适时护理干预对肠造口患者皮肤问题、自我效能及生活质量的影响

目的：分析适时护理干预对肠造口患者皮肤问题、自我效能及生活质量的影响。方法：选择肠造口的80例患者,按照随机数字表法分为对照组与观察组各40例,对照组采用常规护理,观察组在常规护理基础上加用适时护理,比较两组术后造口周围皮肤问题发生率;并采用视觉模拟评分表（VAS）、造口患者自我效能表、造口患者生活质量量表（QOL）评定两组患者术后不同时间造口周围皮肤疼痛情况、干预前后自我效能、生活质量的改善情况。结果：观察组术后造口周围皮肤问题及相关并发症总发生率低于对照组（P<0.05）;观察组术后1 d、3 d、1周、2周VAS评分均低于对照组（P<0.05）;干预3个月,观察组自我效能量表评分、QOL评分均高于对照组（P<0.05）。结论：在肠造口患者临床干预中采用适时护理可减少肠造口相关皮肤问题发生率,减轻患者术后疼痛,提高自我护理能力,改善其生活质量。     

模型讲解与视频宣教对四肢骨折患者自我效能及 康复锻炼依从性的影响

目的 探讨模型讲解与视频宣教对四肢骨折自我效能及康复锻炼依从性的影响。方法 选取2017年1月~12月我院收治的四肢骨折患者110例,根据随机数字表法分为观察组和对照组,每组55例。对照组给予常规性护理指导,观察组给予模型讲解与视频宣教护理指导,比较两组干预情况及干预前后自我效能、Barthel指数及生活质量评分。结果 观察组疾病知识知晓率、康复锻炼依从率、预后良好率、患者满意率均高于对照组,并发症发生率低于对照组,差异有统计学意义（P＜0.05）。干预前两组干自我效能、Barthel指数及生活质量评分比较,差异无统计学意义（P＞0.05）;干预后,观察组自我效能评分、Barthel指数、生活质量评分均高于对照组,差异有统计学意义（P＜0.05）。结论 模型讲解与视频宣教能有效提高四肢骨折患者自我效能及锻炼依从性,促进患者预后,提高患者生活质量。     

The Chinese version of the Outcome Expectations for Exercise scale: validation study

Background

Estimates of the reliability and validity of the English nine-item Outcome Expectations for Exercise (OEE) scale have been tested and found to be valid for use in various settings, particularly among older people, with good internal consistency and validity. Data on the use of the OEE scale among older Chinese people living in the community and how cultural differences might affect the administration of the OEE scale are limited.

Aim

To test the validity and reliability of the Chinese version of the Outcome Expectations for Exercise scale among older people.

Methods

A cross-sectional validation study was designed to test the Chinese version of the OEE scale (OEE-C). Reliability was examined by testing both the internal consistency for the overall scale and the squared multiple correlation coefficient for the single item measure. The validity of the scale was tested on the basis of both a traditional psychometric test and a confirmatory factor analysis using structural equation modelling. The Mokken Scaling Procedure (MSP) was used to investigate if there were any hierarchical, cumulative sets of items in the measure.

Results

The OEE-C scale was tested in a group of older people in Taiwan (n = 108, mean age = 77.1). There was acceptable internal consistency (alpha = .85) and model fit in the scale. Evidence of the validity of the measure was demonstrated by the tests for criterion-related validity and construct validity. There was a statistically significant correlation between exercise outcome expectations and exercise self-efficacy (r = .34, p < .01). An analysis of the Mokken Scaling Procedure found that nine items of the scale were all retained in the analysis and the resulting scale was reliable and statistically significant (p = .0008).

Conclusion

The results obtained in the present study provided acceptable levels of reliability and validity evidence for the Chinese Outcome Expectations for Exercise scale when used with older people in Taiwan. Future testing of the OEE-C scale needs to be carried out to see whether these results are generalisable to older Chinese people living in urban areas.     

Factors associated with older patients' engagement in exercise after hospital discharge

Hill A-M, Hoffmann T, McPhail S, Beer C, Hill KD, Brauer SG, Haines TP. Factors associated with older patients' engagement in exercise after hospital discharge.

Objectives

To identify factors that are associated with older patients' engagement in exercise in the 6 months after hospital discharge.

Design

A prospective observational study using qualitative and quantitative evaluation.

Setting

Follow-up of hospital patients in their home setting after discharge from a metropolitan general hospital.

Participants

Participants (N=343) were older patients (mean age ± SD, 79.4±8.5y) discharged from medical, surgical, and rehabilitation wards and followed up for 6 months after discharge.

Interventions

Not applicable.

Main Outcome Measures

Self-perceived awareness and risk of falls measured at discharge with a survey that addressed elements of the Health Belief Model. Engagement and self-reported barriers to engagement in exercise measured at 6 months after discharge using a telephone survey.

Results

Six months after discharge, 305 participants remained in the study, of whom 109 (35.7%) were engaging in a structured exercise program. Multivariable logistic regression analysis demonstrated participants were more likely to be engaging in exercise if they perceived they were at risk of serious injury from a fall (odds ratio [OR] =.61; 95% confidence interval [CI], .48–.78; P<.001), if exercise was recommended by the hospital physiotherapist (OR=1.93; 95% CI, 1.03–3.59; P=.04), and if they lived with a partner (OR=1.97; 95% CI, 1.18–3.28; P=.009). Barriers to exercise identified by 168 participants (55%) included low self-efficacy, low motivation, medical problems such as pain, and impediments to program delivery.

Conclusions

Older patients have low levels of engagement in exercise after hospital discharge. Researchers should design exercise programs that address identified barriers and facilitators, and provide education to enhance motivation and self-efficacy to exercise in this population.     

自我效能感水平对化疗期间恶性肿瘤患者生活质量、负性自动思维的影响

目的 探讨自我效能感水平对化疗期间恶性肿瘤患者生活质量、负性自动思维的影响.方法 对106例明确诊断的化疗期间恶性肿瘤患者,分别进行一般自我效能感最表(GSES)、世界卫生组织生活质量测定量表简表(WHOQOL-BREF)、负性自动思维问卷(ATQ)测评,依GSES评分从最高分开始向下取27%作为高分组,从最低分开始向上取27%作为低分组,每组各29例.再比较WHOQOL-BREF、ATQ得分情况,并进行Pearson相关分析.结果 106例恶性肿瘤患者GSES评分为(22.32±8.61)分,自信心偏低者占55.66%,高分组GSES评分为(28.64±7.64)分,低分组为(21.37±5.78)分,两者差异有显著性(t=4.18,P＜0.01).自我效能感高分组ATQ评分为(63.71±7.94)分,低分组为(86.57±9.87)分,两者差异有显著性(t=9.72,P＜O.01).自我效能感高分组WHOQOL-BREF总分及各领域评分显著高于低分组,差异有显著性(P＜0.05).相关分析显示,GSES评分与ATQ评分呈显著负相关(P＜0.01).结论 化疗期间恶性肿瘤患者自我效能感水平普遍较低;患者自我效能感越低,则生活质量较低、负性自动思维越强烈.     

Self-efficacy as a predictor of improvement in health status and overall quality of life in pulmonary rehabilitation—An exploratory study

Objective

To evaluate developments in health status (HS) and overall quality of life (QOL), and the impact of self-efficacy on HS and QOL in relation to COPD pulmonary rehabilitation (PR).

Methods

A longitudinal study of 100 COPD patients before and up to 3 months after COPD PR. Self-efficacy was measured by the COPD self-efficacy scale, HS by the St. George Respiratory Questionnaire and QOL by the Quality of Life Scale. Mixed effect models were used.

Results

Patients reported significantly reduced psychosocial impact of disease (estimate = −4.05, p = 0.019) immediately after the PR programme. Higher levels of self-efficacy at baseline predicted significantly reduced psychosocial impact of disease and improved physical activity, total HS and QOL (p < 0.05). Better exercise capacity at baseline predicted significantly reduced psychosocial impact of disease, improved physical activity and QOL (p < 0.05). Older age at baseline predicted significantly fewer respiratory symptoms and improved total HS (p < 0.05).

Conclusions

Patients reported significantly reduced psychosocial impact of disease immediately after a COPD PR, and better exercise capacity and higher self-efficacy at baseline predicted significantly improved HS and QOL.

Practice implications

Increasing self-efficacy is suggested to be an important aim in relation to COPD PR.     

Do people with diabetes understand their clinical marker of long-term glycemic control (HbA1c levels) and does this predict diabetes self-care behaviours and HbA1c?

Objective

Research demonstrates that patients have a poor understanding of glycosylated haemoglobin A1c (HbA1c) and that this impacts on effective diabetes self-management. This study attempted to replicate these findings in a UK outpatient sample of people with diabetes.

Method

83 participants were recruited and asked to fill in a questionnaire assessing their understanding of HbA1c, diabetes self-care behaviours and diabetes-specific self-efficacy in relation to carrying out these self-care behaviours.

Results

Only 26.5% of the participants were classified as having a good understanding of HbA1c. Correlational and univariate analyses indicated that this level of understanding was related to demographic variables, HbA1c levels and certain aspects of self-care and self-efficacy. A series of multiple regressions found that understanding was a significant predictor of HbA1c levels.

Conclusion

The majority of participants seemed to have a poor understanding of HbA1c and this was related to aspects of their diabetes management, self-efficacy and HbA1c levels.

Practical implications

These findings provide support for the application of programmes and initiatives aimed at improving patients understanding of clinical disease markers.     

Motivational interviewing to promote sustained breastfeeding

OBJECTIVE: To explore the feasibility of using motivational interviewing to promote sustained breastfeeding by increasing a mother's intent to breastfeed for 6 months and increasing her breastfeeding self-efficacy. DESIGN: A longitudinal experimental two-group design with repeated measures was selected to explore the feasibility of using motivational interviewing to promote sustained breastfeeding in primiparous mothers. SETTING: Three Western rural community hospital sites. PARTICIPANTS: Convenience sample of 73 primiparous breastfeeding mothers ranging between the ages of 19 and 38, M = 25 (SD = 4.5). MAIN OUTCOME MEASURE: Mothers reported the date of their last day of breastfeeding, defined as any breastfeeding during the previous 24-hour period. Breastfeeding behavior was confirmed at each visit by infant test weights. RESULTS: The motivational interviewing group (M = 98.1 days, SD = 75.2) breastfed longer than the comparison group (M= 80.7 days, SD = 71.9); however, this difference was not significant, t(69) = 0.991, p = .325, Cohen's d = 0.24, related to the variability in the sample. CONCLUSIONS: Although not a statistically significant difference, the mean number of days that mothers in the intervention group breastfed was 98 days compared to the mean of 81 days by the comparison group; therefore, motivational interviewing may be useful as a strategy to test in a comprehensive intervention plan.     

社区-综合医院“治未病”互动管理模式对农村老年人骨质疏松自我康复的影响

目的 评价运用社区-综合医院“治未病”互动管理模式(interactive management model,IMM)对农村社区居民骨质疏松症自我效能的影响,为健康教育的顺利实施提供依据.方法 采用该IMM对常熟市虞山镇兴隆社区老年骨质疏松居民进行管理,采用“一般自我效能感量表”进行调查.结果 常熟市虞山镇兴隆社区老年居民骨质疏松的自我效能分值增加(34.2分),与干预前(23.5分)比较,差异有统计学意义(P＜0.05).结论 运用社区-综合医院“治未病”IMM对老年居民进行骨质疏松健康教育,可有效提高农村社区居民的一般自我效能水平.     

The Eating Disorder Recovery Self-Efficacy Questionnaire (EDRSQ): change with treatment and prediction of outcome

The purpose of this study was to examine the predictive validity of the Eating Disorder Recovery Self-Efficacy Questionnaire (EDRSQ), an empirically-derived self-report instrument that assesses confidence to eat without engaging in eating disordered behavior or experiencing undue emotional distress (Normative Eating Self-Efficacy) and confidence to maintain a realistic body image that is not dominated by pursuit of thinness (Body Image Self-Efficacy). Participants were 104 female inpatients with anorexia nervosa (AN), subthreshold AN, or underweight bulimia nervosa who were treated at a specialized eating disorder clinic and completed the EDRSQ and Eating Disorder Inventory-2 (EDI-2) Drive for Thinness (DT) and Body Dissatisfaction (BD) subscales upon admission. A subset of patients completed the EDRSQ (n=81) and EDI-2 subscales (n=70) following inpatient treatment. Self-efficacy increased significantly during treatment. EDRSQ scores at admission were inversely related to length of hospital stay and posttreatment DT and BD subscales and positively related to partial hospital weight gain rate. The EDRSQ significantly predicted length of hospital stay and posttreatment BD above and beyond clinical indicators and eating disorder psychopathology at inpatient admission. Findings support the validity of the EDRSQ and suggest it is a useful predictor of short-term hospital treatment outcome in underweight eating disorder patients.