健康教育路径单在手术患者健康教育中的应用体会

护理健康教育是一种以患者的健康为中心的新型护理模式,是整体护理的核心;但受护士、患者和环境等多种因素的影响。本文介绍我科自2010年起使用健康教育路径单用于指导护士进行健康教育,取得了良好的效果。     

全程健康教育在青光眼患者中的应用

青光眼是我国四大致盲眼病之一,为终生携带的疾病,从患者入院、住院、出院前、出院后等各个阶段的连续性教育,开展全程、综合、重点相结合的健康教育,提高了患者的知、信、行,可使医、护、患三者建立良好关系,达到提高自我保健、准确用药的目的。本文就我科50例青光眼患者应用全程健康教育的体会报告如下。     

健康教育在高血压患者护理中的应用分析

目的 综合分析健康教育在高血压患者护理中的应用。方法 选取我院在2011年1月~2013年1月接诊的80例高血压患者,随机分为对照组和观察组,每组40例。两组采用同样的药物治疗方案,对照组进行常规护理,观察组的健康教育则更加细致化、更加多样化。观察两组患者出院1年后治疗总有效率,出院时及出院后1年血压及体质量指数,出院1年中再入院情况。结果 出院1年后,观察组治疗总有效率为95.00%,高于对照组的80.00%,差异具有统计学意义（P＜0.05）;对照组血压、BMI较出院时均有所升高,观察组血压、BMI较出院时均有所下降;观察组血压和BMI均低于对照组,差异具有统计学意义（P＜0.05）。出院1年中,对照组患者再入院例次高于观察组,差异具有统计学意义（P＜0.05）。结论 多样化、细致化的健康教育对高血压患者产生了较大影响,对高血压患者的治疗是有效的,对高血压的预防是非常必要的,值得在临床进行长期推广和应用。     

健康教育在骨科患者的应用经验总结

健康教育是一门研究、传播保健知识和技术、影响个体和群体行为、消除危险因素及预防疾病、促进健康的科学。医院开展健康教育的目的是在患者住院过程中，通过一系列教育，使患者了解自身疾病及掌握康复保健知识。至2005年以来，我们在骨科病房开展了健康教育工作，受到了医生、患者及家属的肯定。现就我科开展健康教育工作体会报告如下。     

抑郁症患者睡眠信念与前瞻性记忆的相关性

目的:探讨抑郁症患者睡眠信念及其与前瞻性记忆的关系。方法:采用简式睡眠个人信念和态度量表(DBAS-16)、基于事件前瞻性记忆(EBPM)和基于时间前瞻性记忆(TBPM)测试、汉密尔顿焦虑量表(HAMA)和汉密尔顿抑郁量表(HAMD)对44例发作期的抑郁症患者和32例正常对照组进行评估。结果:抑郁症组DBAS-16总分及其后果、担忧、药物因子得分,以及EBPM和TBPM得分均低于对照组(Z=-4.206,-3.895,-4.755,-3.036,-2.266;P0.01)差异有统计学意义。相关分析显示,抑郁症患者DBAS-16总分(r=0.354,P0.05)及其后果(r=0.350,0.05)和担忧(r=0.365,P0.05)因子分与EBPM得分呈正相关,而DBAS-16得分与TBPM得分间无相关性。以HAMD和HAMA总分为协变量的偏相关分析显示,DBAS-16得分与EBPM得分间的相关性不再具统计学意义(P0.05)。结论:抑郁症患者存在较多错误的睡眠信念和态度以及前瞻性记忆的损害,并且患者功能性失调信念与基于事件的前瞻性记忆损害存在相关,但这种关联性受负性情绪的影响。     

人文关怀在发热患者健康教育中的应用

目的 探讨人文关怀在发热患者健康教育中的重要作用.方法 将100例住院发热患者分为对照组50例和观察组50例,对照组给予常规护理,观察组在此基础上实施人文关怀护理.应用降温效果、患者的心理状况、护理工作满意度3组指标对干预效果进行评价.结果 两组患者降温效果、患者心理状况、护理工作满意度存在显著性差别(P<0.05).结论 人文关怀护理能够改善患者的紧张焦虑情绪,使患者更有效地配合护理工作,达到降温效果,同时提高护理工作满意度.     

PDCA在病房患者健康教育中的运用

目的：观察PDCA循环在病房健康教育的应用效果。方法将200例患者随机分为观察者和对照组各100例,对照组采用口头随机讲解的常规入院教育护理,实验组在此基础上实施PDCA循环形式的对患者健康教育干预。结果实验组在健康教育覆盖率,患者对健康教育内容的知晓率,护士掌握健康教育处方掌握情况,与对照组相比具有显著的差异性。结论应用PDCA循环在病房患者健康教育效果好,能保证护理质量可持续提高。     

社会与情绪健康量表在中国中学生中的验证

目的:引进国外最新的积极心理品质(共同生命力)的理论模型和测量工具(社会与情绪健康量表,SEHS),初步检验其在中国中学生群体中的适宜性。方法:在四川省和河北省选取四所中学17个班级共726名中学生,采用计算机课上老师监督学生完成网上问卷调查(包括SEHS和主观幸福感量表),并收集学生的学业成绩。结果:社会与情绪健康量表的项目质量较好;验证性因素分析结果表明数据较好地拟合了共同生命力的二阶模型;共同生命力显著预测中学生主观幸福感和学业成绩;总量表的内部一致性α系数为0.923,四周后重测信度系数为0.803。结论:SEHS具有较好的信效度,可以作为测量中国中学生积极心理品质—社会与情绪健康的适宜工具。     

性态度量表中文版在中国青少年中应用的信效度检验

目的:检验性态度量表中文版(Attitudes Toward Sexuality Scale,ATSS)在中国青少年人群中应用的信度和效度。方法:用ATSS中文版对697名12-19岁的青少年施测。在所有样本中抽取100人间隔2个月实施重测。另筛查出53名已经发生过无保护性行为的青少年进行测试。同时测查了青春期性心理健康量表、青少年健康相关危险行为问卷(AHBRI)、Barratt冲动量表(BIS)以及美国CDC青少年危害健康监测系统(YRBSS)无保护性行为分量表,进行效标效度的验证。结果:ATSS中文版总分的Cronbach’sα系数为0.72;重测信度为0.86;条目间平均相关系数为0.17;已发生过无保护性行为的青少年ATSS总分高于普通青少年。验证性因子分析显示:一阶单因子模型的拟合指标最好,各拟合指标分别为x2/df=4.54,CFI=0.91,NFI=0.89,TLI=0.90,IFI=0.92,GFI=0.93,AGFI=0.90,RMSEA=0.07。ATSS中文版总分与青春期性心理健康量表总分及性观念、性态度因子的Pearson相关系数分别为0.16、0.29和-0.35;与AHBRI总分和无保护性行为分量表的相关系数分别为0.32和0.19;与BIS中文版总分的相关系数为0.24;与YRBSS无保护性行为分量表得分的相关系数为0.21。结论:性态度量表中文版具有较好的信效度,适合在中国文化背景下使用。     

健康教育路径在老年腹膜透析患者护理中的应用

目的 探讨适合老年腹膜透析患者的健康教育方式.方法 随机选择46例老年腹膜透析患者,分为观察组与对照组,观察组采用健康教育路径方法,对照组给予传统教育方法.从患者对相关知识的掌握程度、自我护理能力及依从性、对护理人员的满意度方面进行观察比较.结果观察组患者对相关知识的掌握程度、自我护理能力及依从性、对护理人员的满意度与对照组比较差异有统计学意义(P<0.05).结论 应用健康教育路径应用于老年腹膜透析患者提高了患者对相关知识的掌握程度,自我护理能力及依从性,同时对护理人员的满意度也明显提高.     

Dysfunctional beliefs about sleep and insomnia symptoms in early adulthood: A twin and sibling study

This study examines the associations between dysfunctional belief about sleep (DBAS), its subtypes and insomnia symptoms and estimates the relative contribution of genetic and environmental influences to these variables and the associations between them. The data came from G1219, a twin/sibling study that comprises 862 individuals (aged 22–32 years, 34% male). The Insomnia Symptoms Questionnaire was used to measure insomnia symptoms and a 10‐item version of the Dysfunctional Beliefs and Attitudes about Sleep Scale was used to assess DBAS. A higher DBAS score was associated with more insomnia symptoms. Overall DBAS showed a mainly non‐shared environmental influence (86%). The genetic correlation between overall DBAS and insomnia symptoms was large but not significant, the shared environmental correlation was very small, negative and not significant, whereas a moderate, significant overlap in the non‐shared environmental influences was evident (non‐shared environmental correlation = 0.32). For the association between the subscales of DBAS and insomnia symptoms no significant overlap for genetic (weak to strong associations) or shared environmental factors (very weak negative to strong associations) was indicated. Most of the non‐shared environmental influences on the four variables were significantly moderately correlated (non‐shared environmental correlation = 0.24–0.46). These findings help to deepen our understanding of cognitive theories of insomnia by dissecting one of its crucial elements and illuminating the factors involved in its association with insomnia symptoms.     

失眠症者睡眠的主观评估和多导睡眠图对比分析

目的：探讨失眠症患者对睡眠评估的心理特征。方法：应用多导睡眠图对５０例失眠症患者进行整夜睡眠描记,次日早晨起床后询问夜间睡眠情况,并与２２名正常人进行对比分析。结果：与对照组比较、失眠症组睡眠潜伏期长,睡眠时间减少,睡眠效率低（Ｐ〈０．０１）;失眠症主观评估的睡眠潜伏期,总睡眠时间和睡眠效率与多导睡眠图结果比较具有显著不一致（Ｐ〈０．０５￣０．０１）。结论：失眠症组不但睡眠质量低于正常人,而且有着     

睡眠障碍评定量表的信度和效度分析

目的对睡眠障碍评定量表（SleepDysfunctionRatingScale,SDRS）进行信效度检验。方法选择符合CCMD-3的失眠症患者215例进行两次SDRS及临床总体印象量表（clinicalglobalimpressionscale-severi-ty,CGI-S）测试,两次间隔时间为3-7天。结果SDRS重测信度系数为0.89（P〈0.001）;各条目的Cronbachα系数较高（0.85-0.88）。SDRS与CGI-S的相关系数为0.70（P〈0.001）。因子分析显示除条目8和9具有相近的公共因子负荷之外,其他条目分别单独负荷不同的公共因子。因子载荷范围在0.73至0.95之间。结论SDRS具有较好的信度和效度。     

失眠症患者状态-特质焦虑与睡眠结构的关系

目的:探讨失眠症患者睡眠结构改变与状态焦虑和特质焦虑的关系.方法:对31例失眠症患者和20例正常对照者进行状态-特质焦虑问卷调查和整夜多导睡眠图描记,失眠症组于症状缓解出院后3~4月回访时重复检查.结果:(1)在睡眠结构上,与对照组相比,失眠症组呈现睡眠时间减少[(333.71±84.33)min vs.(403.65±19.29)min]、睡眠效率下降[(70.41±17.35) % vs.(83.45±4.42) %]、睡眠潜伏期[(39.48±24.24) min vs.(19.65±8.57) min]和快速眼动睡眠潜伏期延长[(106.60±42.89) min vs.(86.80±12.25) min],S_1睡眠时间比例增加[( 25.36±14.22) %vs.(8.86±1.77) %]、觉醒次数增多[(4.45±2.51) vs.(1.75±1.07)].S_(3+4)睡眠[(7.38±9.70)% vs.(13.78±4.24)%]和快速眼动睡眠时间比例[( 14.54±5.61) %vs.(19.18±2.14) %]减少 (Ps<0.05).(2)在状态-特质焦虑问卷评分上,失眠症组状态焦虑[(47.94 ±8.96) vs.(39.15±4.51)]和特质焦虑[(49.94 ±8.90) vs.(42.05±7.13)]得分均高于对照组(Ps<0.05).状态焦虑与睡眠潜伏期、快眼动睡眠潜伏期、觉醒次数和S_1睡眠时间比例均呈正相关(r=0.25~0.44,Ps<0.05),而与快眼动睡眠时间比例呈负相关(r=-0.41,P<0.01);特质焦虑与睡眠潜伏期和觉醒次数正相关(r=0.37,0.29;均Ps<0.05).(3)回访时患者睡眠结构改善,状态焦虑得分下降,特质焦虑无明显变化.结论:失眠症患者有明显的睡眠结构改变和较高的状态焦虑和特质焦虑,其睡眠结构改变与状态焦虑和特质焦虑相关.     

Long-term efficacy and safety of zolpidem extended-release 12.5 mg, administered 3 to 7 nights per week for 24 weeks, in patients with chronic primary insomnia: a 6-month, randomized, double-blind, placebo-controlled, parallel-group, multicenter study

STUDY OBJECTIVES: To evaluate long-term efficacy and safety of zolpidem extended-release 3 to 7 nights/week for chronic primary insomnia. DESIGN: Multicenter, 25-week, phase IIIb, randomized, double-blind, placebo-controlled, parallel-group. SETTING: Outpatient; visits every 4 weeks. PATIENTS: Aged 18 to 64 years; DSM-IV criteria for chronic primary insomnia; > or =3 months of difficulty initiating or maintaining sleep or experiencing nonrestorative sleep. INTERVENTIONS: Single-dose zolpidem extended-release 12.5 mg (n = 669) or placebo (n = 349), self-administered from a minimum of 3 nights/week to a maximum of 7 nights/week. MEASUREMENTS AND RESULTS: Patient's Global Impression (PGI) and Clinical Global Impression-Improvement (CGI-I) were assessed every 4 weeks up to week 24. Patient Morning Questionnaire (PMQ), recorded daily, assessed subjective sleep measures-sleep onset latency (SOL), total sleep time (TST), number of awakenings (NAW), wake time after sleep onset (WASO), and quality of sleep (QOS)-and next-day functioning. At week 12, PGI, Item 1 (aid to sleep), the primary endpoint, was scored as favorable (i.e., "helped me sleep") by 89.8% of zolpidem patients vs. 51.4% of placebo patients (P < 0.0001, based on rank score) and at week 24 by 92.3% of zolpidem extended-release patients vs. 59.7% of placebo patients. Zolpidem extended-release also was statistically significantly superior to placebo at every time point for PGI (Items 1-4) and CGI-I (P < 0.0001, rank score), TST, WASO, QOS (P < 0.0001), and SOL (P < or = 0.0014); NAW (Months 2-6; P < 0.0001). Sustained improvement (P < 0.0001, all time points) was observed in morning sleepiness and ability to concentrate (P = 0.0014, month 6) with zolpidem extended-release compared with placebo. Most frequent adverse events for zolpidem extended-release were headache, anxiety and somnolence. No rebound effect was observed during the first 3 nights of discontinuation. CONCLUSIONS: These findings establish the efficacy of 3 to 7 nights per week dosing of zolpidem extended-release 12.5 mg for up to 6 months. Treatment provided sustained and significant improvements in sleep onset and maintenance and also improved next-day concentration and morning sleepiness.     

Identifying, recruiting, and enrolling adolescent survivors of childhood cancer into a randomized controlled trial of health promotion: preliminary experiences in the Survivor Health and Resilience Education (SHARE) Program

OBJECTIVE: To report on the identification, recruitment, and enrollment of adolescent survivors of childhood cancer into an ongoing randomized controlled trial (RCT) of health promotion. METHODS: A total of 244 adolescents were contacted by mail and telephone to assess their trial eligibility. Data were collected with respect to each adolescent's demographics and trial recruitment efforts (frequency and intensity of telephone call contact); exclusion and randomization status were tracked throughout. RESULTS: Thirty-one percent of adolescents were ultimately randomized in the trial and 69% were excluded from randomization (13% were ineligible, 33% refused to participate, 22% were unreachable or nonresponsive, that is, did not respond to trial mailings or telephone calls, and less than 1% were withdrawn prior to randomization). Among all eligible adolescents, the trial's consent rate was 49%. Adolescents excluded owing to refusal resided the farthest away from the intervention site and experienced the least amount of telephone call contact time. The primary reasons for trial refusal were lack of interest in health promotion (28%) and lack of time to participate (23%). CONCLUSIONS: Health promotion RCTs among adolescent survivors of childhood cancer may help prevent and control the onset and severity cancer-treatment-related late effects. However, trial success may be contingent upon tracing nonresponsive adolescents and reducing and eliminating barriers to participation.     

Efficacy and Safety of Doxepin 1 mg and 3 mg in a 12-week Sleep Laboratory and Outpatient Trial of Elderly Subjects with Chronic Primary Insomnia

Study Objectives:

To evaluate the efficacy and safety of doxepin 1 mg and 3 mg in elderly subjects with chronic primary insomnia.

Design and Methods:

The study was a randomized, double-blind, parallel-group, placebo-controlled trial. Subjects meeting DSM-IV-TR criteria for primary insomnia were randomized to 12 weeks of nightly treatment with doxepin (DXP) 1 mg (n = 77) or 3 mg (n = 82), or placebo (PBO; n = 81). Efficacy was assessed using polysomnography (PSG), patient reports, and clinician ratings. Objective efficacy data are reported for Nights (N) 1, 29, and 85; subjective efficacy data during Weeks 1, 4, and 12; and Clinical Global Impression (CGI) scale and Patient Global Impression (PGI) scale data after Weeks 2, 4, and 12 of treatment. Safety assessments were conducted throughout the study.

Results:

DXP 3 mg led to significant improvement versus PBO on N1 in wake time after sleep onset (WASO; P < 0.0001; primary endpoint), total sleep time (TST; P < 0.0001), overall sleep efficiency (SE; P < 0.0001), SE in the last quarter of the night (P < 0.0001), and SE in Hour 8 (P < 0.0001). These improvements were sustained at N85 for all variables, with significance maintained for WASO, TST, overall SE, and SE in the last quarter of the night. DXP 3 mg significantly improved patient-reported latency to sleep onset (Weeks 1, 4, and 12), subjective TST (Weeks 1, 4, and 12), and sleep quality (Weeks 1, 4, and 12). Several global outcome-related variables were significantly improved, including the severity and improvement items of the CGI (Weeks 2, 4, and 12), and all 5 items of the PGI (Week 12; 4 items after Weeks 2 and 4). Significant improvements were observed for DXP 1 mg for several measures including WASO, TST, overall SE, and SE in the last quarter of the night at several time points. Rates of discontinuation were low, and the safety profiles were comparable across the 3 treatment groups. There were no significant next-day residual effects; additionally, there were no reports of memory impairment, complex sleep behaviors, anticholinergic effects, weight gain, or increased appetite.

Conclusions:

DXP 1 mg and 3 mg administered nightly to elderly chronic insomnia patients for 12 weeks resulted in significant and sustained improvements in most endpoints. These improvements were not accompanied by evidence of next-day residual sedation or other significant adverse effects. DXP also demonstrated improvements in both patient- and physician-based ratings of global insomnia outcome. The efficacy of DXP at the doses used in this study is noteworthy with respect to sleep maintenance and early morning awakenings given that these are the primary sleep complaints of the elderly. This study, the longest placebo-controlled, double-blind, polysomnographic trial of nightly pharmacotherapy for insomnia in the elderly, provides the best evidence to date of the sustained efficacy and safety of an insomnia medication in older adults.

Citation:

Krystal AD; Durrence HH; Scharf M; Jochelson P; Rogowski R; Ludington E; Roth T. Efficacy and safety of doxepin 1 mg and 3 mg in a 12-week sleep laboratory and outpatient trial of elderly subjects with chronic primary insomnia. SLEEP 2010;33(11):1553-1561.     

循证健康教育在癌性疼痛病人护理中的应用初探

目的探讨癌性疼痛病人实施循证健康教育的效果。方法对80例癌性疼痛病人应用循证方法通过专业护士收集资料、确定问题、查询并评价文献、临床护理实践、及时评价与反馈，在健康教育前后采用自制问卷及病人疼痛程度的反应对病人的健康教育效果进行评价与分析。结果80例病人在循证健康教育前后对疼痛知识掌握有统计学差异（P〈0．01），循证健康教育后疼痛治疗缓解率为81．5％。结论循证健康教育能提高健康教育的效果和有效的缓解疼痛。     

Effectiveness of a Web-Based Tailored Interactive Health Communication Application for Patients With Type 2 Diabetes or Chronic Low Back Pain: Randomized Controlled Trial

BackgroundThe prevalence of chronic diseases such as type 2 diabetes and chronic low back pain is rising. Patient empowerment is a key strategy in the management of chronic diseases. Patient empowerment can be fostered by Web-based interactive health communication applications (IHCAs) that combine health information with decision support, social support, and/or behavioral change support. Tailoring the content and tone of IHCAs to the needs of individual patients might improve their effectiveness.ObjectiveThe main objective was to test the effectiveness of a Web-based, tailored, fully automated IHCA for patients with type 2 diabetes or chronic low back pain against a standard website with identical content without tailoring (control condition) on patients’ knowledge and empowerment.MethodsWe performed a blinded randomized trial with a parallel design. In the intervention group, the content was delivered in dialogue form, tailored to relevant patient characteristics. In the control group, the sections of the text were presented in a content tree without any tailoring. Participants were recruited online and offline and were blinded to their group assignments. Measurements were taken at baseline (t₀), directly after the first visit (t₁), and at 3-month follow-up (t₂). The primary hypothesis was that the tailored IHCA would have larger effects on knowledge and patient empowerment (primary outcomes) than the control website. The secondary outcomes were decisional conflict and preparation for decision making. All measurements were conducted by online self-report questionnaires. Intention-to-treat (ITT) and available cases (AC) analyses were performed for all outcomes.ResultsA total of 561 users agreed to participate in the study. Of these, 179 (31.9%) had type 2 diabetes and 382 (68.1%) had chronic low back pain. Usage was significantly higher in the tailored system (mean 51.2 minutes) than in the control system (mean 37.6 minutes; P<.001). Three months after system use, 52.4% of the sample was retained. There was no significant intervention effect in the ITT analysis. In the AC analysis, participants using the tailored system displayed significantly more knowledge at t₁ (P=.02) and more emotional well-being (subscale of empowerment) at t₂ (P=.009). The estimated mean difference between the groups was 3.9 (95% CI 0.5-7.3) points for knowledge and 25.4 (95% CI 6.3-44.5) points for emotional well-being on a 0-100 points scale.ConclusionsThe primary analysis did not support the study hypothesis. However, content tailoring and interactivity may increase knowledge and reduce health-related negative effects in persons who use IHCAs. There were no main effects of the intervention on other dimensions of patient empowerment or decision-related outcomes. This might be due to our tailored IHCA being, at its core, an educational intervention offering health information in a personalized, empathic fashion that merely additionally provides decision support. Tailoring and interactivity may not make a difference with regard to these outcomes.

Trial Registration

International Clinical Trials Registry: DRKS00003322; http://apps.who.int/trialsearch/Trial2.aspx?TrialID=DRKS00003322 (Archived by WebCite at http://www.webcitation.org/6WPO0lJwE).