本文選題：糖尿病 + 護(hù)理門診�。� 參考：《天津醫(yī)科大學(xué)》2014年碩士論文

【摘要】：目的 1調(diào)查糖尿病護(hù)理門診患者失訪的原因,分析可能造成失訪結(jié)局的相關(guān)影響因素。 2將賦能教育應(yīng)用于失訪患者,確定其應(yīng)用效果和推廣價(jià)值。 方法 1采用病例對照研究分析造成失訪的相關(guān)因素。將2010年1月至2011年5月期間出院的糖尿病患者根據(jù)失訪與否進(jìn)行分組,隨機(jī)抽取失訪和非失訪患者各180例。根據(jù)預(yù)留聯(lián)系方式對兩組患者進(jìn)行電話聯(lián)系。采取開放式提問,了解兩組患者對隨訪的態(tài)度、現(xiàn)狀,另外向失訪患者提問失訪的原因；收集患者病歷資料：包括性別、年齡、病程、家族史、受教育情況,工作狀況、醫(yī)保、定點(diǎn)醫(yī)療、治療方式、用藥情況、并發(fā)癥嚴(yán)重程度等。將兩組患者的資料進(jìn)行對照,并作回歸分析。 2作為補(bǔ)充試驗(yàn),探討不同隨訪頻率與失訪結(jié)局的關(guān)聯(lián)性：重新抽取自2011年11月起新出院糖尿病患者240人,隨機(jī)分為三組開展隨訪健康教育。教育內(nèi)容完全一致,但三組隨訪教育頻率分別為：每周1次、每2周1次和每月1次。教育周期均為3個(gè)月,之后改為每月1次門診隨訪。在3個(gè)月和1年后進(jìn)行監(jiān)測,應(yīng)用卡方檢驗(yàn)和重復(fù)測量方差分析法分析隨訪頻率與失訪、血糖控制的關(guān)系。 3應(yīng)用賦能教育對失訪患者進(jìn)行干預(yù)：電話聯(lián)系失訪患者,征得患者和家屬同意后對其中80例患者實(shí)施3個(gè)月的糖尿病賦能教育。期間應(yīng)用中文版糖尿病賦能量表(CM-DES)進(jìn)行評估,并按照賦能教育5個(gè)步驟實(shí)施以患者為主導(dǎo)的賦能教育,于干預(yù)前、干預(yù)6個(gè)月和1年時(shí)進(jìn)行效果監(jiān)測。 結(jié)果 1患者對隨訪的主觀態(tài)度不重視(OR=I.60)、獨(dú)自隨訪能力降低(OR=2.53)、在崗工作(OR=I.90)、未出現(xiàn)嚴(yán)重并發(fā)癥(OR=2.17)與失訪存在相關(guān)性,是造成失訪的危險(xiǎn)性因素。而患者性別、年齡、病程、家族史、受教育程度、醫(yī)保、定點(diǎn)醫(yī)療、治療方式、社會(huì)支持與失訪未發(fā)現(xiàn)明顯相關(guān)(p0.05)。 2不同隨訪頻率設(shè)置組中失訪的發(fā)生率(χ2=1.96)不存在顯著性差異(p=0.375),可認(rèn)為其不是造成失訪的原因。隨訪干預(yù)后,各組患者糖化血紅蛋白(F=37.63)、空腹血糖(F=21.68)和餐后2小時(shí)血糖(F=199.44)均顯著下降(p0.05)。三組之間血糖水平相當(dāng)(p0.05),不同隨訪頻率對患者血糖控制效果一致。 3失訪患者通過賦能教育指導(dǎo),1年內(nèi)失訪率同普通患者基線水平相當(dāng),為21.5%。通過賦能教育,患者自我護(hù)理行為得到顯著改善：其中飲食(F=38.22)、運(yùn)動(dòng)(F=89.39)、血糖監(jiān)測(F=50.7)、足部護(hù)理(F=20.63)和平均吸煙情況(F=9.43)顯著改善(p0.05),然而用藥情況(F=3.45)在賦能教育前后無顯著差異(p0.05)�；颊咦晕倚�(F=122.16)和賦能得分(F=127.53)較之前顯著提高。 結(jié)論 1造成患者失訪的因素是多方面的�；颊咧饔^對于隨訪的重視程度,自身行動(dòng)能力、是否在崗工作以及并發(fā)癥的程度是影響隨訪的重要原因。 2不同隨訪頻率設(shè)置不會(huì)造成失訪,可結(jié)合患者自身情況合理設(shè)置。護(hù)士需要在工作中對于容易失訪的患者予以重視,盡可能提高隨訪出席率。 3賦能教育是幫助患者發(fā)現(xiàn)自身內(nèi)在的能力以控制自身疾病的有效方法,通過強(qiáng)調(diào)患者的自我管理,激發(fā)患者主觀的動(dòng)力以促進(jìn)行為改變。對失訪人群進(jìn)行賦能教育,可促使失訪患者回歸隨訪,增強(qiáng)自我效能和自我管理能力,使血糖水平得到更好地控制,從而改善預(yù)后。
[Abstract]:objective
1 to investigate the causes of missed visits in diabetes outpatients, and analyze the related factors that may cause the outcome of missed visits.
2 apply empowerment education to patients who lost their visit, and determine their application effect and promotion value.
Method
1 a case-control study was used to analyze the related factors that caused the loss of visits. The diabetic patients discharged from January 2010 to May 2011 were divided into groups according to the loss of visits, and 180 cases of the patients who were lost and non lost were randomly selected. The two groups of patients were contacted by telephone according to the way of reservation. Open questions were taken to understand the two groups of patients. The attitude of the visit, the status quo, and the reasons for the loss of the patients who have lost the interview, and collect the patient's medical records, including sex, age, course of disease, family history, education, work condition, medical insurance, fixed-point medical treatment, treatment, medication, and the severity of complications. The data of the two groups of patients were compared, and a regression analysis was made.
2 as a supplementary trial, the relevance of different follow-up frequencies and unvisited outcomes was investigated: 240 newly discharged diabetic patients were re selected from November 2011, randomly divided into three groups to carry out follow-up health education. The education content was completely consistent, but the three groups of follow-up education frequencies were 1 times a week, 1 times every 2 weeks and 1 times a month. The educational cycle was 3. It was followed up to 1 visits per month and followed up for 3 months and 1 years after 3 months and 1 years. The relationship between the frequency of follow-up and the control of blood glucose control was analyzed with chi square test and repeated measurement of variance analysis.
3 the intervention of the disabled patients: the telephone contact with the patients who lost the patients and the consent of the patients and their families to carry out the education of 80 patients for 3 months of diabetes empowerment. During the period, the Chinese version of the diabetes empowerment table (CM-DES) was applied to the assessment, and the patient oriented education was carried out in accordance with the 5 steps of the education. Before intervention, the effect was monitored for 6 months and 1 years.
Result
1 the subjective attitude of follow-up was not attached to the subjective attitude (OR=I.60), the ability to follow up (OR=2.53), working (OR=I.90), no serious complications (OR=2.17) and the loss of visits were related to the loss of visits. The sex, age, course of illness, family history, education, medical insurance, fixed-point medical treatment, treatment, social support No significant correlation was found between the loss of visits (P0.05).
2 there was no significant difference (p=0.375) in the incidence of loss of visits (2=1.96) in the setting group of different follow-up frequencies (p=0.375). It was considered that it was not the cause of the loss of visits. After the follow-up, the glycated hemoglobin (F=37.63), fasting blood glucose (F=21.68) and postprandial blood glucose (F=199.44) were significantly decreased (P0.05). The level of blood glucose between the three groups was equal (p0. 05) the frequency of blood glucose control was consistent with the frequency of follow-up.
The rate of loss of visits within 1 years was equal to the baseline level of the ordinary patients through the instruction of the education of 3 lost visits. The self-care behavior of the patients was significantly improved by the education of 21.5%., including diet (F=38.22), exercise (F=89.39), blood glucose monitoring (F=50.7), foot Nursing (F=20.63) and average smoking (F=9.43), however, the use of P0.05 was significantly improved (P0.05). There was no significant difference in drug status (F=3.45) before and after empowerment education (P0.05). Patients' self-efficacy (F=122.16) and empowerment score (F=127.53) were significantly higher than before.
conclusion
1 the factors that cause the patient's loss of visits are multifaceted. The degree of attention to the follow-up, the ability to act, the work on duty, and the degree of complications are the important factors that affect the follow-up.
2 the setting of different follow-up frequency will not cause the loss of visits. It can be reasonably set up with the patient's own situation. Nurses need to pay attention to the patients who are easy to lose the visit in the work, and improve the attendance rate as much as possible.
3 enforced education is an effective way to help patients find their own inherent ability to control their own diseases. By emphasizing the self management of the patients and stimulating the subjective motivation of the patients to promote the change of behavior, the education of the disabled people can encourage the patients to return to the follow-up, strengthen their self-efficacy and self-management ability, and make the blood sugar level. Better control is achieved to improve the prognosis.
【學(xué)位授予單位】：天津醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R473.5

【參考文獻(xiàn)】

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本文編號：1994391