多个护理门诊联合健康教育对慢性结核性脓胸患者疾病不确定感的影响研究

Effects of health education of multiple nursing departments on uncertainty of illness in patients with chronic tuberculous empyema

【摘要】目的探讨多个护理门诊联合健康教育对慢性结核性脓胸患者疾病不确定感的影响。方法对2014年7月至2015年12月在上海市肺科医院门诊治疗的87例慢性结核性脓胸患者实施多个护理门诊联合方式进行健康教育，包括结核病护理门诊、胸外科护理门诊、伤口护理门诊、心理护理门诊，在健康教育实施前和实施后1个月应用疾病不确定感量表（包括不明确、复杂性、与疾病相关的信息缺乏或不一致性、不可预测性4个维度，32个条目；所有条目均采用Likert5级评分法，从“完全不同意”到“完全同意”分别赋值1～5分，分值32～160分，得分越高表示不确定的水平越高）和自行设计的疾病知识知晓测评表（包括结核性脓胸、胸腔闭式引流管、胸壁伤口3个方面25个题目的相关知识；每题4分，满分为100分）分别对患者疾病不确定感及疾病知识掌握程度进行测评，在符合正态分布的条件下对疾病不确定感量表测评各项目得分及疾病知识知晓测评表平均得分进行配对t检验，以P％0．05为差异有统计学意义。结果87例慢性结核性脓胸患者均接受了4个护理门诊37名护理人员联合健康教育及测评；实施前不明确、复杂性、与疾病相关的信息缺乏或不一致性、不可预测性各维度均分及总分均分分别为（47．65±0．78）分、（21．68±2．29）分、（18．96±2．72）分、（18．44±1．82）分、（106．75±5．21）分，实施后各维度均分及总分均分分别为（35．19±2．61）分、（15．90±2．90）分、（10．37±1．12）分、（12．31±1．19）分、（73．78±4．26）分，实施后的疾病不确定感量表各维度均分及总分均分均低于实施前（t值分别为3．198、3．309、3．313、3．010、3．041，P值分别为0．003、0．003、0．002、0．004、0．004）。疾病知识知晓测评表平均得分在健康教育实施后（88分）较实施前（68分）明显提高（t=6．825，P=0．000）。结论多个护理门诊联合健康教育能降低慢性结核性脓胸患者的疾病不确定感，提高患者对疾病知识的掌握程度。

Objective To explore the effects of health education performed by multiple nursing departments on uncertainty of illness in patients with chronic tuberculous empyema. Methods A total of 87 patients with chro- nic tuberculous empyema who received treatment at the Outpatient Department of Shanghai Pulmonary Hospital from July 2014 to December 2015 were enrolled into this study. Health education was provided to those patients by multiple nursing departments, including tuberculosis （TB） nursing clinic, thoracic surgical nursing clinic, wound care clinic and psychological nursing clinic. Before the health education and after 1 month of the health education, those patients were evaluated in terms of the degree of their uncertainty and knowledge about their illness by using the Mishel＇s Uncertainty in Illness Scale （MUIS） and the self-designed assessment form about the disease know- ledge. The MUIS included 32 items and covered four dimensions （ambiguity, complexity, inconsistency, and unpre- dictability）. A five-point Likert format was used for all items： from Strongly Disagree （1 point） to Strongly Agree （5 points）, and the total scores ranged from 32 to 160 points （the higher scores reflected the higher level of uncer- tainty of illness）. The self-designed assessment form empyema, closed thoracic drainage tube and wound of （each 4 points）. Scores of all items of the MUIS and on disease knowledge was related to 3 aspects= tuberculous chest wall. There were 25 questions for a total of 100 points the average score of the disease knowledge assessment form were analyzed by using t test, and P〈0.05 was considered to be statistically significant. Results All enrolled 87 cases received the health education which was performed by 37 paramedics from 4 nursing departments and were in- volved in the evaluation. Before the health education, the average score of ambiguity, complexity, inconsistency and unpredictability was 47. 65±0.78, 21.68±2. 29, 18.96±2.72 and 18.44!±1.82 respectively, the total average score was 106.75±5.21; after the health education, the average score of each dimension was 35.19± 2.61, 15.90±2.90, 10.37±1.12, 12.31±1.19 respectively, and the total average score was 73.78±4.26. The average score of each MUIS dimension and the total average score after the health education were significantly lower than those before the heahh education （t=3.198, 3.309, 3.313, 3.010, 3.041, P 0.003, 0.003, 0.002, 0.004, 0. 004）. The average score of the disease knowledge assessment form significantly improved from 68 before the health education to 88 after the health education （t=6. 825, P 0. 000）. Conclusion A combined health education performed by multiple nursing departments to the patients with chronic tuberculous empyema can reduce their uncer tainty of illness and improve their disease knowledge.