时机理论框架下授权赋能教育对急性心肌梗死介入术后应对方式及自我管理能力的影响-现代医学

时机理论框架下授权赋能教育对急性心肌梗死介入术后应对方式及自我管理能力的影响

单位：南京医科大学第一附属医院心血管内科, 江苏南京 210029

分类号：R473.5

出版年·卷·期（页码）：2024·52·第三期（384-391）

摘要：

目的：探索时机理论框架下授权赋能教育对急性心肌梗死(AMI)介入术后应对方式及自我管理能力的影响。方法：应用便利抽样法纳入本院2022年8月至2023年7月接受经皮冠状动脉介入术(PCI)治疗的AMI患者124例，依据入院时间顺序分为研究组(62例)和参照组(62例)。参照组给予常规护理干预，研究组给予时机理论框架下授权赋能教育，两组均干预3个月。比较两组干预前后医学应对方式问卷(MCMQ)、冠心病自我管理量表(CSMS)、欧洲五维健康量表(EQ-5D)等评分。结果：研究组干预后回避、屈服维度评分低于参照组(t＝8.149、9.857,均P＜0.001)，面对维度评分高于参照组(t＝7.555,P＜0.001)，差异具有统计学意义；两组干预前后MCMQ各维度评分差值差异具有统计学意义(t＝9.621、10.707、15.060,均P＜0.001)；研究组干预后情绪认知管理、治疗依从性管理、疾病知识获得管理、症状管理、一般生活管理与不良嗜好管理维度评分及总分均较参照组高，差异具有统计学意义(t＝5.240、6.521、5.385、2.033、7.524、8.839、11.401,均P＜0.05)；两组干预前后情绪认知管理、治疗依从性管理、疾病知识获得管理、症状管理、一般生活管理与不良嗜好管理维度评分及总分的差值差异具有统计学意义(t＝25.656、14.551、12.207、5.195、18.240、24.311、24.664,均P＜0.001)；研究组干预后健康状况视觉模拟量表(EQ-VAS)、健康描述系统(EQ-5D-3L)效用值评分均较参照组高，差异具有统计学意义(t＝6.879、6.407,均P＜0.001)，研究组EQ-VAS、EQ-5D-3L效用值评分干预前后差值大于参照组(t＝13.477、14.173,均P＜0.001)。结论：应用时机理论框架下授权赋能教育可改善AMI患者PCI术后应对方式及自我管理能力，利于提升生活质量。

Objective: To explore the effect of empowerment education on coping style and self-management ability after acute myocardial infarction(AMI) intervention under the framework of timing theory.Methods: A total of 124 patients with AMI who underwent percutaneous coronary intervention(PCI) in our hospital from August 2022 to July 2023 were selected by convenience sampling method. According to the order of admission time, they were divided into study group(62 cases) and reference group(62 cases). The reference group was given routine nursing intervention, and the study group was given empowerment education under the framework of timing theory. Both groups were intervened for 3 months. The scores of Medical Coping Style Questionnaire(MCMQ), Coronary Heart Disease Self-Management Scale(CSMS) and European Five-Dimensional Health Scale(EQ-5D) were compared between the two groups before and after the intervention.Results: After intervention, the scores of avoidance and yield dimensions of the study group were lower than those of the reference group, and the scores of the face dimension were higher than those of the reference group, the differences were statistically significant(t=8.149, 9.857, 7.555, all P＜0.001). There were significant differences in the scores of each dimension of MCMQbetween the study group and the reference group before and after intervention(t=9.621, 10.707, 15.060, all P＜0.001).The scores of emotional cognition management, treatment compliance management, disease knowledge acquisition management, symptoms management, general life management and bad habits management, and total scores of study group were higher than those of the reference group, and the differences were statistically significant(t=5.240, 6.521, 5.385, 2.033, 7.524, 8.839, 11.401, all P＜0.05). There were statistically significant differences in the scores of emotional cognition management, treatment compliance management, disease knowledge acquisition management, symptoms management, general life management and bad habits management dimensions and total scores in the CSMS scale before and after intervention in the study group and the reference group(t=25.656, 14.551, 12.207, 5.195, 18.240, 24.311, 24.664, all P＜0.001). The post-intervention health status visual analog scale(EQ-VAS) and EQ-5D-3L utility value score of the study group were higher than those of the reference group(t=6.879, 6.407, all P＜0.001), and the pre- and post-intervention differences in EQ-VAS and EQ-5D-3L utility scores of the study group were greater than those of the reference group(t=13.477, 14.173, all P＜0.001). Conclusion: The application of empowerment education under the framework of timing theory can improve the coping style and self-management ability of patients with AMI after PCI, which is beneficial to improve the quality of life.

参考文献：

[1] 中国心血管健康与疾病报告编写组.中国心血管健康与疾病报告2019概要[J].心脑血管病防治,2020,20(5):437-450.
[2] SAITO Y,KOBAYASHI Y.Percutaneous coronary intervention strategies in patients with acute myocardial infarction and multivessel disease:completeness,timing,lesion assessment,and patient status[J].J Cardiol,2019,74(2):95-101.
[3] 赵玉君,孙宏超,王翠平,等.外周血单个核细胞miR-143表达对STEMI患者急诊PCI术后1年发生支架内再狭窄的预测价值[J].东南大学学报(医学版),2021,40(2):164-169.
[4] WU Q,ZHANG D,ZHAO Q,et al.Effects of transitional health management on adherence and prognosis in elderly patients with acute myocardial infarction in percutaneous coronary intervention:a cluster randomized controlled trial[J].PLoS One,2019,14(5):e0217535.
[5] SHAN Z,HUANG H,TANG S.Effect of diversified and staged health education on the compliance of elderly patients with coronary heart disease[J].Ann Palliat Med,2020,9(6):4074-4080.
[6] CAMERON J I,GIGNAC MAM.“Timing it right”:a conceptual framework for addressing the support needs of family caregivers to stroke survivors from the hospital to the home[J].Patient Educ Couns,2008,70(3):305-314.
[7] WOHLFAHRT P,STEHLIK J,PAN I Z,et al.Empowering people living with heart failure[J].Heart Fail Clin,2020,16(4):409-420.
[8] 胡晓蓉,李修英,许娟,等.赋能授权教育模式在糖尿病血糖控制不佳患者中的应用[J].中华全科医学,2021,19(8):1339-1342.
[9] 中华医学会心血管病学分会,中华心血管病杂志编辑委员会,《中国循环杂志》编辑委员会.急性心肌梗死诊断和治疗指南[J].中华心血管病杂志,2001,29(12):710-725.
[10] FEIFEL H,STRACK S,NAGY V T.Coping strategies and associated features of medically ill patients[J].Psychosom Med,1987,49(6):616-625.
[11] 沈晓红,姜乾金.医学应对方式问卷中文版701例测试报告[J].中国行为医学科学,2000,9(1):18.
[12] 任洪艳,唐萍,赵庆华.冠心病自我管理量表的开发和评价[J].第三军医大学学报,2009,31(11):1087-1090.
[13] EUROQOL GROUP.Euroqol--a new facility for the measurement of health-related quality of life[J].Health Policy,1990,16(3):199-208.
[14] LIU G G,WU H,LI M,et al.Chinese time trade-off values for EQ-5D health states[J].Value Health,2014,17(5):597-604.
[15] 徐英,侯霁芯,庄雪平,等.医护患协同模式对经皮冠状动脉介入治疗术后患者自我管理能力及心血管事件的影响[J].中国实用护理杂志,2021,37(3):190-196.
[16] 芮立美,高学姣,朱红涛,等.赋能教育在中青年冠心病患者PCI术后的应用效果研究[J].现代医学,2022,50(11):1451-1455.
[17] WEN M,LIANG Y,SHEN Q,et al.The effect of resourcefulness training on depression and coping styles of patients with coronary heart disease in China:retraction[J].J Cardio vasc Nurs,2021,36(2):130.
[18] 王一,赵乐妍,陈飞,等.正强化干预对急性心肌梗死患者心理弹性量表评分和健康结局的影响[J].中国心血管病研究,2022,20(1):25-29.
[19] 秦庆祝,李一聪,范晓青.时机理论对PCI患者自我管理行为和服药依从性的影响[J].中华现代护理杂志,2019,25(16):2058-2060.
[20] 章琳慧,徐兰,金艳.基于时机理论的延续护理对PCI手术患者自护能力及术后恢复的影响[J].中华现代护理杂志,2018,24(22):2698 -2701.

服务与反馈：

【文章下载】【发表评论】【查看评论】【加入收藏】

提示：您还未登录，请登录！点此登录