妊娠期糖尿病结构化教育临床实践促进与阻碍因素分析

doi:10.3761/j.issn.1672-9234.2023.09.014

摘要/Abstract

摘要：

目的深入了解妊娠期糖尿病结构化教育干预方案转化为临床实践的促进与阻碍因素。方法采用目的抽样法，对某三级甲等医院7名产科医护人员进行半结构式访谈，采用Colaizzi 7步分析法，辅以NVivo 12软件分析资料。结果从访谈资料中凝练出2个主题，8个亚主题。促进因素包括：明确的课程方案将易于临床应用与推广；持续追踪随访将有效巩固实施效果；医护人员认同变革的临床实践意义；患者对变革的参与度和配合度较高。阻碍因素包括：固定小组线下授课难以开展；多学科团队协作机制有待优化；医院膳食未能满足住院妊娠期糖尿病患者需求；医疗成本投入不足影响变革实施。结论妊娠期糖尿病患者产前结构化教育课程方案在变革和接受者层面的促进因素明确了方案临床实践的可行性，在接受者、组织环境层面的阻碍因素提示方案调整的必要性。由此提示，该干预方案临床转化过程中应关注并纠正障碍因素，进一步优化健康教育资源配置，并从管理层面克服及改善障碍因素。

关键词: 糖尿病,妊娠, 健康教育, 定性研究, 促进与阻碍因素

Abstract:

Objective To investigate factors promote and hinder the transforming of structured educational intervention program into clinical practice of gestational diabetes mellitus（GDM）. Methods The objective sampling method was employed to conduct semi-structured interviews with seven experts in obstetric care in a third-class A hospital. The interview outline was formulated according to the i-PARIHS framework，and the data was analyzed by Colaizzi 7-step analysis method and NVivo 12 software. Results After analysis，two themes and eight sub-themes were condensed from the interview data. Facilitating factors were as following. Firstly，clear curriculum plan will benefit clinical application and promotion. Besides，continuous follow-up will effectively consolidate the implementation effect. Also，clinical practice significance of the reform should be recognized by the medical staff. Still，the degree of participation and cooperation of patients to the reform is high. Meanwhile，hindrance factors were summarized include difficulty to carry out offline teaching in fixed groups. Multidisciplinary team cooperation mechanism needs to be optimized. Hospital diet fails to meet the needs of hospitalized GDM patients. Insufficient input of medical cost affects the implementation of reform. Conclusion For the program of "Structured Prenatal Education Course for GDM Patients"，the promotion factors at the reform level and the recipient level confirm the feasibility of the program’s clinical practice. Meanwhile，the hindrance factors at the recipient level and the organizational environment level suggest the necessity of program adjustment. In conclusion，it is necessary to pay attention to and correct the obstacle factors，further optimize the allocation of health education resources，and overcome and improve the obstacle factors from the management level in the process of clinical transformation of the intervention program.

Key words: Diabetes,Gestational, Health Education, Qualitative Research, Promoting and hindering factors

孙月萍, 周蓉, 蒙莉萍, 郭亚琼, 张彩虹, 郭洪花. 妊娠期糖尿病结构化教育临床实践促进与阻碍因素分析[J]. 中华护理教育, 2023, 20(9): 1100-1106.

SUN Yueping, ZHOU Rong, MENG Liping, GUO Yaqiong, ZHANG Caihong, GUO Honghua. Factors that promote and hinder clinical practice of structured education in gestational diabetes mellitus[J]. Chinese Journal of Nursing Education, 2023, 20(9): 1100-1106.

图/表 1

参考文献 24

[1]	International Diabetes Federation. IDF Diabetes Atlas 2021[EB/OL]. [2021-12-06]. https://www.diabetesatlas.org.
[2]	王彬苏, 周秋明, 盛望望, 等. 中国妊娠期糖尿病危险因素及妊娠结局的调查分析[J]. 中国医刊, 2019, 54(9):1014-1019.
[3]	Johns EC, Denison FC, Norman JE, et al. Gestational diabetes mellitus:mechanisms,treatment,and complications[J]. Trends Endocrinol Metab, 2018, 29(11):743-754. doi: 10.1016/j.tem.2018.09.004
[4]	American Diabetes Association 14. Management of diabetes in pregnancy:standards of medical care in diabetes—2021[J]. Diabetes Care, 2021, 44(Suppl.1):S200-S210. doi: 10.2337/dc21-S014
[5]	符颖. 妊娠期糖尿病患者产前结构化教育课程方案的构建[D]. 海口: 海南医学院, 2021.
	Fu Y. Construction of prenatal structured education curriculum programme for gestational diabetes mellitus patients[D]. Haikou: Hainan Medical University, 2021.
[6]	顾芳臣, 林征, 尚星辰, 等. 结构化教育在慢性病自我管理中的应用研究进展[J]. 护理研究, 2019, 33(19):3361-3365.
	Gu FC, Lin Z, Shang XC, et al. Research progress on applica-tion of structured education in self-management of chronic diseases[J]. Chin Nurs Res, 2019, 33(19):3361-3365.
[7]	National Institute for Health and Care Excellence. Type 2 diabetes in adults:management(NG28)[EB/OL].(2022-09-29) [2022-09-26]. https://www.nice.org.uk/guidance/ng28.
[8]	National Institute for Health and Care Excellence. Type 1 diabetes in adults:diagnosis and management(NG17) [EB/OL].(2022-08-17) [2022-09-26]. https://www.nice.org.uk/guidan-ce/ng17.
[9]	中华医学会糖尿病学分会. 中国2型糖尿病防治指南(2020年版)[J]. 中华糖尿病杂志, 2021, 13(4):315-409.
	Chinese Diabetes Society. Guideline for the prevention and treatment of type 2 diabetes mellitus in China (2020 edition)[J]. Chin J Diabetes Mellitus, 2021, 13(4):315-409.
[10]	蒋新军, 刘叶灵, 罗丹, 等. 结构化教育在糖尿病患者中的应用进展[J]. 中华护理教育, 2019, 16(12):897-901.
	Jiang XJ, Liu YL, Luo D, et al. Structured education in pa-tients with diabetes:a literature review[J]. Chin J Nurs Educ, 2019, 16(12):897-901.
[11]	Chatterjee S, Davies MJ, Heller S, et al. Diabetes structured self-management education programmes:a narrative review and current innovations[J]. Lancet Diabetes Endocrinol, 2018, 6(2):130-142. doi: 10.1016/S2213-8587(17)30239-5
[12]	陈菊红, 解红文, 阮永兰, 等. 妊娠期糖尿病孕妇线上线下结构化健康教育研究[J]. 护理学杂志, 2020, 35(11):5-8.
	Chen JH, Xie HW, Ruan YL, et al. Online-offline structured education for pregnant women with gestational diabetes mellitus[J]. J Nurs Sci, 2020, 35(11):5-8.
[13]	周雯珺, 朱进美. 妊娠期糖尿病患者结构化健康教育的实施及效果[J]. 实用临床护理学电子杂志, 2019, 4(30):193-194,197.
[14]	陈耀龙, 史乾灵, 赵俊强, 等. 从知到行:跨越指南理论与实践的鸿沟[J]. 协和医学杂志, 2020, 11(6):746-753.
	Chen YL, Shi QL, Zhao JQ, et al. From knowledge to action: bridging the gap between theory and practice in clinical practice guidelines[J]. Med J PUMCH, 2020, 11(6):746-753.
[15]	张立华, 顾莺. 临床实践变革的概念框架:从PARIHS到i-PARIHS[J]. 中国循证医学杂志, 2019, 19(6):741-747.
	Zhang LH, Gu Y. The framework of the innovation of clinical practice:from PARIHS to i-PARIHS[J]. Chin J Evid Based Med, 2019, 19(6):741-747.
[16]	董会民, 刘朝英, 来艳辉, 等. 健康教育在妊娠期糖尿病孕妇中的应用研究进展[J]. 中国医学创新, 2015(2):153-156.
	Dong HM, Liu CY, Lai YH, et al. Research progress on app-lication of the health education in gestational diabetes mellitus[J]. Medical Innovation of China, 2015(2):153-156.
[17]	徐智园, 张宁. 2型糖尿病患者的结构化健康教育[J]. 护理学报, 2014, 21(18):68-69.
	Xu ZY, Zhang N. Structured health education for people with type 2 diabetes[J]. J Nurs(China), 2014, 21(18):68-69.
[18]	孙婷婷, 戴莉敏. 云门诊随访对妊娠期糖尿病患者院外血糖管理的效果研究[J]. 当代护士(上旬刊), 2022, 29(7):112-115.
	Sun TT, Dai LM. Effect of cloud outpatient follow-up on out-of-hospital blood glucose management in patients with gestational diabetes mellitus[J]. Modern Nurse, 2022, 29(7):112-115.
[19]	Qi SP, Dong YM. Effect of multidisciplinary team continuous nursing on glucose and lipid metabolism,pregnancy outcome,and neonatal immune function in gestational diabetes mellitus[J]. Dis Markers, 2022, 2022:7285639.
[20]	Zou JL, Huang JH. Effect of high-quality nursing on blood glucose level,psychological state,and treatment compliance of patients with gestational diabetes mellitus[J]. Am J Transl Res, 2021, 13(11):13084-13092.
[21]	周文成, 姚婷婷, 吴俊仪. 员工变革认知、组织认同与工作绩效[J]. 江海学刊, 2020(2):233-238.
	Zhou WC, Yao TT, Wu JY. Employee change cognition,organi-zational identification and job performance[J]. Jianghai Aca-demic Journal, 2020(2):233-238.
[22]	邓永芳, 卢荔婕, 刘美玲, 等. 妊娠期糖尿病孕妇患病体验的Meta整合[J]. 中国护理管理, 2021, 21(8):1218-1225.
	Deng YF, Lu LJ, Liu ML, et al. Experience of pregnant women with gestational diabetes mellitus:a Meta-synthesis[J]. Chin Nurs Manag, 2021, 21(8):1218-1225.
[23]	蒋维连, 黄宪丽, 李赛花, 等. 妊娠期糖尿病孕妇健康促进行为成因的质性研究[J]. 护理学杂志, 2020, 35(12):20-22.
	Jiang WL, Huang XL, Li SH, et al. Qualitative study on the causes of health promotion behaviors in pregnant women with gestational diabetes[J]. J Nurs Sci, 2020, 35(12):20-22.
[24]	周英凤, 钟婕, 李丽, 等. 妊娠期糖尿病临床护理实践指南实施的障碍因素分析[J]. 护士进修杂志, 2021, 36(4):307-310,316.
	Zhou YF, Zhong J, Li L, et al. Barriers analysis of implemen-tation of clinical nursing practice guideline for gestational diabetes mellitus[J]. J Nurses Train, 2021, 36(4):307-310,316.