基于计划行为理论的延续性护理模式对脑卒中患者健康行为的影响

Effect of transitional care based on theory of planned behavior on health behavior of stroke patients

目的:探索计划行为理论(theory of planned behavior,TPB)在脑卒中患者延续性护理中的应用,建立更为高效的延续性护理模式。方法:以方便抽样法选取2015年7月至2016年6月在四川大学华西医院首次发病住院的脑卒中患者124例,年龄41~79(53.60±11.67)岁,按住院时间先后随机分为干预组(65例)与对照组(59例),对两组患者入院后进行健康行为因素和护理需求调查。对照组患者常规护理,于出院前1~2 d开展出院指导与脑卒中健康知识教育;干预组患者除常规护理外,实施以计划性理论为框架的延续性护理干预。嘱两组患者出院后3,6个月复检,收集基线信息和生化指标,并填写健康促进生活方式量表,评价干预效果。结果:随访124例患者,脑卒中首次发病后,患者延续性护理需求总分为94.21±0.98,家庭常用护理技术需求评分最高(12.73±0.97),脑卒中知识需求次之(12.42±1.02);干预前健康行为的总体评分为109.93±18.47,患者出院6个月后,对照组健康行为评分为118.58±16.78,干预组健康行为评分为133.85±18.66,提高幅度显著大于对照组(t=21.48,P<0.01);TPB的各变量之间存在两两相关,主观规范与行为意向的相关强度最大,知觉行为控制与健康行为评分间的相关性最大;对照组脑卒中复发率和并发症出现率均高于干预组(χ~2=10.14,P<0.01;χ~2=4.54,P=0.03)。结论:基于TPB的延续性护理,一定程度上能改变脑卒中患者不良健康行为、降低复发率及防止并发症的发生。

Objective： To explore the application of theory of planned behavior（TPB） in the transitional care of stroke patients and to establish a more effective continuum nursing model. Methods： From July 2015 to June 2016, 124 patients with stroke were randomly selected from West China Hospital of Sichuan University, and the age range of the patients was 41–79（53.60±11.67） years old. The patients were randomly divided into an intervention group（65 cases） and a control group（59 cases）. After admission, the two groups of patients were investigated for health behavior factors and nursing needs. The patients in the control group were given discharge guidance and stroke health knowledge education 1–2 d before discharge. In addition to routine care, patients in the intervention group were treated with a transitional care based on the planning theory. All patients were asked came back to hospital for a reexamination and to fill out the Health Promotion Lifestyle Scale in 3 and 6 months after discharge, and we will collect the baseline information and biochemical indicators and evaluate the effect of intervention. Results： After the first onset of stroke, the average score of need for nursing care were（94.21±0.98） points. The highest demands were home care services which scored（12.73±0.97） points and the demands for knowledge of stroke was followed by（12.42±1.02）. The score of pre-intervention health behavior was（109.93±18.47） points. After 6 months of discharged, the health behavior score of control group were（118.58±16.78） points, while the intervention group scored（133.85±18.66） points which was significantly higher than that of the control group（t=21.48, P〈0.01）. There is pairwise correlation between the variables of the TPB. The correlation between subjective norms and behavioral intention is the largest, and the correlation between perceptual behavior control and health behavior score is the largest. The recurrence rate and complication rate were significantly higher in the control group than in the intervention group（χ^2=10.14, P〈0.01; χ^2=4.54, P=0.03）. Conclusion： Transitional care based on TPB can change the adverse health behaviors of stroke patients, reduce the recurrence rate and prevent the occurrence of complications.