本文選題：跨理論模型 + 協(xié)同護(hù)理　； 參考：《青島大學(xué)》2017年碩士論文

【摘要】：目的本研究旨在探討基于跨理論模型的協(xié)同護(hù)理模式對老年冠心病患者生活質(zhì)量、自我效能、體適能和臨床指標(biāo)變化水平的影響;探討適合老年冠心病患者運(yùn)動(dòng)康復(fù)訓(xùn)練行為改變的干預(yù)模式,評價(jià)其對老年冠心病患者心臟康復(fù)的干預(yù)效果,為進(jìn)一步發(fā)展和完善心臟康復(fù)程序提供參考。方法本研究采用便利抽樣的方法選取2015年12月至2016年6月在青島某三級(jí)甲等醫(yī)院心內(nèi)科住院的老年冠心病患者,按照入院時(shí)間的先后順序?qū)颊哌M(jìn)行統(tǒng)一編號(hào),其中奇數(shù)為對照組,偶數(shù)為干預(yù)組。對照組患者采用常規(guī)護(hù)理措施,干預(yù)組患者實(shí)施基于跨理論模型的協(xié)同護(hù)理模式,根據(jù)制定的心臟康復(fù)計(jì)劃給予患者與各個(gè)行為變化階段相對應(yīng)的護(hù)理干預(yù)措施。分別收集了兩組患者在出院前、出院后3個(gè)月、6個(gè)月三個(gè)時(shí)間點(diǎn)的資料,包括一般資料、CQQC量表、自我效能量表、六分鐘步行試驗(yàn)、行為改變階段評估量表和Borg量表,并通過測量老年患者的體適能和生理指標(biāo)的變化水平來評價(jià)其干預(yù)效果。所有數(shù)據(jù)采用SPSS17.0錄入及分析,統(tǒng)計(jì)方法有t檢驗(yàn)、卡方檢驗(yàn)、秩和檢驗(yàn)及重復(fù)方差分析。結(jié)果1老年冠心病患者的自我效能在干預(yù)后明顯提升(t=-7.097,P0.05),差異具有統(tǒng)計(jì)學(xué)意義。CQQC量表中病情狀況、一般生活、社會(huì)心理、工作情況這四個(gè)維度的得分在干預(yù)后明顯增加,具有顯著性差異(P0.05)。2干預(yù)組運(yùn)動(dòng)行為改變階段的人數(shù)和對照組相比,差異具有統(tǒng)計(jì)學(xué)意義(P0.05),在干預(yù)6個(gè)月以后處于運(yùn)動(dòng)的行動(dòng)和維持階段的人數(shù)比例分別為45.1%和29.4%,而對照組的人數(shù)比例為18.9%和15.1%。3干預(yù)后患者的體適能指標(biāo)中,運(yùn)動(dòng)耐力、上肢肌力、下肢肌力及身體的靈活性改善較為顯著,重復(fù)方差分析顯示存在交互效應(yīng)(P0.05),而患者的上肢柔韌性、下肢柔韌性改善效果不明顯(P0.05)。干預(yù)后患者的生理指標(biāo)中,重復(fù)方差分析顯示體重指數(shù)、總膽固醇、收縮壓、舒張壓的時(shí)間和組別之間存在著交互效應(yīng),干預(yù)組的改善情況優(yōu)于對照組,差異具有統(tǒng)計(jì)學(xué)意義(P0.05)。4在患者的生活方式比較中,患者在干預(yù)后3個(gè)月、6個(gè)月,干預(yù)組吸煙率低于對照組,差異具有統(tǒng)計(jì)學(xué)意義(P0.05),在吸煙數(shù)量上,干預(yù)組在干預(yù)后的各時(shí)間點(diǎn)的改善情況和干預(yù)前相比較為顯著。兩組患者的運(yùn)動(dòng)參與情況、運(yùn)動(dòng)的頻率和時(shí)間在干預(yù)后3個(gè)月、6個(gè)月均有顯著性差異(P0.05),干預(yù)組的運(yùn)動(dòng)情況較對照組顯著改善,患者的運(yùn)動(dòng)依從性良好。結(jié)論1基于TTM的協(xié)同護(hù)理模式和常規(guī)護(hù)理干預(yù)均有助于改善老年冠心病患者的生活質(zhì)量、一般自我效能,但前者的改善效果優(yōu)于后者。2基于TTM的協(xié)同護(hù)理模式保證了老年冠心病患者康復(fù)治療的依從性,改善了患者的體適能和生理指標(biāo)。3基于TTM的協(xié)同護(hù)理模式增強(qiáng)了患者戰(zhàn)勝疾病的信心,提高老年冠心病患者疾病自我管理能力和疾病的應(yīng)對能力,促進(jìn)了患者的康復(fù)。4基于TTM的協(xié)同護(hù)理模式優(yōu)于傳統(tǒng)的常規(guī)宣教和護(hù)理,值得進(jìn)一步堅(jiān)持與完善。
[Abstract]:The purpose of this study is to explore the effect of the cooperative nursing mode based on the cross theoretical model on the quality of life, self-efficacy, physical fitness and the change of clinical indicators in elderly patients with coronary heart disease, and to explore the intervention mode suitable for the behavior changes of exercise rehabilitation training for elderly patients with coronary heart disease and to evaluate the intervention of the intervention on the heart rehabilitation of the elderly patients with coronary heart disease. The effect is to provide reference for further development and improvement of cardiac rehabilitation program. Methods this study adopted convenient sampling method to select the elderly patients in the Department of Cardiology of a class three grade a hospital of Qingdao from December 2015 to June 2016. The patients were numbered according to the order of admission time. The odd number was the control group. The control group was given the intervention group. The patients in the control group were treated with routine nursing measures. The patients in the intervention group carried out a cooperative nursing model based on the cross theory model. The patients were given the corresponding nursing interventions according to the established cardiac rehabilitation program. Two groups of patients were collected before discharge, 3 months after discharge, and 6 months and three months after discharge. The data, including the general data, the CQQC scale, the self-efficacy scale, the six minute walk test, the behavioral change stage assessment scale and the Borg scale, were used to evaluate the intervention effect by measuring the level of physical fitness and physiological changes of the elderly patients. All data were recorded and analyzed by SPSS17.0, and the statistical method had t test and chi square test. Results 1 the self-efficacy of 1 elderly patients with coronary heart disease increased significantly after intervention (t=-7.097, P0.05). The difference was statistically significant in the.CQQC scale, and the scores of the four dimensions of general life, social psychology and work were significantly increased after intervention, with significant difference (P0.05).2 intervention group. The number of people in the stage of exercise change was statistically significant compared with the control group (P0.05). The proportion of people in the movement and maintenance stage after 6 months of intervention was 45.1% and 29.4% respectively, while the proportion of the control group was 18.9% and the body fitness index of the patients with the prognosis of 15.1%.3, exercise endurance, upper limb muscle strength, lower limbs. The flexibility of the muscle and body was improved significantly. The repeated variance analysis showed that there was an interaction effect (P0.05), while the patient's upper limb was flexible and the lower limb flexibility improved (P0.05). In the physiological indexes of the patients after intervention, the repeated variance analysis showed that the body mass index, total cholesterol, systolic pressure, diastolic pressure time and group existed between the patients. In the interaction effect, the improvement of the intervention group was better than the control group, the difference was statistically significant (P0.05).4 in the patient's lifestyle comparison, 3 months after intervention, 6 months after intervention, the smoking rate in the intervention group was lower than the control group, the difference was statistically significant (P0.05). In the number of smoking, the intervention group was improved at each time point of the intervention. The movement participation of two groups of patients, the frequency and time of exercise were significantly different in the 3 months after intervention and 6 months after intervention (P0.05). The exercise situation in the intervention group was significantly better than that in the control group, and the compliance of the patients was good. Conclusion the cooperative nursing mode based on the TTM based cooperative nursing and the routine nursing intervention were helpful. The quality of life and general self-efficacy of elderly patients with coronary heart disease were improved, but the improvement effect of the former was better than that of the latter.2 based cooperative nursing model based on TTM, which ensured the compliance of the elderly patients with coronary heart disease, improved the physical fitness and physiological index of the patients, and enhanced the confidence of the patients to overcome the disease based on the cooperative nursing model of TTM based on.3. The ability of self management of disease and the ability to cope with disease in elderly patients with coronary heart disease have promoted the recovery of patients' rehabilitation.4 based on TTM based cooperative nursing mode, which is better than traditional routine education and nursing. It is worth further insisting and improving.
【學(xué)位授予單位】：青島大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R473.5

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