本文選題：癡呆 + 護(hù)士培訓(xùn)�。� 參考：《第三軍醫(yī)大學(xué)》2017年碩士論文

【摘要】：目的:伴隨著老齡化問題的加劇老年癡呆病人正逐年增多,其應(yīng)對(duì)形勢(shì)變得日趨嚴(yán)峻。世界阿爾茨海默病協(xié)會(huì)近年來(lái)多次在其年度報(bào)告中呼吁全世界關(guān)注癡呆的早期篩查、風(fēng)險(xiǎn)控制和消除歧視等問題,并指出社區(qū)將是癡呆預(yù)防及干預(yù)的主戰(zhàn)場(chǎng)。社區(qū)護(hù)士在癡呆早期篩查、診斷及癡呆病人的照護(hù)中均扮演著重要角色,但多數(shù)人并沒有通過(guò)正規(guī)課程學(xué)習(xí)掌握相關(guān)的技能,護(hù)士們不知道如何協(xié)助醫(yī)生開展癡呆高風(fēng)險(xiǎn)人群的早期篩查診斷工作和協(xié)助指導(dǎo)家庭照護(hù)者為癡呆病人提供更好的照護(hù)。特別是在我國(guó)老年護(hù)理專業(yè)課程體系建設(shè)尚不完善的情形下,這一情況尤為突出并亟待改善。本研究擬設(shè)計(jì)一項(xiàng)適用于本地區(qū)社區(qū)護(hù)士的癡呆護(hù)理專項(xiàng)培訓(xùn)項(xiàng)目,評(píng)估其對(duì)社區(qū)護(hù)士的癡呆相關(guān)知識(shí)、態(tài)度和早期篩查診斷意識(shí)的影響。方法:以隨機(jī)數(shù)字法的抽樣方式從重慶市沙坪壩區(qū)23個(gè)社區(qū)衛(wèi)生服務(wù),中心選取4個(gè)社區(qū),隨機(jī)分為對(duì)照組和干預(yù)組并實(shí)施干預(yù)培訓(xùn)。干預(yù)組接受癡呆護(hù)理專項(xiàng)培訓(xùn),對(duì)照組接受其他護(hù)理知識(shí)的面授培訓(xùn)。分別于干預(yù)前(T1)、干預(yù)后2周(T2)和干預(yù)后3個(gè)月(T3)對(duì)兩組進(jìn)行測(cè)評(píng)。研究對(duì)象的癡呆相關(guān)知識(shí)測(cè)評(píng)采用阿爾茨海默病知識(shí)量表(Alzheimer's Disease Knowledge Scale,ADKS)和癡呆知識(shí)量表(Dementia Knowledge Assessment Tool Version 2,DKAT2);研究對(duì)象的癡呆相關(guān)態(tài)度測(cè)評(píng)采用癡呆態(tài)度量表(Dementia Attitudes Scale,DAS);以自設(shè)的一個(gè)半開放式問題在干預(yù)前(T1)和干預(yù)后3個(gè)月(T3)測(cè)評(píng)研究對(duì)象對(duì)癡呆高風(fēng)險(xiǎn)人群的早期篩查診斷意識(shí);在干預(yù)后2周(T2)和干預(yù)后3個(gè)月(T3)運(yùn)用自制滿意度問卷測(cè)評(píng)干預(yù)組對(duì)培訓(xùn)的滿意度,并以一個(gè)開放式問題測(cè)評(píng)干預(yù)組對(duì)培訓(xùn)的評(píng)價(jià)和改進(jìn)建議。采用SPSS 19.0對(duì)數(shù)據(jù)進(jìn)行描述性分析、?2檢驗(yàn)、獨(dú)立樣本t檢驗(yàn)、非參數(shù)Mann-Whitney U秩和檢驗(yàn)和重復(fù)測(cè)量方差分析。檢驗(yàn)水準(zhǔn)為P㩳0.05。結(jié)果:本研究初始共入組社區(qū)護(hù)士115人,失訪了14人,最終有效人數(shù)101例,有效率87.8%,其中干預(yù)組49人,對(duì)照組52人。1.社區(qū)護(hù)士癡呆相關(guān)知識(shí)、態(tài)度和癡呆早期篩查診斷意識(shí)的現(xiàn)狀101名護(hù)士的ADKS得分為(19.36±2.40)分,得分較低的維度是“癥狀”、“癡呆照料”和“危險(xiǎn)因素”,分別為(2.16±1.00)分、(2.77±0.94)分、(3.57±1.10)分。DKAT2得分為(15.17±2.57)分。DAS得分為(88.78±12.75)分,其分維度“社會(huì)舒適度”和“癡呆知識(shí)”得分分別為(37.52±8.11)分、(51.26±10.76)分。對(duì)主觀記憶抱怨人群的處理方式中,有33.7%的護(hù)士選擇“建議找�？漆t(yī)生會(huì)診”,有27.7%和13.9%的護(hù)士選擇“建議做簡(jiǎn)易認(rèn)知篩查”和“為病人做簡(jiǎn)易認(rèn)知篩查”,有高達(dá)24.8%的護(hù)士選擇“安慰病人”和“忽視/轉(zhuǎn)移話題”。兩組人員在癡呆相關(guān)知識(shí)、態(tài)度和癡呆,早期篩查診斷意識(shí)方面的得分差異,無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。2.癡呆護(hù)理專項(xiàng)在職培訓(xùn)的效果評(píng)價(jià)(1)采用重復(fù)測(cè)量方差分析顯示,干預(yù)組ADKS得分高于對(duì)照組,其差異有統(tǒng)計(jì)學(xué)意義(F=96.10,P0.001),兩組對(duì)象的ADKS得分隨時(shí)間變化的差異有統(tǒng)計(jì)學(xué)意義(F=81.61,P0.001),分組和,時(shí)間,兩因素有交互作用(F=48.95,P0.001)。兩組的ADKS基線值得分不存在統(tǒng)計(jì)學(xué)差異(P㧐0.05),但干預(yù)后進(jìn)一步進(jìn)行t檢驗(yàn)顯示在T2和T3時(shí)間點(diǎn),干預(yù)組ADKS得分高于對(duì)照組(t=11.80,P0.001;t=10.09,P0.001)。采用重復(fù)測(cè)量方差分析顯示,干預(yù)組DKAT2得分高于對(duì)照組,其差異有統(tǒng)計(jì)學(xué)意義(F=47.10,P0.001),兩組對(duì)象的DKAT2得分隨時(shí)間變化的差異有統(tǒng)計(jì)學(xué)意義(F=19.87,P0.001),分組和時(shí)間,兩因素有交互作用(F=16.52,P0.001)。兩組的DKAT2基線值得分不存在統(tǒng)計(jì)學(xué)差異(P㧐0.05),但干預(yù)后進(jìn)一步進(jìn)行t檢驗(yàn)顯示在T2和T3時(shí)間點(diǎn),干預(yù)組DKAT2得分高于對(duì)照組(t=7.79,P0.001;t=6.77,P0.001)。(2)采用重復(fù)測(cè)量方差分析顯示,干預(yù)組DAS得分高于對(duì)照組,其差異有統(tǒng)計(jì)學(xué)意義(F=52.40,P0.001),兩組對(duì)象的DAS得分隨時(shí)間變化的差異有統(tǒng)計(jì)學(xué)意義(F=25.07,P0.001),分組和時(shí)間兩因素有交互作用(F=26.05,P0.001)。兩組的DAS基線值得分不存在統(tǒng)計(jì)學(xué)差異(P㧐0.05),但干預(yù)后進(jìn)一步進(jìn)行t檢驗(yàn)顯示在T2和T3時(shí)間點(diǎn),干預(yù)組DAS得分高于對(duì)照組(t=7.90,P0.001;t=7.91,P0.001)。(3)培訓(xùn)干預(yù)前,兩組對(duì)象的癡呆早期篩查診斷意識(shí)無(wú)顯著性差異(P㧐0.05),干預(yù)后3個(gè)月經(jīng)獨(dú)立樣本t檢驗(yàn)顯示,兩組人員處理主觀記憶抱怨人群時(shí),干預(yù)組選擇“建議病人進(jìn)行認(rèn)知篩查”或“為病人進(jìn)行認(rèn)知篩查”的比率多于對(duì)照組,組間差異具有統(tǒng)計(jì)學(xué)意義(P=0.044;P=0.004)。(4)培訓(xùn)后,干預(yù)組對(duì)本項(xiàng)目的滿意度較高,干預(yù)后2周對(duì)問卷各條目的滿意度均超過(guò)91.8%;干預(yù)后3個(gè)月對(duì)問卷各條目的滿意度均超過(guò)89.8%。結(jié)論:本研究顯示,癡呆護(hù)理專項(xiàng)培訓(xùn)可以有效改善社區(qū)護(hù)士癡呆相關(guān)知識(shí)和態(tài)度,并且可以提高其對(duì)癡呆高風(fēng)險(xiǎn)人群的早期篩查診斷意識(shí)。除此之外,社區(qū)護(hù)士對(duì)本項(xiàng)目的滿意度較高,表明本項(xiàng)目具有一定的可行性并且接受度較高。
[Abstract]:Objective: the increase of Alzheimer's disease is increasing year by year with the aging problem, and its response to the situation is becoming increasingly severe. In recent years, the world Alzheimer's Association has repeatedly called for worldwide attention to the early screening of dementia, risk control and elimination of discrimination, and points out that the community will be the prevention and intervention of dementia. Community nurses play an important role in early dementia screening, diagnosis and care for dementia patients, but most people do not learn the related skills through regular courses. Nurses don't know how to assist doctors in early screening and diagnosis of high risk dementia people and help guide family caregivers to be dementia. This situation is particularly prominent and urgent to improve. This study intends to design a special training program for dementia care for community nurses in the region to assess the knowledge, attitude and early screening of dementia in community nurses. Methods: 23 community health services in Shapingba District of Chongqing were selected by random number method, and 4 communities were selected from the center of Chongqing city. The control group was randomly divided into control group and intervention group, and intervention training was carried out. The intervention group received special training for dementia nursing and the control group received other nursing knowledge training. T1), 2 weeks (T2) and 3 months after intervention (T3) were used to evaluate the two groups. The dementia related knowledge of the subjects was evaluated by the Alzheimer's disease knowledge scale (Alzheimer's Disease Knowledge Scale, ADKS) and the dementia knowledge scale (Dementia Knowledge Assessment Tool 2). The Dementia Attitudes Scale (DAS) was used to examine the early screening diagnostic awareness of the subjects with high risk of dementia before the 1.5 open questions (T1) and 3 months after intervention (T3), and the intervention group was assessed by the self-made satisfaction questionnaire after 2 weeks of intervention (T2) and 3 months after intervention (T3). The evaluation and improvement proposal of the intervention group on an open question. The data were analyzed with SPSS 19, 2 test, independent sample t test, non parameter Mann-Whitney U rank sum test and repeated measurement variance analysis. The test level was P? 0.05. results: 115 community nurses in the initial co entry group were lost to visit. 14, the final effective number of 101 cases, the effective 87.8%, 49 of the intervention group, the control group of 52.1. community nurses with dementia related knowledge, attitude and the status of early screening diagnosis of dementia in 101 nurses score (19.36 + 2.40) scores, the lower scores are "symptoms", "dementia care" and "risk factors", respectively (2). The score of.16 + 1), (2.77 + 0.94), (3.57 + 1.10) and (15.17 + 2.57) score was (15.17 + 2.57).DAS score (88.78 + 12.75), and the scores of "social comfort" and "dementia knowledge" were (37.52 + 8.11) scores, respectively (37.52 + 8.11), and (51.26 + 10.76) points. 27.7% and 13.9% of the nurses chose "simple cognitive screening" and "simple cognitive screening for patients". Up to 24.8% of the nurses chose "comfort patients" and "neglect / transfer topics". The two groups had differences in dementia related knowledge, attitude and dementia, and early screening diagnostic awareness. Evaluation of the effect of P0.05.2. dementia nursing special on-the-job training (1) repeated measurement of variance analysis showed that the score of ADKS in the intervention group was higher than that of the control group, and the difference was statistically significant (F=96.10, P0.001). The difference of the ADKS score with time was statistically significant (F=81.61, P0.001), group and time, and two factors had two factors. Interaction (F=48.95, P0.001). The ADKS baseline of the two groups was worth no statistical difference (P? 0.05), but further t test showed that the score of ADKS in the intervention group was higher than that of the control group (t=11.80, P0.001; t=10.09, P0.001). The difference between the intervention group and the control group was higher than that of the control group. The difference between the intervention group and the control group was higher than the control group. There were statistically significant (F=47.10, P0.001), the DKAT2 scores of the two groups were statistically significant (F=19.87, P0.001), group and time, and the two factors had interaction (F=16.52, P0.001). The two groups of DKAT2 baselines were worthy of no statistical difference (P? 0.05), but further t test showed in T2 and T3 time points, The score of DKAT2 in the intervention group was higher than that of the control group (t=7.79, P0.001; t=6.77, P0.001). (2) the repeated measurement of variance analysis showed that the score of DAS in the intervention group was higher than that of the control group, and the difference was statistically significant (F=52.40, P0.001). The difference of the DAS score of the two groups was statistically significant (F=25.07, P0.001), and the two factors of grouping and time were interactive. The effect (F=26.05, P0.001). The DAS baseline of the two groups was worth no statistical difference (P? 0.05), but further t test showed that the score of DAS in the intervention group was higher than that of the control group (t=7.90, P0.001; t=7.91, P0.001). (3) before the training intervention, there was no significant difference in the awareness of the early diagnosis of dementia in the two groups (0.05). After the intervention, the t test of 3 menstrual independent samples showed that the ratio of the intervention group was more than the control group when the two groups were dealing with the subjective memory complaints. The difference was statistically significant (P=0.044; P=0.004). (4) after training, the intervention group was satisfied with the project. The degree of satisfaction of all the items of the questionnaire over 2 weeks was more than 91.8%, and the satisfaction of all the items in the 3 months after the intervention was more than 89.8%. conclusion: This study showed that the special training of dementia nursing can effectively improve the knowledge and attitude of dementia in community nurses and can improve their early screening for people with high risk of dementia. Apart from this, the satisfaction of community nurses to this project is higher, indicating that this project is feasible and acceptable.
【學(xué)位授予單位】：第三軍醫(yī)大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R473.2

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