脑卒中恢复期患者居家自我管理任务清单的设计与应用

doi:10.3761/j.issn.1672-9234.2022.03.007

摘要/Abstract

摘要：

目的探讨脑卒中恢复期患者居家自我管理任务清单的设计及应用效果。方法采用半结构式访谈、专家会议等方式设计自我管理任务清单,清单包括行为、角色、情绪及改善自评4个部分。于2020年3月—9月便利选取上海市某康复医院74例脑卒中恢复期患者为研究对象,按照抽签法分为对照组（n=38）和试验组（n=36）。试验组采用自行设计的居家自我管理任务清单,指导患者及家属参照清单执行居家康复锻炼;对照组根据宣教内容自行锻炼。在出院后2个月、出院后6个月,分别采用自行设计的患者康复锻炼依从性问卷、中风自我管理行为评定量表进行评估。结果出院后2个月、出院后6个月,试验组依从性得分均优于对照组（Z=8.408,18.941;P<0.05）。试验组与对照组自我管理行为得分组间与时间存在交互效应（F=119.506,P<0.001）,简单效应分析显示,出院后2个月、出院后6个月,试验组自我管理行为得分均高于对照组（t=4.112,13.047;P<0.001）。结论居家自我管理任务清单可以提升脑卒中恢复期患者康复依从性,提高其自我管理能力。

关键词: 卒中, 恢复期, 家庭医疗保健服务, 自我护理

Abstract:

Objective To explore the development and effects of a home self-management checklist for stroke patients in recovery. Methods The self-management checklist was designed based on semi-structured interviews and expert meetings. The record list consisted of four parts:behavior,role,emotion and self-assessment. From March to September,2020,a total of 74 stroke patients in a rehabilitation hospital in Shanghai were randomly divided into the control group（n=38） and the experimental group（n=36）. Patients in the experimental group received the self-designed home self-management checklist and their home rehabilitation exercises were guided by the checklist. Patients in the control group exercised according to the contents of the education. At 2 months and 6 months after discharge,patients were assessed by the self-designed patient compliance questionnaire and the stroke self-management behavior assessment scale. Results After 2 months and 6 months after discharge from hospital,the compliance scores of patients in the experimental group were higher than those of the control group（Z=8.408,18.941;P<0.05）. There was a interaction effect regarding the self-management behavior score in group and time（F=119.506,P<0.001）. Simple effect analysis showed that the self-management behavior score of the experimental group was higher than that of the control group at 2 and 6 months after discharge（t=4.112,13.047;P<0.001）. Conclusion Self-management checklist can improve the rehabilitation compliance and self-management capacity of stroke patients in recovery.

Key words: Stroke, Convalescence, Home Care Services, Self Care

顾盼,王晓旭. 脑卒中恢复期患者居家自我管理任务清单的设计与应用[J]. 中华护理教育, 2022, 19(3): 230-235.

GU Pan,WANG Xiao-xu. Design and application of a home self-management checklist for stroke patients in recovery[J]. Chinese Journal of Nursing Education, 2022, 19(3): 230-235.

图/表 4

参考文献 16

[1]	中华医学会神经病学分会, 中华医学会神经病学分会脑血管病学组. 中国脑血管病一级预防指南2015[J]. 中华神经科杂志, 2015, 48(8):629-643.
	Chinese Society of Neurology,Chinese Stroke Society. Guidelines for primary prevention of cerebrovascular diseases in China 2015[J]. Chin J Neurol, 2015, 48(8):629-643.
[2]	高春华, 黄晓琳, 黄杰, 等. 自我管理对提高社区脑卒中患者日常生活活动能力及生活质量的效果[J]. 中国康复理论与实践, 2014, 20(8):789-793.
	Gao CH, Huang XL, Huang J, et al. Effect of chronic disease self-management on activities of daily living and quality of life of stroke patients in community[J]. Chin J Rehabil Theory Pract, 2014, 20(8):789-793.
[3]	杨亚娟, 费才莲, 荆瑶, 等. 医护患一体化自我管理教育在脑卒中患者居家康复中的应用[J]. 解放军护理杂志, 2015, 32(17):6-10.
	Yang YJ, Fei CL, Jing Y, et al. Application of doctor-nurse-patient integration model in self-management education on the home rehabilitation of stroke patients[J]. Nurs J Chin PLA, 2015, 32(17):6-10.
[4]	Hales BM, Pronovost PJ. The checklist:a tool for error management and performance improvement[J]. J Crit Care, 2006, 21(3):231-235. doi: 10.1016/j.jcrc.2006.06.002
[5]	金婕, 钟美容, 于秀婷, 等. 急性缺血性脑卒中患者中医延续性护理方案的构建与应用研究[J]. 中华护理杂志, 2021, 56(8):1125-1132.
	Jin J, Zhong MR, Yu XT, et al. Construction and application of a traditional Chinese medicine continuing care program for patients with acute ischemic stroke[J]. Chin J Nurs, 2021, 56(8):1125-1132.
[6]	徐晓蓉, 平鹏娜, 王欣, 等. 应用心力衰竭清单对慢性心力衰竭患者进行社区管理的效果研究[J]. 中国全科医学, 2020, 23(2):141-146. doi: 10.12114/j.issn.1007-9572.2019.00.751
	Xu XR, Ping PN, Wang X, et al. Community-based management of chronic heart failure patients using heart failure inventory project[J]. Chin Gen Pract, 2020, 23(2):141-146. doi: 10.12114/j.issn.1007-9572.2019.00.751
[7]	魏丽丽, 修红, 修麓璐. 清单式护理管理实践[M]. 北京: 科学出版社, 2019:150-204.
	Wei LL, Xiu H, Xiu LL. Practice of list nursing management [M]. Beijing: Science Press, 2019:150-204.
[8]	张通, 赵军, 白玉龙, 等. 中国脑血管病临床管理指南(节选版):卒中康复管理[J]. 中国卒中杂志, 2019, 14(8):823-831.
	Zhang T, Zhao J, Bai YL, et al. Chinese stroke association guidelines for clinical management of cerebrovascular disorders (excerpts)—management of stroke rehabilitation[J]. Chin J Stroke, 2019, 14(8):823-831.
[9]	Winstein CJ, Stein J, Arena R, et al. Guidelines for adult stroke rehabilitation and recovery:a guideline for healthcare professionals from the American Heart Association/American Stroke Association[J]. Stroke, 2016, 47(6):e98-e169.
[10]	Lacasse Y, Rousseau L, Maltais F. Prevalence of depressive symptoms and depression in patients with severe oxygen-dependent chronic obstructive pulmonary disease[J]. J Cardiopulm Rehabil, 2001, 21(2):80-86. pmid: 11314288
[11]	国家体育总局健身气功管理中心. 健身气功·六字诀[M]. 北京: 人民体育出版社, 2003.
[12]	各类脑血管病诊断要点[J]. 中华神经科杂志, 1996, 12(6):379.
	Diagnostic points of various cerebrovascular diseases[J]. Chin J Neurol, 1996, 12(6):379.
[13]	王艳桥. 中风自我管理项目的构建与应用研究[D]. 成都:成都中医药大学, 2012.
	Wang YQ. Construction and application of self-management intervention project for patients after stroke[D]. Chengdu:Chengdu University of TCM, 2012.
[14]	穆欣, 李娟, 刘瑞荣, 等. 首发脑卒中患者自我管理行为及影响因素的研究[J]. 中华护理杂志, 2016, 51(3):289-293.
	Mu X, Li J, Liu RR, et al. The current status and influencing factors of self-management behaviors in patients with first stroke[J]. Chin J Nurs, 2016, 51(3):289-293.
[15]	盛晗, 邵圣文, 王惠琴, 等. 脑卒中患者康复锻炼依从性动态变化的研究[J]. 中华护理杂志, 2016, 51(6):712-715.
	Sheng H, Shao SW, Wang HQ, et al. A study on the rehabilitation exercise compliance curve in stroke patients[J]. Chin J Nurs, 2016, 51(6):712-715.
[16]	鞠陶然, 鞠芳, 那娜, 等. 中年脑卒中患者自我管理行为意向的影响因素研究[J]. 护理学报, 2017, 24(19):1-5.
	Ju TR, Ju F, Na N, et al. Influence factors of self-management behavior intention in middle-aged patients with stroke[J]. J Nurs (China), 2017, 24(19):1-5.