本文選題：跌倒效能　切入點(diǎn)：健康教育　出處：《重慶醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:調(diào)查住院老年患者預(yù)防跌倒知、信、行及跌倒效能的現(xiàn)狀,分析二者的影響因素;評(píng)價(jià)健康信念模式和程序式健康教育模式的雙模式健康教育對(duì)住院老年患者預(yù)防跌倒知識(shí)、態(tài)度、行為及跌倒效能、預(yù)防跌倒行為依從性、跌倒發(fā)生率的影響。方法:本研究包含兩部分。第一部分:橫斷面研究。采用便利抽樣法對(duì)重慶市某三甲醫(yī)院老年病科、神經(jīng)內(nèi)科350例住院老年患者行問(wèn)卷調(diào)查。內(nèi)容包括社會(huì)人口學(xué)資料、跌倒史、疾病史、服藥情況、是否使用輔具、活動(dòng)情況、跌倒效能、預(yù)防跌倒的知識(shí)、態(tài)度、行為、是否害怕跌倒等。第二部分:隨機(jī)對(duì)照試驗(yàn)研究。病例來(lái)源為第一部分篩選出存在害怕跌倒(Fear of falling,FOF)的住院老年患者,納入病例104,隨機(jī)分為兩組,各52例。干預(yù)組在常規(guī)健康教育的基礎(chǔ)上結(jié)合健康信念模式及程序式健康教育模式行健康教育,分5階段進(jìn)行,第一階段:使患者意識(shí)到跌倒嚴(yán)重性及易感性,時(shí)間3天;第二階段:認(rèn)識(shí)預(yù)防跌倒健康行為的益處和采取健康行為的障礙,時(shí)間3天;第三階段:讓患者自愿采取一定的預(yù)防跌倒健康行為,協(xié)商制定個(gè)性化健康教育方案及預(yù)防跌倒的健康行為,時(shí)間3天;第四階段:讓患者自覺(jué)實(shí)踐預(yù)防跌倒行為,具備預(yù)防跌倒的自我效能,時(shí)間5天;第五階段:出院后繼續(xù)強(qiáng)化健康行為,時(shí)間3月。出院第4周、8周、12周、3月行電話或微信隨訪。各階段按程序式健康教育五步驟進(jìn)行,提供個(gè)性化健康教育。對(duì)照組采用常規(guī)健康教育方式,入院健康教育內(nèi)容和出院隨訪時(shí)間和干預(yù)組一致。3月后收集資料進(jìn)行數(shù)據(jù)統(tǒng)計(jì)。結(jié)果:1.研究對(duì)象平均年齡為75.01±8.40歲。2.有跌倒史為167名,占總?cè)藬?shù)的47.7%。3預(yù)防跌倒知識(shí)維度得分為(45.33±6.16)分,態(tài)度維度得分為(25.06±3.69)分,行為維度得分為(24.50±6.20)分,跌倒效能得分為(77.05±39.14)分,4.將影響預(yù)防跌倒知、信、行及跌倒效能的單因素結(jié)果進(jìn)入多元線性逐步回歸分析,影響跌倒知、信、行的因素為:文化程度、經(jīng)濟(jì)來(lái)源、經(jīng)濟(jì)狀況,決定系數(shù)為0.301(調(diào)整r2)。影響跌倒效能的因素為:助行器、活動(dòng)鍛煉、年齡、跌倒史、文化程度,決定系數(shù)為0.452(調(diào)整r2)。5預(yù)防跌倒知識(shí)、態(tài)度、行為與跌倒效能進(jìn)行相關(guān)性分析,預(yù)防跌倒知識(shí)、態(tài)度與跌倒效能呈正相關(guān),相關(guān)系數(shù)知識(shí)(r=0.110,p0.05,)態(tài)度(r=0.150,p0.01);6干預(yù)后,比較兩組患者預(yù)防跌倒知識(shí)、態(tài)度、行為得分,干預(yù)組明顯高于對(duì)照組,差異具有統(tǒng)計(jì)學(xué)意義(p0.01);比較兩組跌倒效能得分,干預(yù)組(modifiedfallsefficacyscale,mfes)總分高于對(duì)照組,差異有統(tǒng)計(jì)學(xué)意義(p0.01);比較兩組患者干預(yù)14天前后預(yù)防跌倒行為依從性變化,干預(yù)組依從性明顯高于對(duì)照組,差異有統(tǒng)計(jì)學(xué)意義(p0.01),比較兩組患者干預(yù)期間跌倒發(fā)生率,干預(yù)組低于對(duì)照組,差異有統(tǒng)計(jì)學(xué)意義。結(jié)論:1.住院老年患者預(yù)防跌倒的認(rèn)知不強(qiáng),跌倒效能總體水平不高。文化程度、經(jīng)濟(jì)來(lái)源、經(jīng)濟(jì)狀況是影響跌倒認(rèn)知的重要因素;是否使用助行器、活動(dòng)鍛煉、年齡、跌倒史、文化程度是影響住院老年患者跌倒效能的重要因素,活動(dòng)鍛煉、使用助行器對(duì)跌倒效能影響較大。2.雙模式健康教育可以有效提高住院老年患者跌倒的認(rèn)知及效能,提高預(yù)防跌倒行為的依從性,提高對(duì)跌倒的認(rèn)知度,預(yù)防跌倒發(fā)生,可以在臨床上進(jìn)行應(yīng)用。
[Abstract]:Objective: to know the prevention of falls in hospitalized elderly patients, investigation letter, and present fall efficacy, analysis of factors affecting the two; attitude dual mode health education mode of health education and health belief model program evaluation on prevention of falls in hospitalized elderly patients, knowledge, behavior and fall efficacy, fall prevention compliance, falls the rate of effect. Methods: This study consists of two parts. The first part: a cross-sectional study. The Department of Geriatrics, General Hospital of Chongqing city with the convenient sampling method, Department of Neurology, 350 patients in hospital by questionnaire survey. The contents include social demographic data, fall history, disease history, medication, whether the use of assistive devices, activities fall, efficiency, fall prevention knowledge, attitude, behavior, whether the fear of falling. The second part: a randomized controlled trial. All cases were first part were screened for the presence of fear of falling (Fear Of falling, FOF) of the hospitalized elderly patients, included 104 patients, were randomly divided into two groups, 52 cases in each group. The intervention group with the health belief model and the program of health education mode for health education based on routine health education, is divided into 5 stages, the first stage: to make patients aware of the severity and susceptibility to fall time, 3 days; second stages: awareness of fall prevention health behavior benefits and adopt healthy behavior disorder, 3 days; the third stage: let the patients voluntarily take certain fall prevention health behavior, consultation and individualized health education plan and fall prevention health behavior, time of 3 days; the fourth stage: let the patient conscious the practice of fall prevention behaviors, have fall prevention self-efficacy, time of 5 days after discharge; the fifth stage: continue to strengthen the health behavior, the time of March. Discharged fourth weeks, 8 weeks, 12 weeks, March WeChat phone or follow-up. According to each stage of history Order five steps to carry out health education, providing personalized health education. The control group uses the conventional health education, hospital health education content and follow-up time and intervention group consistent.3 months after collecting data for statistical data. Results: 1. subjects with an average age of 75.01 + 8.40 years.2. a history of falls was 167, accounting for the total the number of 47.7%.3 falls prevention knowledge score was (45.33 + 6.16), attitude score was (25.06 + 3.69) points, the behavior score was (24.50 + 6.20) points, scores fall efficacy (77.05 + 39.14) points, 4. will affect the fall prevention knowledge, faith, and single factor fall performance results into multiple linear stepwise regression analysis, influence of fall knowledge, letter, for factors: education, economic resources, economic conditions, the coefficient of determination was 0.301 (adjusted R2). For the factors influencing the effectiveness of the fall: walker, exercise, age, history of fall, The cultural degree, the coefficient of determination was 0.452 (R2).5 fall prevention knowledge, attitude, behavior and fall efficacy correlation analysis, fall prevention knowledge, attitude and fall efficacy was positively related to the correlation coefficient of knowledge (r=0.110, P0.05) (r=0.150, P0.01); attitude 6 intervention, compared two groups of patients fall prevention knowledge, attitude, behavior scores, the intervention group was significantly higher than the control group, the difference was statistically significant between the two groups (P0.01); fall efficacy score, the intervention group (modifiedfallsefficacyscale, MFEs) score higher than the control group, the difference was statistically significant (P0.01); the intervention of two groups were compared before and after 14 days of fall prevention compliance changes, intervention group compliance was significantly higher than the control group, the difference was statistically significant (P0.01), compared between the two groups during the intervention in patients with the incidence of falls, the intervention group was lower than that of the control group, the difference was statistically significant. Conclusions: 1. hospitalized elderly patients Fall prevention awareness is not strong, the overall level of efficiency is not high. The fall culture degree, economic resources, economic situation is an important factor affecting the fall of cognition; whether to use walkers, exercise, age, history of falls, cultural level is an important factor of falls among hospitalized elderly patients, the effectiveness of exercise, use walking aid for larger fall efficacy.2. dual mode of health education can effectively improve the efficiency of cognition and hospitalization falls in elderly patients, improve prevention compliance fall behavior, improve the fall awareness, fall prevention, and can be used in clinic.

【學(xué)位授予單位】：重慶醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R473

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