哮喘儿童自我管理教育的评估

目的：评估哮喘儿童自我管理教育的效果。方法：对５４例哮喘儿童自我管理教育前后１ａ的肺功能、哮喘发作情况、医疗费用,以及自我管理知识和技能、治疗依从性进行自身对照研究。结果：病人教育后,呼气峰流速（ＰＥＦ）及其变异率（ＰＥＦＲＶ）有明显改善（Ｐ＜０．０１）。哮喘引起的急性发作和急诊、住院次数、缺课、父母缺勤和使用口服激素、支气管扩张剂日数,以及医疗费用皆显著减少（Ｐ＜０．０１）。结论：自我管理知识和技术（认识哮喘、环境控制、吸入技术、峰流速仪使用和监测）,以及治疗依从性皆显著提高和改善（Ｐ＜０．０１）。     

自我管理教育在门诊胃食管反流性哮喘患者中的应用

目的：探讨门诊自我管理教育在胃食管反流性哮喘患者自我管理中的应用效果。方法便利抽取呼吸科门诊的胃食管反流性哮喘患者71例为研究对象,按就诊单双号分为观察组35例和对照组36例,对照组给予常规药物治疗和门诊指导,观察组在药物治疗的基础上给予系统性门诊自我管理教育,总管理时间为6个月。比较教育前后两组患者的胃食管反流症状、哮喘控制水平、肺通气功能改善程度。结果干预后,观察组患者胃食管反流症状评分为（5．1±1．2）分,低于对照组评分（6．8±1.6）分,两组比较差异有统计学意义（t＝5．07,P＜0．01）;观察组哮喘控制自评得分为（23．5±0．6）分,高于对照组自评得分（22．7±0．9）分,两组比较差异有统计学意义（ t＝4．41,P＜0．01）;观察组在肺通气功能指标方面1秒用力肺活量占预计百分比（ FEV1％）为（87．4±3．9）％、1秒率（ FEV1/FVC％）为（86.7±3．1）％、峰流速（PEF）为（8．8±1．8）L/s,分别高于对照组的（83．4±4．6）％,（84．3±4．2）％,（7．7±1.2）L/s,两组比较差异有统计学意义（t值分别为3．96,2．74,3．05;P＜0．01）。结论门诊自我管理教育能提高胃食管反流性哮喘患者的自我管理水平,可缓解患者的临床症状,提高患者的肺功能。     

Cochrane reviews of educational and self-management interventions to guide nursing practice: A review

Background

The burden of chronic disease on healthcare services worldwide is growing and the increased development of educational interventions which help patients to better manage their own conditions is evident internationally.

Objectives

This paper reports on findings of a review of Cochrane systematic reviews of interventions designed to improve patients’ knowledge and skills to manage chronic disease, with particular reference to nursing contribution and practice.

Methods

Thirty Cochrane systematic reviews were identified as meeting the inclusion criteria. Data were extracted and summarised.

Findings

The majority of reviews included in this paper were judged by Cochrane reviewers to provide inadequate evidence (n = 18, 60%) of the effectiveness of the interventions reviewed. Information on the professional delivering the interventions was often not available, although 77% (23) of reviews mentioned that nurses were involved in a proportion of studies.

Conclusion

Educational programmes have definite benefits for patients suffering from asthma and are promising for interventions in areas such as diabetes mellitus, epilepsy and mental health. However, it still is not clear what the active ingredients of many successful interventions are.     

目标设置理论在膝关节韧带损伤术后早期系统康复训练中的应用观察

目的观察目标设置理论在膝关节韧带损伤后早期系统康复训练中的应用效果。方法选取2018年1月至2019年1月某院收治的102例膝关节韧带损伤术后患者作为分析对象,按照随机数表法将其分为观察组与对照组各51例。对照组患者实行术后常规康复训练,观察组患者在对照组基础上应用目标设置理论进行指导。比较干预前、干预3个月后两组患者膝关节功能(Lyshom评分标准)、步行功能[功能性步行量表(FAC)]、运动功能(Fugl-Meyer运动功能量表)评分及关节活动度(ROM)差异。结果干预3个月后,两组患者Lyshom评分、FAC评分、ROM及运动功能各项目评分均高于治疗前,且观察组高于对照组(P均<0.05)。结论对膝关节韧带损伤后患者早期康复训练中应用目标设置理论进行干预,能有效改善患者膝关节功能及步行、运动功能。     

个体化教育对老年代谢综合征患者自我管理的影响

目的 探讨个体化教育对老年代谢综合征患者自我管理的影响.方法 选择84例老年代谢综合征患者,随机分为实验组和对照组,每组42例,实验组采取个体化教育,对照组采取常规健康宣教,比较两组患者在教育前后相关知识掌握程度和自我管理能力.结果 个体化教育组患者对代谢综合征相关知识的掌握程度和自我管理能力有明显提高.结论 对老年代谢综合征患者进行个体化教育可以显著提高他们对疾病的认识水平和自我管理能力.     

自我管理教育对老年2型糖尿病患者自我管理行为的影响

目的:探讨对老年2型糖尿病患者实施自我管理教育的效果。方法:采用随机抽样的方法选择2010年2月～2011年3月在南通市妇幼保健院门诊就诊的60岁以上2型糖尿病患者80例,随机分为观察组和对照组各40例。对照组接受常规糖尿病教育项目,观察组在对照组基础上实施自我管理教育。于干预前和干预后6个月采用自我管理行为量表对患者进行评分。结果:观察组患者干预后6个月自我管理行为能力评分明显高于对照组(P<0.01)。结论:对老年2型糖尿病患者在常规教育基础上实施自我管理教育,可以提高患者自我管理能力,从而提高患者认知能力,改善生活质量。     

哮喘健康教育的临床效果

目的研究哮喘健康教育各个方面对临床效果的影响,为系统规范的进行哮喘健康教育提供科学参考。方法对我院呼吸科104例哮喘病患者进行健康教育,出院时以问卷调查的方式,对患者掌握健康教育5个方面的效果进行评价。用Logistic回归分析影响复发住院率的因素。结果疾病知识、饮食注意、日常活动、正确用药和心理情绪合格率分别为43．75％,52．86％,76．68％,70．64％,67．46％;复发住院率22．12％;日常活动、疾病知识和正确用药对应的OR值为0．176,0．451,0．791,差异有统计学意义（P〈0．05）,表明是复发住院的重要影响因素。饮食注意和心理情绪OR值均小于1,差异无统计学意义（P〉0．05）。结论对于哮喘的健康教育需要更加规范化,专业化,需要着重注意对日常活动、疾病知识和正确用药等方面有针对性地进行健康教育。     

目标设置理论在门诊换药室实习护生管理中的应用

目的:探讨目标设置理论在门诊换药室实习护生管理中的应用效果。方法:选择2007年2月～2008年12月来我科的58名实习护生应用目标设置理论进行管理,通过设置目标(强调目标的明确度和难度),保证护生能接受并承担目标,同时为护生提供支持(包括相信护生、获取信息并及时作出反馈)。结果:提高了护生对带教老师的满意度;提高了患者对护生操作的满意度;实习护生的出科理论和操作考核平均成绩均在92.5分以上。结论:目标设置理论在门诊换药室实习护生的管理中起到了很好的作用,它使教学中各个环节的质量始终得到有效控制,减少了实习过程中的随意性和盲目性,使实习护生的管理更加科学化,提高了临床教学质量。     

自我管理教育对下肢深静脉血栓形成患者的影响研究

目的 探讨自我管理教育在下肢深静脉血栓(DVT)患者中的应用效果.方法 将本科60例DVT患者分为观察组和对照组,两组治疗方法相同,对照组采用常规健康教育,观察组采用自我管理教育,比较两组患者的自我管理行为以及治疗效果.结果 观察组在纠正不良饮食习惯、坚持运动、心理调整等自我管理行为方面的评分均显著高于对照组(P＜0.05).观察组的治愈率及护理满意度评分均显著高于对照组(P＜0.05).结论 自我管理教育能够显著促进DVT患者掌握健康知识,提高自我管理能力和治疗效果.     

哮喘患者自我管理现状和护理需求的质性研究

目的了解哮喘患者自我管理中存在的问题以及对医疗护理服务的需求,探索为患者提供针对性的医疗护理服务的内容和方法,并为实施以家庭为中心的自我护理提供依据。方法应用现象学研究方法,对17例住院期病情稳定后哮喘患者进行面对面访谈,并进行现场录音和笔录,收集资料。采用Colaizzi的现象学资料7步分析法,对获得的资料进行分析、整理,提炼出主题。结果哮喘患者的自我护理现状及家庭需求主要包括5个方面,即疾病知识不足,治疗不规则,对激素治疗缺乏正确认识,对强化哮喘防治知识的需求,与医护人员保持沟通交流的需求。结论医护人员应经常、反复对患者进行哮喘知识的教育、指导,提供针对性和可操作性的家庭照顾知识和技能培训。     

The development of a patient-specific method for physiotherapy goal setting: a user-centered design

Purpose: To deliver client-centered care, physiotherapists need to identify the patients’ individual treatment goals. However, practical tools for involving patients in goal setting are lacking. The purpose of this study was to improve the frequently used Patient-Specific Complaints instrument in Dutch physiotherapy, and to develop it into a feasible method to improve physiotherapy goal setting.

Methods: An iterative user-centered design was conducted in co-creation with the physiotherapists and patients, in three phases. Their needs and preferences were identified by means of group meetings and questionnaires. The new method was tested in several field tests in physiotherapy practices.

Results: Four main objectives for improvement were formulated: clear instructions for the administration procedure, targeted use across the physiotherapy process, client-activating communication skills, and a client-centered attitude of the physiotherapist. A theoretical goal-setting framework and elements of shared decision making were integrated into the new-called, Patient-Specific Goal-setting method, together with a practical training course.

Conclusions: The user-centered approach resulted in a goal-setting method that is fully integrated in the physiotherapy process. The new goal-setting method contributes to a more structured approach to goal setting and enables patient participation and goal-oriented physiotherapy. Before large-scale implementation, its feasibility in physiotherapy practice needs to be investigated.

• Implications for rehabilitation

• Involving patients and physiotherapists in the development and testing of a goal-setting method, increases the likelihood of its feasibility in practice.

• The integration of a goal-setting method into the physiotherapy process offers the opportunity to focus more fully on the patient’s goals.

• Patients should be informed about the aim of every step of the goal-setting process in order to increase their awareness and involvement.

• Training physiotherapists to use a patient-specific method for goal setting is crucial for a correct application.

     

Goal setting in palliative care: A structured review

Abstract

Background

Palliative care and rehabilitation both aim to support patients to live as actively as possible. Goal setting has been identified in health policy and clinical guidelines as a mechanism to achieve this. While goal setting is well established in traditional rehabilitation, it is unclear how it should be implemented within palliative care where people are faced with diminishing abilities.

Aim

To identify and synthesize published literature regarding goal setting in palliative care.

Method

Electronic searches were carried out on MEDLINE, PSYCHINFO, EMBASE, CINAHL, ASSIA, and Google Scholar databases between November 2010 and January 2011. Papers were included if they focused on patient-centred goal setting in palliative care. No restrictions were placed on study design or type of paper. Papers were classified according to the type and design and research papers were quality appraised. Papers were read and analysed using framework analysis.

Findings

Sixteen papers met the inclusion criteria. Three themes were identified: 1. Definitions, process, and functions of goal setting;

2. The challenges of delivering goal setting;

3. Theories underpinning goal setting.

Conclusions

Goal setting is recognized as an important component of patient-centred palliative care, but there is no agreement regarding ‘best practice’ and clinicians face particular challenges when trying to set goals with patients in this context. Little attention has been paid to developing a robust, theory-based approach to goal setting in this setting. Hope theory and theories of how people adapt to life-threatening illness could inform the process of goal setting in palliative care.     

自我管理教育对老年原发性高血压病患者的影响

目的：探讨自我管理教育对老年原发性高血压病患者的影响,旨在提高患者治疗依从性。方法：选择2011年1月～2012年6月我院确诊的老年原发性高血压病患者148例作为研究对象,将其随机分为干预组和对照组,每组74例。干预组予以系统性自我管理教育,对照组予以常规护理,分别观察并评价两组患者自我管理能力及血压变化。结果：干预组在生活方式、躯体活动、治疗相关、社会心理和自我管理总分问均高于对照组（P〈0．05）,收缩压和舒张压均低于对照组（P〈0．05）。结论：对高血压病患者实施系统性自我管理教育,能有效提高患者自我管理能力,有效控制血压水平,值得推广应用。     

Rehabilitees perspective on goal setting in rehabilitation – a phenomenological approach

Purpose: Setting meaningful goals for the rehabilitation process after acute illness is essential for rehabilitees recovery. The aim of this study was to understand the meanings of the goal setting situation with professionals from rehabilitees point of view.

Method: We included 20 acute stroke and back pain rehabilitees (mean age 66?y) who set goals with a multidisciplinary rehabilitation team. Data was collected by interviewing the rehabilitees after the goal setting situations. A qualitative analysis from a phenomenological perspective using Spiegelberg’s seven-phase meaning analysis was performed to reveal meanings.

Results: The five meanings were identified as: (i) “trust in the rehabilitation situation, professionals, oneself, and relatives;” (ii) “respectful presence;” (iii) “confusing awareness;” (iv) “disturbing pain;” and (v) “fear of unpredictability.” When professionals committed to working in a patient-centred manner, the rehabilitees felt respected and they trusted professionals and thus their self-efficacy was empowered. Moreover, relatives were an important support in the situation. However, disturbing pain and fear of the future limited patients level of participation in the situation.

Conclusion: Rehabilitee commitment to rehabilitation can be supported with equality in communication and presence of relatives, while pain and uncertainty because of changed health limit participation in a goal setting situation.

• Implications for Rehabilitation

• Multidisciplinary rehabilitation professionals should be recommended to support the active role of a patient in the goal setting situation.

• Relatives are recommended to participate in goal setting situation as they are an important support for rehabilitees.

• Professionals should be recommended to remove obstacles that restrain patient’s participation in the goal setting situation.

• Professionals should be recommended to recognize patients with changed health and offer psychosocial support for those in need to improve their participation in rehabilitation process.

     

自我管理教育对结肠造口患者自我管理疾病能力的影响

目的探讨自我管理教育对结肠造口患者自我管理疾病能力的影响。方法选择68例造口患者进行为期6个月的自我管理教育,比较教育前后患者自我管理能力和自我效能水平的变化情况。结果自我管理教育后患者自我管理疾病能力及自我效能水平评分较教育前明显提高,差异具有统计学意义（P〈0．01）。结论自我管理教育可以提高患者的自我管理疾病能力和自我效能水平,从而改善患者的生活质量。     

自我管理教育对缓解期抑郁症患者的影响研究

目的探讨自我管理教育对抑郁症患者的影响。方法将112例抑郁症患者,根据不同年度分为观察组56例和对照组56例,两组均进行抗抑郁治疗和一般的健康教育,观察组在此基础上实施自我管理教育。采用汉密尔顿抑郁量表17项、汉密尔顿焦虑量表和世界卫生组织生活质量量表分别在两组患者入组时、教育干预6月和1年时作测评,同时统计两组的复发率及自行停药例数。结果教育干预6月和1年时,观察组患者汉密尔顿抑郁量表17项、汉密尔顿焦虑量表和世界卫生组织生活质量量表的部分领域评分,与对照组比较有统计学意义,干预教育1年时的自行停药率、复发率明显低于对照组。结论自我管理教育可改善抑郁症患者的抑郁情绪,降低复发率,提高患者生活质量。     

自我管理教育对糖尿病伴抑郁症患者的影响

目的探讨自我管理教育对糖尿病伴抑郁症患者的影响,旨在提高患者自我管理能力。方法将85例患者随机分为教育组43例和对照组42例,对照组接受一般说教式健康教育,教育组患者参与自我管理教育活动,采用自行设计的自我管理行为问卷及抑郁自评量表（SDS）和汉密尔顿抑郁量表（HAMD）调查患者自我管理行为和抑郁状况,8周后比较两组患者自我管理行为、抑郁状况、空腹血糖、餐后2h血糖控制状况。结果干预前两组患者自我管理行为评分、SDS、HAMD、空腹血糖、餐后2h血糖比较差异均无统计学意义（P〉0．05）;8周后教育组患者服药依从性得分为（1．77±0．504）分,并发症的管理为（2．19±0．588）分,SDS（29．3±4．8）分、HAMD（11．5±6．9）分、空腹血糖（5．3±1．4）mmol／L、餐后2h血糖（8．6±1．1）mmol／L,对照组分别为（1．32±0．744）,（1．83±0．590）,（36．5±5．4）,（18．3±1．3）分,（9．2±2．1）,（11．1±2．2）mmol／L,差异均有统计学意义（t=2．813,3．358,2．91,2．34,2．65,2．78;P〈0．01）,教育组患者自我管理行为问卷其他4项评分也高于对照组（P〈0．01）。结论自我管理教育能有效提高患者自我管理能力,控制患者血糖水平和改善抑郁症状,值得临床推广应用。     

自我管理教育对行干扰素治疗丙型肝炎患者的影响

目的:探讨自我管理教育对行干扰素治疗丙型肝炎(丙肝)患者的影响。方法:将60例适宜干扰素治疗丙肝患者随机分为干预组和对照组各30例,干预组住院期间给予自我管理教育;对照组只进行常规的治疗,不包括系统的指导内容。均追踪随访半年,评估患者的自我管理能力、对抗病毒治疗的依从性。结果:出院后6个月两组患者自我管理能力、对抗病毒治疗依从性均优于对照组(P<0.01)。结论:实施自我管理教育可提高行干扰素治疗丙肝患者的自我管理能力和对抗病毒治疗的依从性。