费曼式学习法干预模式改善终末期肾脏疾病患者健康素养及生活质量的研究

Research of Feynman′s Learning Method Intervention Model to Improve the Health Quality and Life Quality of Patients with End-stage Renal Disease

目的探讨费曼式学习法对提高终末期肾脏疾病(end-stage renal disease,ESRD)患者健康素养水平及生活质量的临床价值。方法选取本科室2018-01/2019-01月在作者科室规律随访的184例ESRD患者,随机分成研究组和对照组,每组各92例。研究组采用在常规护理的基础上融入费曼式学习法为框架制定的护理干预模式,对照组采用常规护理,比较两组患者健康素养水平、自我管理行为及生活质量。结果干预前两组患者的健康素养水平、自我管理行为及生活质量评分无统计学差异(P>0.05);入组后12个月,费曼式学习组的信息获取能力评分(t=-2.052,P=0.042)、沟通与互动能力评分(t=-2.386,P=0.018)、改善健康意愿评分(t=-2.637,P=0.009)、经济支持意愿(t=-4.631,P<0.001)及总体(t=-5.104,P<0.001)均高于对照组;入组后12个月研究组的慢性肾脏病自我管理量表(chronic kidney disease self-efficacy,CKD-SE)评分中自主性(t=-3.367,P=0.001)、自我调节(t=-3.390,P=0.001)、寻求社会支持(t=-2.064,P=0.040)和总体(t=-4.137,P<0.001)均高于对照组;入组后12个月研究组生存质量量表(36 item short from health survey,SF-36)评分躯体功能(t=-4.207,P<0.001)、角色限制(t=-4.692,P<0.001)、躯体不适(t=-2.532,P=0.017)、健康总体自评(t=-2.921,P=0.023)分值均高于对照组(P<0.05)。结论基于费曼式学习法的护理干预模式能提高ESRD患者的健康素养水平、自我管理行为及生活质量,有一定临床价值。

Objective To investigate the clinical value of Feynman′s learning method in improving the health literacy level and quality of life of patients with end stage renal disease(ESRD).Methods A total of 184 patients with ESRD who were regularly followed up in authors′center from January 2018 to January 2019 in the undergraduate room were selected and randomly divided into two groups,there were 92 patients in control group and 92 in study group,and the Study group adopted Feynman′s learning method as the framework of nursing intervention model based on routine nursing.Routine nursing were received by the control group.Then,the level of health literacy,self-behavior management and quality of life of patients in those two groups were compared.Results Before the intervention,there was no significant difference in the health literacy,self-management behavior and quality of life between the two groups of patients(P>0.05).Twelve months after enrollment,the Feynman learning group′s score of information acquisition ability(t=-2.052,P=0.042),score of communication and interaction ability(t=-2.386,P=0.018),willingness to improve health(t=-2.637,P=0.009),willingness of financial support(t=-4.631,P<0.001)and overall(t=-5.104,P<0.001)were higher than those of the control group.The chronic kidney disease self-efficacy(CKD-SE)scores of the study group at 12 months after enrollment included autonomy(t=-3.367,P=0.001),self-regulation(t=-3.390,P=0.001),seeking social support(t=-2.064,P=0.040)and overall(t=-4.137,P<0.001)were all higher than those of the control group.Twelve months after enrollment,the study group′s 36 item short from health survey(SF-36)physical functioning(t=-4.207,P<0.001),role physical(t=-4.692,P<0.001),bodily pain(t=-2.532,P=0.017),general health(t=-2.921,P=0.023)were higher than those of the control group(P<0.05).Conclusion The nursing intervention model based on Feynman′s learning method can improve the level of health literacy,self-management behavior and quality of life of patients with ESRD,which has certain clinical value.