流程化沟通模式结合微信随访对肺结核并发2型糖尿病患者的护理效果观察

Nursing effect of CICARE model of communication combined with WeChat for follow-up of type 2 diabetes mellitus patients complicated with pulmonary tuberculosis＆#39; s observation

目的 探讨运用流程化沟通模式（CICARE model of communication,CICARE）结合微信随访教育对肺结核并发2型糖尿病患者实施护理的效果.方法 选取2016年1月1日至6月1日新疆维吾尔自治区胸科医院住院治疗的80例肺结核并发2型糖尿病患者,按照随机数字表法将患者分为对照组（40例）和实验组（40例）.对照组患者在住院期间及出院后6个月均给予常规健康教育;实验组患者在对照组常规健康教育的基础上,住院期间辅以流程化沟通模式对患者开展健康教育工作,出院后加用微信随访6个月.比较两组患者入院时与出院6个月后的健康知识知晓情况、一般自我效能感评分、治疗依从性等方面的差异.通过SPSS 17.0软件分析数据,计数资料用频数和百分比表示,率的比较采用卡方检验;计量资料用“（x）±s”表示,均数的比较采用t检验;均以P＜0.05为差异有统计学意义.结果 干预6个月后实验组在消毒隔离（75.0％,30/40）、疾病知识（62.5％,25/40）、治疗方法（70.0％,28/40）、药物相关知识（87.5％,35/40）、饮食与休息（75.0％,30/40）等方面的知晓率及总知晓率（74.0％,148/200）均高于对照组（17.5％,7/40;20.0％,8/40;30.0％,12/40;25.0％,10/40;37.5％,15/40;26.0％,52/200）（x2值分别为26.60、14.91、12.80、31.75、11.43、92.16,P值均＜0.001）.实验组在消毒隔离[（13.10±2.53）分]、疾病知识[（15.33±2.71）分]、治疗方法[（15.90±1.72）分]、药物相关知识[（14.63±2.37）分]、饮食与休息[（16.10±1.98）分]等方面的得分均高于对照组[（11.80±2.04）分、（14.08±2.30）分、（14.25±2.06）分、（13.03±2.07）分、（14.45±2.69）分]（t=2.53,P=0.013;t=2.22,P=0.029;t=3.89,P=0.001;t=3.22,P=0.002;t=3.12,P=0.003）.实验组干预6个月后一般自我效能感评分[（20.38±3.41）分]高于对照组[（18.77±3.17）分]（t=2.17,P=0.032）;实验组在饮食干预（60.0％,24/40）、药物治疗（67.5％,27/40）、自我监测（80.0％,32/40）、戒烟戒酒（60.0％,24/40）方面的依从率及总的依从率（63.8％,153/240）高于对照组[37.5％,15/40;45.0％,18/40;50.0％,20/40;35.0％,14/40;42.1％,101/240]（x2=4.05,P=0.044;x2 =4.11,P=0.043;x2=7.91,P=0.005;x2=5.01,P=0.025;x2=22.61,P=0.000）.结论 应用流程化沟通模式结合微信平台的沟通和传播功能,可以提高新疆地区肺结核并发2型糖尿病患者的认知水平和自我护理能力,并且有利于疾病控制,从而提高临床治疗效果.

Objective To explore the nursing effect of CICARE model of communication combined with WeChat for follow-up of type 2 diabetes mellitus patients complicated with pulmonary tuberculosis＇s observation.Methods Eighty type 2 diabetes mellitus patients complicated with pulmonary tuberculosis from Xinjiang Uygur Autonomous Region Chest Hospital between January 1,2016 and June 1,2016 were randomly divided into control group （n=40） and experimental group （n=40）.Patients in the control group were given routine health education during hospitalization and after discharge.As to patients in experimental group,they were additionally given CICARE mode of communication during hospitalization and were followed up for 6 months with WeChat.The differences of health knowledge,general self-efficacy score and treatment compliance between the two groups were compared using SPSS 17.0.Counting data are expressed by frequency and percentages,measuring data were recorded as ＂（x）±s＂.The Chi-square test was used to compare the rates of the two groups.The difference was statistically significant when P〈0.05.Results Six months after the intervention,the disinfection and isolation （75.0%,30/40）,knowledge of the disease （62.5%,25/40）,treatment （70.0%,28/40）,drug related knowledge （87.5%,35/40）,diet and rest （75.0%,30/40） and other aspects of the awareness rate of experimental group in were higher than those of the control group （17.5%,7/40;20.0%,8/40;30.0%,12/40;25.0%,10/40;37.5%,15/40）（Chi-square were 26.60,14.91,12.80,31.75 and 11.43,respectively;all P〈0.01）.Scores of experimental group in the disinfection and isolation （13.10± 2.53）,disease knowledge （15.33 ± 2.71）,treatment （15.90±1.72）,drug related knowledge （14.63±2.37） and diet and rest （16.10± 1.98） were higher than those of the control group （（11.80±2.04）,（14.08±±2.30）,（14.25±2.06）,（13.03±2.07） and （14.45±2.69）,respectively）（t=2.53,P=0.013;t=2.22,P=0.029;t=3.89,P=0.001;t=3.22,P=0.002;t=3.12,P=0.003）.After the intervention for 6 months,the general self-efficacy score （20.38± 3.41） was higher than that of the control group （18.77± 3.17） （t=2.17,P =0.032）.The diet intervention （60.0%,24/40）,drug therapy （67.5%,27/40）,self monitoring （80.0%,32/40）,smoking and drinking （60.0%,24/40） of experimental group are higher than those in the control group （37.5% （15/40）,45.0% （18/40）,50.0% （20/40）,35.0% （14/40）） （x2 =4.05,P=0.044;x2=4.11,P=0.043;x2=7.91,P=0.005;x2=5.01,P=0.025）.Conclusion The application of CICARE model of communication combined with WeChat could improve the patients＇ cognitive level and self-care ability,and is conducive to disease control,to improve clinical treatment.