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中国防痨杂志 ›› 2026, Vol. 48 ›› Issue (7): 1007-1014.doi: 10.19982/j.issn.1000-6621.20260053

• 论著 • 上一篇    下一篇

基于达标理论的出院准备服务在肺结核患者中的应用研究

魏潇雯1, 董宁1(), 吴元浩1, 杨洁1, 杨依静1, 沈克兰1, 张林2   

  1. 1 上海市公共卫生临床中心呼吸与危重症医学科, 上海 201508
    2 上海市公共卫生临床中心护理部, 上海 201508
  • 收稿日期:2026-01-26 出版日期:2026-07-10 发布日期:2026-07-02
  • 通信作者: 董宁,Email:dongning@shaphc.org
  • 基金资助:
    复旦-复星护理科研项目(FNF202557);上海市公共卫生临床中心科研项目(KY-GW-2026-34)

Effects of intervention scheme based on the theory of goal attainment on discharge readiness of patients with pulmonary tuberculosis

Wei Xiaowen1, Dong Ning1(), Wu Yuanhao1, Yang Jie1, Yang Yijing1, Shen Kelan1, Zhang Lin2   

  1. 1 Respiratory and Critical Care Medicine Department, Shanghai Public Health Clinical Center, Shanghai 201508, China
    2 Nursing Department, Shanghai Public Health Clinical Center, Shanghai 201508, China
  • Received:2026-01-26 Online:2026-07-10 Published:2026-07-02
  • Contact: Dong Ning, Email: dongning@shaphc.org
  • Supported by:
    Fudan University Nursing Research Program(FNF202557);Shanghai Public Health Clinical Center Research Program(KY-GW-2026-34)

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摘要：

目的: 探讨基于达标理论的出院准备服务在肺结核患者中的应用效果。方法: 采用目的抽样法,选取2024年8月至2025年10月上海市公共卫生临床中心结核科肺结核患者65例为对照组(实施出院准备常规措施),以呼吸与危重症医学科肺结核患者65例为观察组(实施基于达标理论的出院准备服务方案)。研究期间,观察组有1例患者脱落,对照组有2例患者脱落。最终,观察组纳入64例患者,对照组纳入63例患者。比较两组患者的出院准备度和住院时长,干预前后自我管理行为和出院后2个月内的非计划再入院率及出院后2个月末的痰菌阴转率。结果: 干预后,观察组患者出院准备度量表总分,以及个人状态、适应能力、预期性支持分量表得分[分别为(89.82±9.69)分、23.00(20.00, 25.75)分、37.75(33.00, 40.50)分、30.00(25.25, 33.00)分]均明显高于对照组[分别为(79.62±11.03)分、20.00(18.00, 23.00)分、34.50(31.33, 37.00)分、25.00(22.00, 28.17)分],差异均有统计学意义(t=5.537,P<0.001;Z=-3.608,P<0.001;Z=-3.215,P=0.001;Z=-4.035,P<0.001);出院后2个月末观察组患者的自我管理行为量表总分,以及坚持治疗、支持治疗、预防传播分量表得分[分别为(82.48±2.30)分、(23.31±1.77)分、(29.53±1.01)分、(29.64±0.76)分]均明显高于对照组[(78.05±4.27)分、(21.63±2.76)分、(27.78±1.87)分、(28.63±1.73)分],差异均有统计学意义(t=7.271,P<0.001;t=4.068,P<0.001;t=6.563,P<0.001;t=4.236,P<0.001)。观察组住院时长[11.00 (9.00, 14.00) d]与对照组[11.50 (9.50, 14.00) d]比较,差异无统计学意义(Z=-0.230,P=0.818)。出院后第2个月末观察组痰菌阴转率[91.67%(33/36)]与对照组[87.88%(29/33)]比较,差异无统计学意义(Fisher确切概率检验,P=0.702)。结论: 基于达标理论的出院准备服务有助于提升肺结核患者的出院准备度和自我管理行为,降低出院后2个月内的非计划再入院率,但对患者的住院时长和出院后第2个月末的痰菌阴转率影响不明显。

关键词: 结核,肺, 病人出院, 健康教育, 护理理论

Abstract:

Objective: To explore the application effects of a discharge preparation service program based on King’s theory of goal attainment in patients with pulmonary tuberculosis (PTB). Methods: Using purposive sampling, sixty-five patients with PTB from the TB department of Shanghai Public Health Clinical Center were enrolled as the control group (receiving routine discharge preparation) between August 2024 and October 2025. Another sixty-five PTB patients from the department of respiratory and critical care medicine were enrolled as the experimental group (receiving a discharge preparation service program based on King’s theory of goal attainment). During the study period, one patient dropped out from the experimental group and two from the control group, yielding a final sample of sixty-four patients in the experimental group and sixty-three in the control group. The two groups were compared on discharge readiness, length of hospital stay, self-management behaviors (pre- and post-intervention), unplanned readmission rates within two months after discharge, and the sputum negative conversion rate at the end of the second month after discharge. Results: After the intervention, the total score on the readiness for hospital discharge scale, as well as the scores on its personal status, adaptive ability, and anticipated support subscales, were significantly higher in the experimental group (89.82±9.69, 23.00 (20.00, 25.75), 37.75 (33.00, 40.50), 30.00 (25.25, 33.00)) than in the control group (79.62±11.03, 20.00 (18.00, 23.00), 34.50 (31.33, 37.00), 25.00 (22.00, 28.17)), with statistically significant differences (t=5.537, P<0.001; Z=-3.608, P<0.001; Z=-3.215, P=0.001; Z=-4.035, P<0.001). At two months after discharge, the total score on the self-management behavior scale, as well as the scores on its treatment adherence, treatment support, and transmission prevention subscales, were significantly higher in the experimental group (82.48±2.30, 23.31±1.77, 29.53±1.01, 29.64±0.76) than in the control group (78.05±4.27, 21.63±2.76, 27.78±1.87, 28.63±1.73), with statistically significant differences (t=7.271, P<0.001; t=4.068, P<0.001; t=6.563, P<0.001; t=4.236, P<0.001). The unplanned readmission rate within two months after discharge in the experimental group (14.06% (9/64)) was significantly lower than that in the control group (28.57% (18/63)), with a statistically significant difference (χ2=3.992, P=0.046). There was no statistically significant difference (Z=-0.230, P=0.818) in length of hospital stay between the experimental group (11.00 (9.00, 14.00) d) and the control group (11.50 (9.50, 14.00) d). At the end of the second month after discharge, the sputum negative conversion rate in the experimental group (91.67% (33/36)) showed no statistically significant difference (Fisher’s exact test,P=0.702) compared with the control group (87.88% (29/33)). Conclusion: The discharge preparation service based on King’s theory of goal attainment can effectively improve discharge readiness and self-management behavior, and reduce unplanned readmission rates within two months after discharge in patients with PTB, but has no significant effect on the length of hospital stay and sputum negative conversion rate at the end of the second month after discharge.

Key words: Tuberculosis, pulmonary, Patient discharge, Health education, Nursing theory

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