基于罗伊适应模式的护理干预对心力衰竭患者适应的促进作用

Theory-guided interventions for Chinese patients to adapt to heart failure:A quasi-experimental study

目的探讨基于罗伊适应模式的护理干预措施对促进心力衰竭患者适应的作用。方法2018年3月至2019年11月,在杭州市一所有多个院区的医院开展类实验研究。采用方便抽样纳入112例心力衰竭患者,按照所在院区分为干预组55例、对照组57例。干预组实施基于罗伊适应模式的个性化护理照护计划,对照组接受常规患者教育并在出院前发放家庭照护手册。采用心脏超声检查、明尼苏达心力衰竭量表(MinnesotaLiving with Heart Failure Questionnaire,MLHFQ)、知识问卷、心力衰竭自我护理量表(Self-care Heart FailureIndex,SCHFI)和应对适应过程量表(Adaptation Processing Scale-Short Form,CAPS-SF)评价患者基线水平和出院6个月时生理功能、自我概念、角色功能和互相依赖方面的适应情况。结果共有91例心力衰竭患者完成此项研究,其中,干预组43例,对照组48例。干预组完成了60%以上的干预内容。随访6个月,干预组患者适应性行为良好,各项指标得分高于对照组:MLHFQ(70.90+22.45 vs.54.78±18.04)、心力衰竭知识(13.79土2.45vs.10.73主4.28),SCHFI维持维度(57.67±13.22 vs.50.35±10.88),CAPS-SF(40.23+4.36 vs.38.27+2.60),差异有统计学意义(P<0.05)。两组左室射血分数、SCHFI管理维度和SCHFI信心维度得分差异没有统计学意义(P>0.05)。结论研究结果提示心力衰竭患者存在积极适应,基于罗伊适应模式形成的理论框架能有效应用于心力衰竭患者护理的临床实践。基于该理论的个性化护理方案能促进心力衰竭患者的适应行为。

Objectives:To examine the effects of the Roy Adaptation Model-based interventions on adaptation in persons with heart failure.Methods:A quasi-experimental study was conducted in Hangzhou,China,from March 2018 to November 2019.A convenience sample of 112 participants with heart failure from a multi-campus hospital was enrolled.Participants were allocated into an intervention group(n=55)and a control group(n=57)according to their hospitalized campus.A culturally-tailored care plan intervention based on the Roy Adaptation Model was performed in the intervention group.The control group received bedside patient education and a regular booklet for HF home care before discharge.Heart ultrasound,Minnesota Living with Heart Failure Questionnaire(MLHFQ),a knowledge survey,Self-care Heart failure Index(SCHFI),and Coping and Adaptation Processing Scale-Short Form(CAPS-SF)were used to measure patients’levels of adaptation of physical function,self-concept,role function,and interdependence at baseline and six months after discharge.Results:Ninety-one participants with complete data,43 in the intervention group and 48 in the control group,were included in the analysis for the primary endpoints and showed adaptive improvement trends.Most patients in the intervention group completed 60%or more of the given interventions.At the sixth month after discharge,compared with the control group,the intervention group had improved adaptive behaviors showing higher scores of the MLHFQ(70.90±22.45 vs.54.78±18.04),heart failurerelated knowledge(13.79±2.45 vs.10.73±4.28),SCHFI maintenance(57.67±13.22 vs.50.35±10.88),and CAPS-SF(40.23±4.36 vs.38.27±2.60)at the six-month follow-up(P<0.05).There were no significant differences between the two groups in the scores of left ventricular ejection fraction,scores of SCHFI management and SCHFI confidence subscales(P>0.05).Conclusions:The findings reported evidence of positive adaptation in patients with heart failure,indicating that the Roy Adaptation Model is an effective guide for developing an implemented framework for the nursing practice of the patients.The culturally-tailored care plan intervention is helpful to improve adaptation of patients with heart failure.