延续性护理对脑卒中患者知信行的效果研究

发布时间：2018-12-08 13:13

【摘要】：目的:本研究旨在探索符合我省现状的延续护理健康教育方式,制定并且实施脑卒中患者延续护理干预方案,对脑卒中出院患者实施微信平台、电话随访结合家庭随访的延续性护理干预;通过描述两组脑卒中患者从出院前到出院后6周及3个月对疾病知识,态度及行为的变化;探讨改善患者健康行为的可能性,对延续护理模式提供相应依据。方法:1.本研究从某三级甲等医院神经内科选取110例首次发病的脑卒中患者,采用随机数字表法将其分为对照组(55例)和干预组(55例),对照组实行神经内科患者常规出院指导,在患者出院前2天进行健康宣教。干预组的患者除了接受神经内科常规护理以外,以“4C延续护理理论”为基础,采取出院前护理结合出院后护理的护理方案。干预方案以中华医学会神经病学分会制定的《中国脑卒中康复治疗指南》为标准,内容主要涉及疾病基本知识、药物服用、生活起居,饮食运动、康复锻炼等。具体由研究员于患者出院前2天对其进行疾病相关知识及健康行为等方面进行专门指导,并且在其出院后每周通过微信平台发送脑卒中保健知识,并在线为患者解答疑惑;每2周进行一次电话访问,为患者提供及时反馈的机会,强化患者需掌握的疾病相关的知识和技能;每3周进行一次家庭随访,通过与患者面对面进行访问沟通,对其生活行为方式进行面对面指导。2.研究者在患者出院时、干预后6周以及干预后3个月,采用《脑卒中知识问卷》、《慢性病管理自我效能量表》和《脑卒中患者自我管理行为评定表》对脑卒中患者的知识、态度及行为的变化进行相应评价。3.收集到的数据采用SPSS17.0软件对数据进行处理,采用两独立样本t检验,配对t检验、重复测量方差分析等统计学方法进行分析。结果:1.比较两组患者的基本资料,差异无明显统计学意义。(P=0.759)。2.患者出院时、干预后6周和干预后3个月时,统计对照组和干预组的患者知信行问卷的总体得分,数据结果显示相对于对照组,干预组的总分升高趋势比较明显,两者的差异有明显的统计学意义。(P0.05)。3.两组患者在出院时、干预后6周、干预后3个月时,患者脑卒中知识、慢性病管理自我效能、自我管理行为各部分得分均有所提高(P0.05)。相对于对照组,干预组患者得分升高趋势更加明显。而且同一时间点相比干预组在干预后6周、干预后3个月脑卒中知信行问卷总体得分均高于对照组(P0.05)。结论:采用微信平台、电话随访、家庭随访的延续护理干预方式改善脑卒中患者的知信行水平是有效的。该方式能够明显地提高脑卒中患者对疾病知识的认识水平,一定程度上改正患者平日生活中不当的行为方式,可以有效的督促患者采用积极的功能锻炼方法。另一方面还可以还以提高患者康复锻炼的依从性,对于临床工作的护理工作以及社区护理工作者有一定的参考意义。
[Abstract]:Objective: the purpose of this study was to explore the mode of continuous nursing and health education in accordance with the present situation of our province, to formulate and implement the intervention scheme of continuous nursing for stroke patients, and to implement the WeChat platform for stroke discharged patients. Telephone follow-up combined with continuous nursing intervention in family follow-up; By describing the changes of knowledge attitude and behavior of stroke patients from 6 weeks and 3 months after discharge to explore the possibility of improving patients' health behavior and provide the corresponding basis for continuing nursing mode. Methods: 1. In this study, 110 first-onset stroke patients were selected from neurology department of a certain Grade 3A hospital. They were divided into control group (55 cases) and intervention group (55 cases) by random number table method. The control group was given routine discharge guidance for patients in neurology department. Health education was conducted 2 days before discharge. In the intervention group, in addition to the routine nursing care in neurology department, the pre-discharge nursing combined with post-discharge nursing was adopted on the basis of "4C continuous nursing theory". The intervention program is based on the guidelines for Rehabilitation treatment of Stroke made by the Neurology Branch of the Chinese Medical Association. The main contents are related to the basic knowledge of the disease, drug use, daily living, diet and exercise, rehabilitation exercise, and so on. Specifically, the researcher gave specific guidance to patients about disease related knowledge and health behavior two days before discharge, and sent out stroke health care knowledge through WeChat every week after discharge, and answered patients' questions online. Telephone interviews are conducted every two weeks to provide patients with opportunities for timely feedback and to enhance the knowledge and skills they need to master about diseases; Family follow-up every 3 weeks, through face-to-face interviews with patients, face to face guidance on their lifestyle. 2. 2. At the time of discharge, 6 weeks after intervention and 3 months after intervention, the researchers used the stroke knowledge questionnaire, the chronic disease management self-efficacy scale and the self-management behavior assessment table of stroke patients. The change of attitude and behavior should be evaluated accordingly. 3. The collected data were processed by SPSS17.0 software. Two independent samples t-test, paired t-test, repeated measurement variance analysis and other statistical methods were used to analyze the data. Results: 1. There was no significant difference in basic data between the two groups (P0. 759). At the time of discharge, 6 weeks after the intervention and 3 months after the intervention, the total scores of the patients in the control group and the intervention group were statistically analyzed. The results showed that the total score of the intervention group was significantly higher than that of the control group. The difference was statistically significant (P0.05). At the time of discharge, 6 weeks after intervention and 3 months after intervention, the scores of stroke knowledge, chronic disease management self-efficacy and self-management behavior were improved in both groups (P0.05). Compared with the control group, the intervention group patients increased the trend of more obvious score. At the same time, compared with the intervention group at 6 weeks after intervention, 3 months after intervention, the overall scores of the questionnaire were higher than those of the control group (P0.05). Conclusion: continuous nursing intervention with WeChat platform, telephone follow-up and family follow-up is effective in improving the level of knowledge and practice in stroke patients. This way can obviously improve the knowledge level of stroke patients, correct the improper behavior of patients in their daily life to a certain extent, can effectively urge the patients to adopt the positive functional exercise method. On the other hand, it can also improve the compliance of patients with rehabilitation exercise, which has certain reference significance for clinical nursing work and community nursing workers.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R473.74

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