基于认知改善的临床护理在糖尿病自我效能中的作用

Role of Cognitive Improvement-Based Clinical Nursing in Diabetes Self-Efficacy

目的探讨基于认知改善的临床护理对糖尿病患者自我效能的作用。方法选择2013年12月至2014年5月在中国人民解放军第九四医院住院治疗的糖尿病患者92例,针对改善糖尿病患者的疾病认知开展针对性的健康教育和心理疏导。在干预前后采用简易疾病认知问卷(包括疾病辨识、疾病时间性、疾病结果、疾病个人可控性、疾病治疗可控性、疾病综合理解、疾病对患者情绪的影响及疾病关心度)及糖尿病患者自我效能量表(饮食控制、运动、药物治疗、血糖监测、自我护理及并发症处理)对患者疾病认知水平及自我效能进行评分。结果 92例糖尿病患者,12例失访,共80例患者纳入本研究。干预后患者对疾病结果、疾病个人可控性、疾病综合理解、疾病关心度及疾病对情绪影响的评分较干预前均有显著改善,差异有统计学意义(均P<0.05);干预前后患者对疾病辨识、疾病时间性及疾病医疗可控性的评分比较差异均无统计学意义(均P>0.05)。干预后患者总自我效能及饮食控制、血糖监测、自我护理、并发症处理评分较干预前均显著升高(均P<0.05),运动和药物治疗评分干预前后比较差异均无统计学意义(均P>0.05)。糖尿病自我效能与疾病的个人可控性和综合理解呈正相关(r=0.545、0.313,均P<0.05),与疾病对情绪的影响呈负相关(r=-0.358,P<0.05)。结论基于改善糖尿病患者疾病认知的临床护理可提高患者的自我效能。

Objective To explore the role of cognitive improvement-based clinical nursing in diabetes self-efficacy.Methods Health education and psychological counseling were performed in 92 patients treated for diabetes in No.94 Hospital of Chinese People’s Liberation Army between December 2013 and May 2014 to improve the cognition of patients with diabetes.Patient cognition with disease and self-efficacy were evaluated by using the brief illness perception questionnaire （disease identification,disease timeliness,disease outcome,individual controllability,treatment controllability,comprehensive understanding of disease,effect of disease on emotion,and concern about disease）and the diabetes self-efficacy scale（diet control,exercise,medication,blood glucose monitoring,self-care,and complication treatment）,respectively.Results Among the 92 patients, 12 patients were lost to follow-up,and the other 80 patients completed this study.The scores of disease outcome,individual controllability,comprehensive understanding of disease,concern about disease,effect of disease on emotion,diet control,blood glucose monitoring,self-care and complication treatment were obviously improved after intervention（P〈0.05）.No significant changes in scores of disease identification,disease timeliness,treatment controllability,exercise and medication were found after intervention（P〉0.05）.Diabetes self-efficacy was positively correlated with individual controllability and comprehensive understanding of disease（r=0.545 and 0.313,respectively;P 〈0.05）,but negatively correlated with the effect of disease on emotion（r=-0.358,P〈0.05）.Conclusion Cognitive improvement-based clinical nursing can improve the self-efficacy of diabetes patients.