格林模式在中青年腰椎间盘突出症患者健康教育中的应用

doi:10.3761/j.issn.1672-9234.2020.09.010

摘要/Abstract

摘要：

目的探究格林模式健康教育对中青年腰椎间盘突出症患者疾病认知水平、腰椎间盘自护行为水平及功能障碍的影响。方法采取临床随机对照试验方法,将福州市和莆田市某2所三级甲等医院骨科门诊就诊的205例非手术中青年腰椎间盘突出症患者随机分为试验组（n=103）和对照组（n=102）。两组在院内都接受思维导图联合微视频的健康教育,在此基础上,试验组实施院外格林模式健康教育,即分别针对倾向因素、促进因素和强化因素进行干预;对照组利用微信群进行常规团体辅导。比较两组干预前及第2、4、6个月末患者疾病认知水平、腰椎间盘自护行为水平和Oswestry功能障碍指数。结果两组疾病认知水平、腰椎间盘自护行为水平、功能障碍改善程度均得到提高,试验组干预效果优于对照组（P<0.001）。结论思维导图联合微视频健康教育能够提高中青年腰椎间盘突出症患者疾病认知水平和腰椎间盘自护行为水平,改善其功能障碍程度,同时在此基础上应用格林模式进行干预效果更佳。

关键词: 椎间盘移位, 健康教育, 格林模式, 自护行为, 疾病认知, 功能障碍

Abstract:

Objective To explore the influence of PRECEDE-PROCEED model health management on the level of knowledge,self-care behavior and dysfunction in young and middle-aged patients with lumbar disc herniation（LDH）. Methods A total of 205 nonsurgical young and middle-aged patients with LDH from the orthopaedic clinic in two tertiary hospitals in Fuzhou and Putian were divided into the interventional group（n=103） and the control group（n=102）. Patients in both groups received the health education by using mind map combined with micro-video during hospitalization. Besides,patients in the interventional group received PRECEDE-PROCEED model health management intervention provided by the research team after dischareged,that is to intervene separately for tendency factors,promoting factors and strengthening factors,while patients in the control group received WeChat communication for routine counseling. The knowledge of LDH score,level of self-care behavior score and Oswestry Disability Index were compared before the intervention,and 2 months,4 months,and 6 months. Results Patients’ disease cognition level,self-care behavior of lumbar disc level,and the dysfunction were improved in both groups. However,those effects in the interventional group were significantly better than those in the control group（P<0.001）. Conclusion Mind map combined with micro-video health education can enhance the disease cognition level of young and middle-aged patients with LDH,improve their self-care behavior of lumbar disc level,and promote their dysfunction recovery. Besides,the effect will be better by combining out-of-hospital PRECEDE-PROCEED model health management intervention.

Key words: Intervertebral Disc Displacement, Health Education, PRECEDE-PROCEED model, Self-care behaviors, Disease awareness, Disfunction

何丽芳,吴梦雯,吴秀清,肖春秀,甘香,陈君玉. 格林模式在中青年腰椎间盘突出症患者健康教育中的应用[J]. 中华护理教育, 2020, 17(9): 817-822.

HE Li-fang,WU Meng-wen,WU Xiu-qing,XIAO Chun-xiu,GAN Xiang,CHEN Jun-yu. Application of PRECEDE-PROCEED model in health education for young and middle-aged patients with lumbar disc herniation[J]. Chinese Journal of Nursing Education, 2020, 17(9): 817-822.

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参考文献 16

[1]	Fatoye F, Gebrye T, Odeyemi I. Real-world incidence and prevalence of low back pain using routinely collected data[J]. Rheumatol Int, 2019,39(4):619-626. doi: 10.1007/s00296-019-04273-0 pmid: 30848349
[2]	Almeida M, Saragiotto B, Richards B, et al. Primary care management of non-specific low back pain:key messages from recent clinical guidelines[J]. Med J Aust, 2018,208(6):272-275. pmid: 29614943
[3]	吴梦雯, 何丽芳, 肖春秀, 等. 中青年腰椎间盘突出症患者对腰椎间盘自护行为水平及影响因素分析[J]. 中国护理管理, 2020,20(4):582-587.
[4]	Pournaghash-Tehrani S, Etemadi S. ED and quality of life in CABG patients:an intervention study using PRECEDE-PROCEED educational program[J]. Int J Impot Res, 2014,26(1):16-19. doi: 10.1038/ijir.2013.27
[5]	Green LW, Kreuter MW. Health program planning:an educational and ecological approach[M]. 4th ed. New York:Mc Graw-Hil, 2005: 87-90.
[6]	梅晓磊, 王浩. PRECEDE模式护理干预对冠状动脉硬化性心脏病病人健康认知的影响[J]. 护理研究, 2016,30(11C):4181-4183.
[7]	董翠萍, 汪晖, 潜艳. 格林模式促进食管癌患者自我管理研究[J]. 护理学杂志, 2016,31(22):27-29.
[8]	Moshki M, Dehnoalian A, Alami A. Effect of precede-proceed model on preventive behaviors for type 2 diabetes mellitus in high-risk individuals[J]. Clin Nurs Res, 2017,26(2):241-253. doi: 10.1177/1054773815621026 pmid: 26749209
[9]	张利娟, 杨明, 张广清, 等. PRECEDE模式在初产妇母乳喂养健康教育中的应用[J]. 广东医学, 2014,35(20):3286-3288.
[10]	Baker D, Pynsent P, Fairbank J. Back pain:new approaches to rehabilitation and education[M]. UK: Manchester University Press, 1989: 174-186.
[11]	程继伟, 陈昌伟, 幸永明, 等. Oswestry功能障碍指数的改良设计及检验[C]//2016年浙江省骨科学学术年会论文集. 杭州, 2016: 103-104.
[12]	史一欣. 思维导图对腰椎间盘突出症患者术后康复遵医行为的影响[D]. 苏州:苏州大学, 2016.
[13]	王俊, 刘慧萍, 蒋名丽, 等. 婴儿培养箱清洁消毒微视频的制作与应用[J]. 中华护理教育, 2019,16(2):141-145.
[14]	吴一波, 李荀. 高血压患者药学科普微信干预模式构建[J]. 医学信息学杂志, 2016,37(12):56-60.
[15]	李俊花. 基于“遗忘曲线”的健康教育对住院冠心病患者冠心病相关知识及自我管理行为的影响[D]. 杭州:杭州师范大学, 2016.
[16]	段红光. 腰椎间盘突出症的发病机制和诊断[J]. 中国全科医学, 2012,15(36):4227-4230.