Orem 自理模式对脑卒中康复期患者自理能力及心理状况的影响

Effect of Orem self-care mode on the self-care ability and psychological status in patients with stroke rehabilitation

目的：探讨Orem自理模式对脑卒中康复期患者的个人自理能力及心理状况的影响。方法符合纳入标准的脑卒中患者60例，按随机顺序分为对照组和观察组，每组各30例。对照组采用传统的脑卒中常规护理，观察组在此基础上运用Orem自理模式进行护理，在干预前和干预2个月后采用护士用住院患者观察量表（NOSIE）评分进行效果评定，应用症状自评量表（SCL-90）评定患者的心理状况。结果干预前两组患者的NOSIE及SCL-90评分比较，差异无统计学意义（P＞0．05）。干预2个月后观察组NOSIE总分、社会功能、社会兴趣、个人卫生因子得分为（123．49±13．24），（32．76±5．29），（33．59±7．28），（26．34±3．52）分，明显高于对照组（107．57±11．23），（26．32±4．09），（23．29±4．28），（19．29±3．19）分；观察组患者的退缩、抑郁因子得分为（4．02±2．12），（2．03±1．24）分，明显低于对照组的（6．87±1．05），（3．78±1．09）分，两组比较差异均有统计学意义（t值分别为5．023，5．275，6．680，8．129，6．598，5．805；P均＜0．01）。观察组患者SCL-90总分及抑郁、焦虑、躯体化、人际关系因子分分别为（109．59±21．37），（1．81±0．45），（1．23±0．42），（1．09±0．47），（1．32±0．43）分，明显低于对照组的（130．42±29．47），（2．45±0．73），（2．13±0．29），（3．41±0．92），（2．32±0．47）分，两组比较差异均有统计学意义（t值分别为3．134，4．088，9．658，8．311，8．598；P均＜0．01）。结论应用Orem自理模式对脑卒中康复期患者的个人自理能力及心理状况均有显著的改善作用，尤其表现在抑郁、焦虑方面。

Objective To explore the effect of Orem self-care mode on the self-care ability and psychological status in patients with stroke rehabilitation .Methods Sixty stroke patients who met the inclusion criteria were randomly divided into the observation group and the control group in random order , each with 30 cases.The control group received traditional conventional nursing , while the observation group received Orem self-care mode on the basis of conventional nursing .The nurses observation scale for inpatient evaluation＆nbsp;（ NOSIE） was used to assess the clinical effect before the intervention and two months after the intervention , and the psychological status was evaluated by Symptom Checklist-90 （ SCL-90 ） .Results No significant differences were found in the scores of NOSIE and SCL-90 between two groups before intervention （P〉0.05）.The scores of total NOSIE, social function, social interest, personal hygiene were respectively （ 123.49 ±13.24 ）, （32.76 ±5.29）, （33.59 ±7.28）, （26.34 ±3.52） in the observation group two months after intervention , and were significantly higher than （107.57 ±11.23）, （26.32 ±4.09）, （23.29 ±4.28）, （19.29 ±3.19） in the control group;the scores of withdrawal and depression were respectively （4.02 ±2.12）, （2.03 ±1.24） in the observation group two months after intervention , and were significantly lower than （6.87 ±1.05）, （3.78 ± 1.09） in the control group, and the differences were statistically significant （t=5.023, 5.275, 6.680, 8.129, 6.598, 5.805, respectively;P〈0.01）.The total score of SCL-90 and the factor scores of depression , anxiety, somatization, interpersonal were respectively （109.59 ±21.37）, （1.81 ±0.45）, （1.23 ±0.42）, （1.09 ± 0.47）, （1.32 ±0.43） in the observation group, and were significantly lower than （130.42 ±29.47）, （2.45 ±0.73）, （2.13 ±0.29）, （3.41 ±0.92）, （2.32 ±0.47） in the control group, and the differences were statistically significant （ t =3.134, 4.088, 9.658, 8.311, 8.598, respectively; P 〈0.01 ）. Conclusions Application of Orem self-care mode plays a significant role in the improvement of self-careability and psychological status of patients with stroke rehabilitation , especially in depression and anxiety .