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医护合作式健康教育对COPD患者自我护理行为与生活质量的影响
The Infections of Doctor-nurse Cooperative Health Education for the Self-care Behaviors and Quality of Life for COPD Patients
【作者】 申华平;
【导师】 刘学军;
【作者基本信息】 山西医科大学 , 内科学, 2013, 硕士
【摘要】 研究目的通过医护合作对COPD中度、重度患者实施健康教育,以提高患者自我护理行为,达到改善其生活质量的目的,同时为慢性疾病的管理和健康教育提供依据。研究方法本研究收集了从2011年12月~2012年10月山西省汾阳医院呼吸内科住院的慢性阻塞性肺疾病中度与重度急性加重期85例患者作为研究对象,随机分为实验组42人,对照组43人。实验组在常规治疗基础上给予医护合作式健康教育:患者入院后医生和护士共同评估患者存在的健康问题制定个体化健康教育计划,介绍COPD疾病的相关知识、指导患者掌握有效排痰、呼吸康复训练、氧疗等技能,并进行心理疏导,出院时给予出院指导,并于出院后2周、1个月、2个月、3个月电话随访和健康指导。对照组在治疗基础上给与常规健康教育,并于出院后2周、1个月、2个月、3个月电话随访和健康指导。两组患者均于入院时和出院后3个月随访时行自我护理行为评分及生存质量评分。采用SPSS13.0统计软件对数据进行统计分析。计量资料采用t检验,计数资料采用卡方检验。研究结果1.COPD患者健康教育前自我护理行为情况:(1)整体自我护理行为总分范围为:50~117分,总均分为84.61士15.18分,属于中等水平的患者最多,占71.3%,余为低水平,无高水平的患者。(2)满足一般性自理需求的自理行为总分为38.38士8.14,处于中等水平的患者较多,为72.5%;满足健康偏离性自理需求的行为总分为46.24士9.83,处于低水平的患者较多,占50%,中等水平占46.3%,高水平占3.7%。(3)处于低水平的13个自我护理行为条目得分在0.58土1.18~1.88士1.43之间,主要与满足健康偏离性自理需求的自理行为有关;处于高水平的1个条目得分为3.48土1.08,与满足健康偏离性自理需求的自理行为有关。2.两组患者在健康教育前一般资料:性别、年龄、文化程度、职业、家庭居住地、家庭人均收入、医疗费用支付方式、体质指数、住院次数、病程、呼吸困难程度、疾病严重程度等方面的差别无统计学意义(p>0.05),具有可比性;在自我护理行为总分、两维度总分、生存质量总分、日常生活活动得分、社会活动得分、抑郁与焦虑得分差别无统计学意义(p>0.05),具有可比性。3.两组患者健康教育后3个月在自我护理行为总分、两维度总分均高于健康教育前,差别均具有统计学意义(p<0.01)。健康教育后3个月实验组在自我护理行为总分、两维度总分均高于对照组,差别具有统计学意义(p<0.01)。4.对照组健康教育后3个月生存质量的总分(p<0.05)、日常生活活动得分(p<0.05)、焦虑得分(p=0.05)均低于教育前,差别具有统计学意义,但对社会活动与抑郁得分无影响(p>0.05);实验组除社会活动得分(p>0.05)外其余均低于教育前(p<0.01);健康教育后3个月实验组生存质量的总分(p<0.05)、日常生活活动得分(p<0.05)、焦虑与抑郁得分(p<0.01)均低于对照组,差别具有统计学意义,但对社会活动得分无影响(p>0.05)。结论1.COPD患者的自我护理行为属于中等水平,满足健康偏离性自理需求的自理行为较差。2.医护合作式健康教育提高了COPD患者自我护理行为,包括满足一般性自理需求的行为和满足健康偏离性自理需求的行为均得到明显提高。3.医护合作式健康教育提高了COPD患者日常生活活动能力,缓解了患者焦虑和抑郁心理,从而提高了患者生活质量。4.医护合作健康教育的模式促进了医护合作,增进了医护患三方沟通,提高了护士的专业素质,促进了专科护理的发展。
【Abstract】 Objective:Through doctor-nurse cooperation on Chronic obstructive pulmonary disease(COPD) patients with moderate or severe period, to enhance patients self-care behaviors, achieve the aim of improving the quality of life for the patients, and providing the basis for the management of chronic diseases and health education.Method:85patients in acute exacerbations of COPD with moderate or severe period, from fenyang hospital, Shanxi province,between the year2011December-2012October were recruited in this study. They were randomly assigned to the experimental group of42people, control group of43people. Experimental group on the base of general treatment, giving doctor-nurse cooperation health education: After patients admitted, doctors and nurses assessment patients exists of health problem developed individual of health education plans together, tell them of the related knowledge, and make patients master effective row phlegm, and breathing rehabilitation training, and oxygen therapy, and so on. After discharged, giving discharged Guide, and for phone follow-up and health guide after2week,1months,2months,3months. Control group were given general health education, and for phone follow-up and health guide after2week,1months,2months,3months. Self-care behavior scores and quality of life scores were used for two groups of patients on admission and3-month follow-up after discharge. Using SPSS13.0statistical software to analysis the data, Measurement data using T test, the count data using Chi-square test.Results:1. self-care behaviors of patients with COPD before the health education: (1) Holistic self-care behavior score range:50~117, an average of84.61±15.18, most of patients with a moderate level of,71.3%, remaining as a low level, without a high level of patient.(2) The total score that meet the General self-care behaviors is38.38±8.14, most of patients with middle class, to72.5%;the total score that meet the needs of health deviation self-care behavior is46.24±9.83, at a low level in patients with higher50%per cent,46.3%per cent at the secondary level, a high level3.7%.(3) Self-care behaviors at a low level of13entries scored between0.58±1.18~1.88±1.43, associated with self-care behaviors;1entry for high score at3.48±1.08, associated with self-care behaviors.2. General information between two groups of patients before health education: gender, age, education, occupation, family residence, the per capita household income, medical expenses, body mass index, hospital number, course, degree of difficulty breathing, no statistically significant differences in disease severity (p>0.05), has comparable;3.3months after two groups of health education for patients with the score of self-care behaviors, health education of two dimensions total score were higher than the former, differences are statistically significant (p<0.01).3months after the health education group self-care behaviors in total, two dimensions, total score was higher than the control group, statistically significant difference (p<0.01). 4.3months after health education, the quality of life score of control group (p<0.05)、scores of activities of daily living (p<0.05), anxiety scores (p=0.05),each of them is lower than before the education, statistically significant differences, but no impact on social activities and depression scores (p>0.05); In experimental group, Except for social activities(p>0.05),, the others are lower than before the education (p<0.01); after health education for3months, the experimental Group score of quality of life (p<0.05), activities of daily living scores (p<0.05), anxiety and depression scores (p<0.01), each of them is lower than the control group, statistically significant differences, but did not affect scores of social activity (p>0.05).Conclusion1. Self-care behaviors of patients with COPD has a moderate level, poor meet the needs of health deviation self-care behaviors.2. Doctor-nurse cooperative health education improves self-care behaviors of patients with COPD, including meeting the General daily needs and meet the needs of health deviation self-care behaviors,and both of them have been greatly improved.3. Doctor-nurse cooperative health education improves the activities of daily living in patients with COPD, relieve the anxiety and depression of patients, improves the quality of life.4. The mode of doctor-nurse cooperative health education promote the medical and health care cooperation,enhance the communication on health care, improving the professional quality of nurse, promoted the development of specialist care.
【Key words】 doctor-nurse cooperation; health education; COPD; self-care; quality of life;