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中国防痨杂志 ›› 2017, Vol. 39 ›› Issue (12): 1313-1317.doi: 10.3969/j.issn.1000-6621.2017.12.012

• 论著 • 上一篇    下一篇

“知信行”模式在脊柱结核术后患者健康教育中的应用

余兴艳, 毕娜, 刘宁, 于梅, 张延晖, 陈嘉一   

  1. 100091 北京,解放军第三〇九医院脊柱外科
  • 收稿日期:2017-08-11 修回日期:2018-01-10 出版日期:2017-12-10 发布日期:2018-01-11
  • 通信作者: 余兴艳,Email:yxy080901@163.com
  • 基金资助:

    首都临床特色应用研究课题 (Z161100000516178);北京市中医药科技发展基金(JJ2016-58)

Knowledge attitude belief and practice in health education after spinal tuberculosis

YU Xing-yan, BI Na, LIU Ning, YU Mei, ZHANG Yan-hui, CHEN Jia-yi   

  1. Department of Spinal Surgery,The 309th Hospital of Chinese People’s Liberation Army, Beijing 100091, China
  • Received:2017-08-11 Revised:2018-01-10 Online:2017-12-10 Published:2018-01-11
  • Contact: YU Xing-yan, Email: yxy080901@163.com

摘要: 目的 探讨“知信行”模式对脊柱结核术后患者健康教育的效果。方法 选取2016年5—10月解放军第三〇九医院脊柱外科收治的脊柱结核患者438例,去除非脊柱疾病,排除按Frankel分级神经功能为A、B级,按数字表法随机抽取5-7月68例(对照组)和8-10月68例(干预组),患者自愿参与本研究。对照组采用常规护理,干预组在对照组的基础上增加了脊柱结核知识掌握测评,并采取系列方法增强患者及家属战胜疾病的信念;同时要求患者及家属记录每天护理行为,责任组长根据其记录不断改进护理内容。在出院时、出院后3个月及6个月对两组患者日常生活活动能力、治疗依从性及出院时护理服务满意度进行比较。结果 出院6个月时干预组和对照组生活活动能力评分分别为(90.12±4.02)分和(88.13±6.78)分,两组比较差异有统计学意义(t=-2.87,P=0.00)。出院时、出院3个月时对照组和干预组饮食依从性得分为(10.59±0.78)分、(10.88±0.81)和(9.08±0.23)分、(10.26±0.91)分,两组比较差异有统计学意义(t值分别为2.13、3.89,P值分别为0.03、0.02);出院6个月时干预组在服药、饮食及运动方面依从性得分均高于对照组,差异有统计学意义[(7.98±0.21)和(8.05±0.31)分(t=2.22, P=0.04);(8.59±0.82)和(10.14±0.61)分(t=2.01, P=0.00);(9.22±0.53)和(10.98±0.78)分(t=3.51, P=0.01)]。出院时干预组与对照组护理服务满意度总得分分别为(96.77±7.52)和(85.68±8.77)分,两组比较差异有统计学意义(t=6.51,P=0.00)。结论 “知信行”护理模式可提高脊柱结核手术后患者日常生活活动能力和治疗依从性,同时,护理服务满意度也有提升。应用“知信行”健康教育,可以改善患者的健康态度和健康行为,促进疾病恢复。

关键词: 结核,脊柱, 病人出院, 健康知识,态度,实践, 健康教育, 结果与过程评价(卫生保健)

Abstract: Objective To explore the effectiveness of KAP (knowledge, attitude, belief, and practice) on the health education to patients with spinal tuberculosis. Methods Four hundred and thirty eight patients with spinal tuberculosis treated in People’s Liberation Army (PLA) 309 Hospital spinal surgery department from May to October 2016 who signed the informed consent form and joined the research voluntarily, excluding other non-spinal diseases and those patients with grade A, B by nerve function Frankel grade. The patients treated from May to July were enrolled in the control group, and those treated from August to October were enrolled in the intervention group. The control group received routine nursing care, and the intervention group received the same nursing care as the control group, but also added knowledge evaluation of spinal tuberculosis, and took a series of methods to enhance the beliefs of patients and their families, and required the patients and relatives to record daily nursing behavior. According to the record, the responsible leader continuously improved the nursing content. The activities of daily living (ADL) scores, the treatment compliance and the satisfaction of the nursing service at the time of discharge were compared between two groups at the time of discharge, 3 months and 6 months after discharge. Results At 6 months after discharge in the intervention group and the control group ADL scores were 90.12±4.02 and 88.13±6.78 respectively, with a significant difference between two groups (t=-2.87. P=0.00).Dietary compliance between two groups at the time of discharge and 3 months of discharge showed significant differences (10.59±0.78 vs 10.88±0.81, t=2.13, P=0.03; 9.08±0.23 vs 10.26±0.91, t=3.89, P=0.02). The scores of medication, dietary and exercise in the intervention group were significantly higher than the control group at 6 months after discharge (7.98±0.21 vs 8.05±0.31, t=2.22, P=0.04; 8.59±0.82 vs 10.14±0.61, t=2.01, P=0.00; 9.22±0.53 vs 10.98±0.78, t=3.51, P=0.01). The total satisfaction scores of nursing service at discharge were 96.77±7.52 and 85.68±8.77 among the intervention and control groups, with a significant difference (t=6.51, P=0.00). Conclusion KAP nursing mode can improve the activities of daily living and treatment compliance of patients with spinal tuberculosis after operation。 In the meantime, it also improved the satisfaction of the nursing service. The application of KAP health education can improve the patient’s health attitude and health behaviors, which will accele-rate the recovery of the patients.

Key words: Tuberculosis, spine, Patient discharge, Health knowledge, attitudes, practice, Health edu-cation, Outcome and process assessment (health care)