) vs (16.42 (+ 2.60), t = 2.814]. The scores of positive coping style in the experimental group were compared after 3 months of intervention [(22.12 (+ 2.54) vs (19.53 (+ 2.81), t = - 3.232], and the differences were statistically significant (all P 0.05). The scores of positive coping style in the experimental group and the control group were statistically significant (p 0.01); the scores of positive coping style in the experimental group and the control group were statistically significant (p 0.01). The time effect of negative coping style scores in the two groups was statistically significant (p 0.01). There was no significant difference in the intervention effect (f-time effect = 0.584, f-intervention effect = 2.126, P 0.05); the scores of negative coping style between the experimental group and the control group after intervention for one month [(9.44 + 1.59) VS (10.26 + 1.36), t = - 2.545], the difference was statistically significant (P 0.05); the scores of negative coping style between the experimental group and the control group at different time points were compared (F = 5.064). The scores of negative coping styles in the experimental group and the control group were compared at different time points, the results showed that there was a significant difference between the two groups before and after intervention (P 0.05), and the other time points between the two groups were compared (P 0.05). There was no significant difference between the two groups (P 0.05). (3) Comparisons between the experimental group and the control group at different stages of gestational stress behavior showed that the experimental group and the control group were compared at different stages of gestational stress behavior (21 months = 22.928, 23 months = 24.952) after one month of intervention and three months of intervention. The differences were statistically significant (P 0.01); at different time points, the experimental group and the control group were compared within the behavior change stage (_2 solid = 84.488, _2 pair = 37.360), the differences were statistically significant (P 0.01). (5) The experimental group and the control group were compared in blood glucose levels and pregnancy outcomes, the results showed that the experimental group two hours after three meals. The blood glucose values were significantly lower than those of the control group [(5.41+0.55) VS (6.00+0.77), t breakfast =-3.132; (6.31+0.29) VS (6.96+0.89), t lunch =-2.248; (6.23+0.26) VS (7.21+0.67), t dinner =-2.030], the differences were statistically significant (P 0.05); the incidence of cesarean section, neonatal complications and maternal complications in the experimental group were significantly lower than those in the control group (P 0.05). [_2 dissection = 5.296, _2 new = 5.780, _2 birth = 7.026], the difference was statistically significant (P 0.05). Conclusion: 1. GDM patients with pregnancy pressure is in the middle level, need to be timely assessment and give targeted psychological nursing intervention; 2. TTM applied to GDM patients with pregnancy pressure intervention, can effectively reduce the level of patients'pressure, prompt patients to take active measures. TTM can promote the self-management of GDM patients, make them aware of the benefits of behavior change on blood sugar control, and ultimately improve pregnancy outcomes.
【学位授予单位】：承德医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R473.71
本文编号：2246970
[Abstract]:Objective: To evaluate the pregnancy stress level and its influencing factors in patients with gestational diabetes mellitus (GDM), and to evaluate the intervention effect of psychological nursing across theoretical model (TTM) on pregnancy stress, coping style, blood glucose level and pregnancy outcome in GDM patients, so as to find a suitable intervention model for the change of stress management behavior in GDM patients, and to improve the health of GDM patients. Methods: This study is divided into two parts. One part is the study on the pregnancy pressure status and its influencing factors of GDM patients (study 1). From February to July, 2016, 15 cases of GDM patients in the obstetric clinic of a third-class hospital in Chengde were selected by purposeful sampling. Colaizzi analysis method was used to analyze and refine the subject. Another part was the study of psychological nursing intervention of TTM (study 2). Based on informed consent from February to July, 2016, 86 patients with GDM were selected as subjects. The subjects were divided into experimental group (n = 43 cases) and control group (n = 43 cases) according to random number table method; the control group was given routine nursing, and the experimental group was given cross-theoretical model psychological nursing on the basis of routine nursing. The intervening time of the two groups lasted for three months; before intervention, after intervention for one month, after intervention for three months, the pregnancy pressure scale and behavior were adopted. Results: A Colaizzi analysis method was used to extract 8 topics: (1) negative emotions; (2) fetal health; (3) pregnancy outcomes; (4) knowledge acquisition. (5) Future life; (6) Blood glucose control; (7) Work, social aspects; (8) Family aspects. Study 2 TTM psychological nursing intervention results: 1. Baseline data showed: (1) 2 groups of patients in age, occupation, residence, education level, family per capita monthly income, medical expenses payment, times of pregnancy and childbirth, family history of diabetes and adverse. There was no significant difference in pregnancy and childbirth history (p0.05); (2) the total score of gestational stress in GDM patients was (47.05 + 5.11) and the score index was 52.51%; (3) the score of gestational stress in the two groups was (0.52 + 0.05) vs (0.53 + 0.06), t = - 0.842], the stage of behavior change (2 = 3.248) and coping style [positive coping: (16.83 + 2.97) vs (15.51 + 2.68), t = - 1.696; Negative coping: (9.88 + 1.69) vs (10.02 + 1.37), t = 1.634] scores were compared, the differences were not statistically significant (p0.05), with comparability. 2. After intervention, the results showed: (1) Before intervention, 1 month after intervention, 3 months after intervention, the total score of pregnancy pressure in the two groups were repeated measurement of variance analysis, the results showed that the total score of pregnancy pressure in the two groups was in Time effect, intervention effect and interaction effect were statistically significant (f-time effect = 930.459, f-intervention effect = 20.831, f-interaction effect = 90.086, P 0.01); after 1 month intervention, the total score of pregnancy pressure in the two groups was compared [(0.43 + 0.47) vs (0.48 + 0.06), t = - 4.323]; after 3 months intervention, the total score of pregnancy pressure in the two groups was compared [(0.35 + 0.04) vs (0.44 + 0.44]. 0.06, t = - 8.403], the difference was statistically significant (p 0.01); at different time points, the experimental group pregnancy pressure total score comparison (f = 607.241), the control group pregnancy pressure total score comparison (f = 323.332), the difference was statistically significant (p 0.01); two groups of pregnancy pressure total score at each time point were statistically significant (p 0.01); (2) Before intervention, one month after intervention, and three months after intervention, the SCSQ scores of the two groups were analyzed by repeated measures of variance. The results showed that the time effect, intervention effect and interaction effect of the two groups were statistically significant (f-time effect = 232.522, f-intervention effect = 12.280, f-interaction effect = 4.246, P 0). The scores of positive coping style in the experimental group and the control group were compared after 1 month of intervention [(18.02 (+ 2.69) vs (16.42 (+ 2.60), t = 2.814]. The scores of positive coping style in the experimental group were compared after 3 months of intervention [(22.12 (+ 2.54) vs (19.53 (+ 2.81), t = - 3.232], and the differences were statistically significant (all P 0.05). The scores of positive coping style in the experimental group and the control group were statistically significant (p 0.01); the scores of positive coping style in the experimental group and the control group were statistically significant (p 0.01). The time effect of negative coping style scores in the two groups was statistically significant (p 0.01). There was no significant difference in the intervention effect (f-time effect = 0.584, f-intervention effect = 2.126, P 0.05); the scores of negative coping style between the experimental group and the control group after intervention for one month [(9.44 + 1.59) VS (10.26 + 1.36), t = - 2.545], the difference was statistically significant (P 0.05); the scores of negative coping style between the experimental group and the control group at different time points were compared (F = 5.064). The scores of negative coping styles in the experimental group and the control group were compared at different time points, the results showed that there was a significant difference between the two groups before and after intervention (P 0.05), and the other time points between the two groups were compared (P 0.05). There was no significant difference between the two groups (P 0.05). (3) Comparisons between the experimental group and the control group at different stages of gestational stress behavior showed that the experimental group and the control group were compared at different stages of gestational stress behavior (21 months = 22.928, 23 months = 24.952) after one month of intervention and three months of intervention. The differences were statistically significant (P 0.01); at different time points, the experimental group and the control group were compared within the behavior change stage (_2 solid = 84.488, _2 pair = 37.360), the differences were statistically significant (P 0.01). (5) The experimental group and the control group were compared in blood glucose levels and pregnancy outcomes, the results showed that the experimental group two hours after three meals. The blood glucose values were significantly lower than those of the control group [(5.41+0.55) VS (6.00+0.77), t breakfast =-3.132; (6.31+0.29) VS (6.96+0.89), t lunch =-2.248; (6.23+0.26) VS (7.21+0.67), t dinner =-2.030], the differences were statistically significant (P 0.05); the incidence of cesarean section, neonatal complications and maternal complications in the experimental group were significantly lower than those in the control group (P 0.05). [_2 dissection = 5.296, _2 new = 5.780, _2 birth = 7.026], the difference was statistically significant (P 0.05). Conclusion: 1. GDM patients with pregnancy pressure is in the middle level, need to be timely assessment and give targeted psychological nursing intervention; 2. TTM applied to GDM patients with pregnancy pressure intervention, can effectively reduce the level of patients'pressure, prompt patients to take active measures. TTM can promote the self-management of GDM patients, make them aware of the benefits of behavior change on blood sugar control, and ultimately improve pregnancy outcomes.
【学位授予单位】：承德医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R473.71
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