【摘要】：目的:本研究旨在探索符合我省現(xiàn)狀的延續(xù)護(hù)理健康教育方式,制定并且實(shí)施腦卒中患者延續(xù)護(hù)理干預(yù)方案,對(duì)腦卒中出院患者實(shí)施微信平臺(tái)、電話隨訪結(jié)合家庭隨訪的延續(xù)性護(hù)理干預(yù);通過描述兩組腦卒中患者從出院前到出院后6周及3個(gè)月對(duì)疾病知識(shí),態(tài)度及行為的變化;探討改善患者健康行為的可能性,對(duì)延續(xù)護(hù)理模式提供相應(yīng)依據(jù)。方法:1.本研究從某三級(jí)甲等醫(yī)院神經(jīng)內(nèi)科選取110例首次發(fā)病的腦卒中患者,采用隨機(jī)數(shù)字表法將其分為對(duì)照組(55例)和干預(yù)組(55例),對(duì)照組實(shí)行神經(jīng)內(nèi)科患者常規(guī)出院指導(dǎo),在患者出院前2天進(jìn)行健康宣教。干預(yù)組的患者除了接受神經(jīng)內(nèi)科常規(guī)護(hù)理以外,以“4C延續(xù)護(hù)理理論”為基礎(chǔ),采取出院前護(hù)理結(jié)合出院后護(hù)理的護(hù)理方案。干預(yù)方案以中華醫(yī)學(xué)會(huì)神經(jīng)病學(xué)分會(huì)制定的《中國腦卒中康復(fù)治療指南》為標(biāo)準(zhǔn),內(nèi)容主要涉及疾病基本知識(shí)、藥物服用、生活起居,飲食運(yùn)動(dòng)、康復(fù)鍛煉等。具體由研究員于患者出院前2天對(duì)其進(jìn)行疾病相關(guān)知識(shí)及健康行為等方面進(jìn)行專門指導(dǎo),并且在其出院后每周通過微信平臺(tái)發(fā)送腦卒中保健知識(shí),并在線為患者解答疑惑;每2周進(jìn)行一次電話訪問,為患者提供及時(shí)反饋的機(jī)會(huì),強(qiáng)化患者需掌握的疾病相關(guān)的知識(shí)和技能;每3周進(jìn)行一次家庭隨訪,通過與患者面對(duì)面進(jìn)行訪問溝通,對(duì)其生活行為方式進(jìn)行面對(duì)面指導(dǎo)。2.研究者在患者出院時(shí)、干預(yù)后6周以及干預(yù)后3個(gè)月,采用《腦卒中知識(shí)問卷》、《慢性病管理自我效能量表》和《腦卒中患者自我管理行為評(píng)定表》對(duì)腦卒中患者的知識(shí)、態(tài)度及行為的變化進(jìn)行相應(yīng)評(píng)價(jià)。3.收集到的數(shù)據(jù)采用SPSS17.0軟件對(duì)數(shù)據(jù)進(jìn)行處理,采用兩獨(dú)立樣本t檢驗(yàn),配對(duì)t檢驗(yàn)、重復(fù)測(cè)量方差分析等統(tǒng)計(jì)學(xué)方法進(jìn)行分析。結(jié)果:1.比較兩組患者的基本資料,差異無明顯統(tǒng)計(jì)學(xué)意義。(P=0.759)。2.患者出院時(shí)、干預(yù)后6周和干預(yù)后3個(gè)月時(shí),統(tǒng)計(jì)對(duì)照組和干預(yù)組的患者知信行問卷的總體得分,數(shù)據(jù)結(jié)果顯示相對(duì)于對(duì)照組,干預(yù)組的總分升高趨勢(shì)比較明顯,兩者的差異有明顯的統(tǒng)計(jì)學(xué)意義。(P0.05)。3.兩組患者在出院時(shí)、干預(yù)后6周、干預(yù)后3個(gè)月時(shí),患者腦卒中知識(shí)、慢性病管理自我效能、自我管理行為各部分得分均有所提高(P0.05)。相對(duì)于對(duì)照組,干預(yù)組患者得分升高趨勢(shì)更加明顯。而且同一時(shí)間點(diǎn)相比干預(yù)組在干預(yù)后6周、干預(yù)后3個(gè)月腦卒中知信行問卷總體得分均高于對(duì)照組(P0.05)。結(jié)論:采用微信平臺(tái)、電話隨訪、家庭隨訪的延續(xù)護(hù)理干預(yù)方式改善腦卒中患者的知信行水平是有效的。該方式能夠明顯地提高腦卒中患者對(duì)疾病知識(shí)的認(rèn)識(shí)水平,一定程度上改正患者平日生活中不當(dāng)?shù)男袨榉绞?可以有效的督促患者采用積極的功能鍛煉方法。另一方面還可以還以提高患者康復(fù)鍛煉的依從性,對(duì)于臨床工作的護(hù)理工作以及社區(qū)護(hù)理工作者有一定的參考意義。
[Abstract]:Objective: the purpose of this study was to explore the mode of continuous nursing and health education in accordance with the present situation of our province, to formulate and implement the intervention scheme of continuous nursing for stroke patients, and to implement the WeChat platform for stroke discharged patients. Telephone follow-up combined with continuous nursing intervention in family follow-up; By describing the changes of knowledge attitude and behavior of stroke patients from 6 weeks and 3 months after discharge to explore the possibility of improving patients' health behavior and provide the corresponding basis for continuing nursing mode. Methods: 1. In this study, 110 first-onset stroke patients were selected from neurology department of a certain Grade 3A hospital. They were divided into control group (55 cases) and intervention group (55 cases) by random number table method. The control group was given routine discharge guidance for patients in neurology department. Health education was conducted 2 days before discharge. In the intervention group, in addition to the routine nursing care in neurology department, the pre-discharge nursing combined with post-discharge nursing was adopted on the basis of "4C continuous nursing theory". The intervention program is based on the guidelines for Rehabilitation treatment of Stroke made by the Neurology Branch of the Chinese Medical Association. The main contents are related to the basic knowledge of the disease, drug use, daily living, diet and exercise, rehabilitation exercise, and so on. Specifically, the researcher gave specific guidance to patients about disease related knowledge and health behavior two days before discharge, and sent out stroke health care knowledge through WeChat every week after discharge, and answered patients' questions online. Telephone interviews are conducted every two weeks to provide patients with opportunities for timely feedback and to enhance the knowledge and skills they need to master about diseases; Family follow-up every 3 weeks, through face-to-face interviews with patients, face to face guidance on their lifestyle. 2. 2. At the time of discharge, 6 weeks after intervention and 3 months after intervention, the researchers used the stroke knowledge questionnaire, the chronic disease management self-efficacy scale and the self-management behavior assessment table of stroke patients. The change of attitude and behavior should be evaluated accordingly. 3. The collected data were processed by SPSS17.0 software. Two independent samples t-test, paired t-test, repeated measurement variance analysis and other statistical methods were used to analyze the data. Results: 1. There was no significant difference in basic data between the two groups (P0. 759). At the time of discharge, 6 weeks after the intervention and 3 months after the intervention, the total scores of the patients in the control group and the intervention group were statistically analyzed. The results showed that the total score of the intervention group was significantly higher than that of the control group. The difference was statistically significant (P0.05). At the time of discharge, 6 weeks after intervention and 3 months after intervention, the scores of stroke knowledge, chronic disease management self-efficacy and self-management behavior were improved in both groups (P0.05). Compared with the control group, the intervention group patients increased the trend of more obvious score. At the same time, compared with the intervention group at 6 weeks after intervention, 3 months after intervention, the overall scores of the questionnaire were higher than those of the control group (P0.05). Conclusion: continuous nursing intervention with WeChat platform, telephone follow-up and family follow-up is effective in improving the level of knowledge and practice in stroke patients. This way can obviously improve the knowledge level of stroke patients, correct the improper behavior of patients in their daily life to a certain extent, can effectively urge the patients to adopt the positive functional exercise method. On the other hand, it can also improve the compliance of patients with rehabilitation exercise, which has certain reference significance for clinical nursing work and community nursing workers.
【學(xué)位授予單位】：山西醫(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)】：R473.74

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