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自我管理项目对COPD患者知识、信念及行为的影响研究

发布时间:2018-07-18 09:19
【摘要】:目的本研究通过对稳定期COPD患者实施以家庭为背景的自我管理项目干预,旨在帮助COPD患者获得疾病相关知识及自我管理技能,提高患者对症状管理能力的自信心,即自我效能水平,进而提高其呼吸困难症状管理相关行为依从性,促进自我管理行为的建立,最终改善患者的健康状态。 方法筛选自2009年4月-2010年4月由苏州大学附属第一医院及第二医院呼吸内科病房出院的COPD病例,根据随机对照原则,将研究对象分为干预组及对照组各34例。在患者出院后4周或4周以上,由经过培训的研究小组成员到患者家中为干预组患者实施一对一的COPD自我管理项目干预,干预时间共8周,每周1次课程,每次约1-2h,第1-6周进行COPD自我管理理论课程,第7、8周实施康复行为指导。而对照组患者则给予一次呼吸内科常规护理教育。在自我管理项目干预前、干预后2个月采用COPD健康知识问卷、COPD自我效能量表、COPD患者症状管理相关行为依从性调查表、呼吸困难症状评分及圣乔治呼吸问卷(St George's Respiratory Questionnaire, SGRQ)分别对患者的知识、信念及行为、行为结果做资料评估。采用SPSS16.0统计软件对数据资料进行统计分析。 结果自我管理项目干预后2个月,干预组患者健康知识总分(t=-11.659,P=0.000);干预后自我效能总分(t=-9.509,P=0.000)、呼吸困难管理维度(t=-9.528,P=0.000)、情绪维度(t=--7.704,P=0.000)、体力活动维度(t=-7.043,P=0.000)、环境与温度维度(t=-9.259,P=0.000)、安全行为维度(t=-7.127,P=0.000)均较干预前显著提高;而对照组在干预前后上述资料得分均无显著差异(P0.05)。患者在症状管理相关行为的四个方面即呼吸功能锻炼(Z=-4.852,P=0.000)、运动锻炼(Z=-3.947,P=0.000)、药物吸入(Z=-4.852,P=0.000)及家庭氧疗(Z=-3.145,P=0.002)的依从性较干预前显著提高,平均家庭氧疗时间明显延长(t=0.749,P=0.000),干预前后资料间有显著差异(P0.05);而对照组上述资料得分差异无统计学意义(P0.05)。干预后MRC(Medical Research Council Dyspnea Scale)评分较干预前明显改善(z=-2.236,P=0.025),而Brog评分比较(t=0.754,P0.05)无显著差异。干预组患者自我管理项目干预后2个月,SGRQ(St.George's respir atory Questionnaire)总分(t=4.740,P=0.000),症状(t=3.236,P=0.000),活动能力(t=2.374,P=0.000),社会心理(t=4.445,P=0.000)得分均较干预前明显改善;而对照组患者SGRQ总分及各维度评分差异均无统计学意义(P0.05)。 结论1. COPD患者的健康知识水平普遍较低;自我效能总体处于中低水平;患者的呼吸困难症状管理相关行为依从性较差。2.自我管理项目干预有效提高了COP D患者的健康知识水平;增强了患者对呼吸困难症状管理的自信心;进而提高了患者症状管理相关行为依从性,促进了自我管理行为的建立。3.自我管理项目干预有利于改善患者的呼吸困难症状,最终提高患者健康相关生存质量。
[Abstract]:Objective the purpose of this study was to help COPD patients acquire disease related knowledge and self-management skills, and improve their confidence in symptom management ability by implementing family background self-management project intervention to stable COPD patients. That is, self-efficacy level, and then improve their breathing difficulties symptoms management related behavior compliance, promote the establishment of self-management behavior, and ultimately improve the health status of patients. Methods from April 2009 to April 2010, patients with COPD were selected and discharged from the first affiliated Hospital and the second Hospital of Suzhou University. According to the principle of random control, the subjects were divided into intervention group and control group respectively. After the patient was discharged from hospital for 4 weeks or more, one to one COPD self-management program was carried out in the intervention group by the trained members of the research team. The intervention lasted 8 weeks and was taught once a week. Each time about 1-2 hours, 1-6 weeks of COPD self-management theory course, 7 weeks 8 weeks to carry out rehabilitation behavior guidance. The patients in the control group were given routine nursing education in respiratory medicine. Before and 2 months after intervention, COPD self-efficacy scale was used to evaluate the behavior compliance of COPD patients. The scores of dyspnea symptoms and St George's Respiratory questionnaire (SGRQ) were used to evaluate the patients' knowledge, beliefs and behaviors. SPSS 16.0 statistical software was used to analyze the data. Results the total score of health knowledge of patients in the intervention group was 0.000 (t = 11.659) 2 months after the intervention of self-management project. After intervention, the total score of self-efficacy was 0.000, the management dimension of dyspnea was 0.000, the emotional dimension was 7.704P0.000, the physical activity dimension was 0.000, the environment and temperature dimension was 0.000, and the safe behavior dimension was 7.127P0.000. There was no significant difference in the scores of the above data before and after intervention in the control group (P0.05). The compliance of patients in four aspects of symptoms management related behaviors, namely, respiratory function exercise (ZP0. 000), exercise (ZC- 3. 947 P0. 000), drug inhalation (ZC- 4. 852P0. 000) and family oxygen therapy (ZA- 3. 145 P0. 002), was significantly increased compared with that before intervention. The average time of family oxygen therapy was significantly prolonged (t0. 749%), and there was significant difference between the data before and after intervention (P0.05), while in the control group, there was no significant difference in the above data score (P0.05). After intervention, the MRC (Medical Research Council Dyspnea scale) score was significantly improved compared with that before the intervention (zhi-2.236), but there was no significant difference in Brog score (t0. 754P 0.05). In the intervention group, two months after intervention, the total score of SGRQ (St. George's respir atory quionnaire) (t = 4.740), symptoms (t = 3.236), activity ability (t = 2.374) and social psychology (t = 4.445P0. 000) were significantly improved compared with those before intervention, but there was no significant difference in RQ total score and dimension scores between the control group and the control group (P0.05). Conclusion 1. COPD patients' health knowledge level is generally low; self-efficacy is generally in the low and low level; patients with dyspnea symptoms management related behavior compliance is poor. 2. The intervention of self-management project can effectively improve the health knowledge level of patients with cop, enhance the self-confidence of patients with dyspnea symptoms management, and further improve the compliance of patients with symptoms management related behavior, and promote the establishment of self-management behavior. 3. Self-management program intervention can improve patients' dyspnea symptoms and ultimately improve their health-related quality of life.
【学位授予单位】:苏州大学
【学位级别】:硕士
【学位授予年份】:2012
【分类号】:R563.9

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