信息—动机—行为技巧模型对心力衰竭患者自我管理的干预研究

发布时间：2018-03-06 00:00

本文选题：信息-动机-行为技巧模型　切入点：心力衰竭　出处：《山东大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的了解心力衰竭(HF)患者自我管理现状;探讨信息-动机-行为技巧模型(IMB)在心力衰竭患者自我管理中的干预效果;为发展心力衰竭患者从医院到家庭的延续护理提供干预策略。方法采取整群抽样的方法,按照纳入和排除标准将2016年1月1日至2016年12月31日在山东省某三级甲等医院心血管内科住院的200例心力衰竭患者选为研究对象。应用IMB模型理论制订并实施自我管理干预策略。用患者一般资料调查表、明尼苏达心力衰竭生活质量量表、心力衰竭自我管理知识问卷、心力衰竭自我护理指数量表对研究对象进行自我管理能力和干预效果的调查和测评。收集入院时、出院时和出院2周时,患者自我管理知识、自我管理能力的变化情况。数据分析用SPSS23.0统计软件,统计指标有均数、标准差、率、构成比等,重复测量资料用方差分析。结果1.本研究纳入标准的200例心力衰竭患者中,5例死亡,7例失访,有效样本量188例,样本有效率94.00%。2.研究对象人口学特征:心力衰竭患者60岁以上者达81.91%;性别构成男性62.23%高于女性的37.77%,男女比例为1.65:1;初中以下学历者居多143人,占76.06%;配偶和/或子女照顾患者占60.64%;心衰患病率城市55.32%与农村44.68%相接近;患者以医疗保险支付费用占比达到96.28%。3.研究对象疾病特征:188例心力衰竭患者纽约心功能分级Ⅲ～Ⅳ级占89.89%,Ⅰ～Ⅱ级仅占10.11%;冠心病居心衰病因之首占54.79%,其次为心肌病占25.00%,而高血压、瓣膜病分别为14.98%和13.83%;合并高血压居多占34.04%,其次为糖尿病占28.72%。4.心力衰竭患者生活质量差(得分为69.02±16.31分);各维度得分为:身体领域27.63±7.45分,情绪领域15.94±5.06分,其他领域25.45±6.21分。5.本研究心力衰竭患者自我管理能力水平偏低(得分42.42±9.37分)。通过IMB模型理论制订自我管理干预措施及内容,对心衰患者进行干预后,入院时、出院时、出院2周后重复测量资料方差分析显示,患者的自我管理知识、自我护理维持、自我护理管理、自我护理信心和自我护理能力总分在干预前后有显著不同P0.001(F=620.75,P=0.000;F=216.66,P=0.000;F=412.76,P=0.000;F=171.35,P=0.000;F=492.44,P=0.000)。结论心力衰竭患者生活质量差,自我管理能力水平偏低。依据IMB模型理论开展的个性化心力衰竭自我管理干预,提供给患者自我管理知识、动机和技能,提高了心衰患者的自我管理能力。
[Abstract]:Objective to investigate the heart failure (HF) patients self management status; to explore the information motivation behavioral skills model (IMB) intervention in self management of patients with heart failure in patients with heart failure; for the development from the hospital to the family to provide continuing nursing intervention strategies. Methods cluster sampling method, according to the inclusion and exclusion criteria from January 1, 2016 to December 31, 2016 selected as the research object in the 200 cases of heart failure patients in Shandong Province three level of first-class hospital in hospital. The application of IMB model to develop and implement the strategy of self management intervention. Patients with general information questionnaire, Minnesota heart failure quality of life scale, self management questionnaire of heart failure, heart failure self care index questionnaire and evaluation of self management the ability and effect of intervention on the object of study. Collected at admission, discharge and 2 weeks, Patient self management knowledge, the change of self management ability. Statistical analysis software using SPSS23.0 data, statistical indicators mean, standard deviation, rate, constituent ratio, repeated measurement data by variance analysis. Results 200 cases of 1. patients with heart failure were included in the study standard, 5 cases died, 7 cases were lost, effective the sample of 188 cases, the effective rate of sample 94.00%.2. on demographic characteristics: heart failure patients over the age of 60 to 81.91%; 62.23% male gender 37.77% higher than female, male to female ratio was 1.65:1; the junior high school education are 143 people, accounting for 76.06%; the spouse and / or children to take care of patients with heart failure accounted for 60.64%; the prevalence rate of 55.32% and the city close to 44.68% patients in rural areas; medical insurance payments accounted for 96.28%.3. research object: 188 cases of heart failure in patients with the disease characteristics of New York heart function grade III ~ IV grade I-II accounted for 89.89%, accounted for only 10.1 1%; coronary heart disease heart failure first accounted for 54.79%, followed by cardiomyopathy was 25%, hypertension, valvular heart disease were 14.98% and 13.83%; the majority of hypertension accounted for 34.04%, followed by diabetes accounted for 28.72%.4. of poor quality of life of the patients with heart failure (score 69.02 + 16.31 points); the scores for 27.63 + 7.45 points: physical field 15.94, emotion + 5.06, 25.45 + 6.21.5. in other areas of our patients self management ability of the low level of heart failure (score 42.42 + 9.37 points). The IMB model for self management interventions for patients with heart failure and content, intervention, admission, discharge, discharge after 2 weeks of repeated measurement data variance analysis showed that the patients' self-management knowledge, self-care maintenance, self nursing management, nursing self confidence and self care ability scores were significantly different before and after intervention in P0.001 (F=620.75, P=0.000; F =216.66, P=0.000; F=412.76, P=0.000; F=171.35, P=0.000; F=492.44, P=0.000). Conclusion patients with heart failure and poor quality of life, the ability of self management level is low. The IMB model based on personalized heart failure theory of self management intervention, provide self-management knowledge, motivation and skills, improve the self-management ability of patients with heart failure.

【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R473.5

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