医患共享决策模式结合个体化管理对狼疮性肾炎患者自我管理行为和医嘱执行力及生活质量的影响

Effects of shared decision-making model combined with individualized management on self-management behaviors,execution of doctor's orders and quality of life of patients with lupus nephritis

目的:探讨医患共享决策(SDM)模式结合个体化管理对狼疮性肾炎患者自我管理行为、医嘱执行力和生活质量的影响。方法:选择2019年1月—2020年6月进行干预的狼疮性肾炎患者100例,按照随机数字表法分为对照组和观察组,每组50例。对照组给予常规护理干预,观察组给予SDM模式结合个体化管理。比较两组患者干预前后的自我管理行为、医嘱执行力、焦虑、抑郁评分及生活质量。结果:两组患者干预前的症状管理、情绪管理、自我效能、日常生活管理、信息管理评分比较,差异无统计学意义(P>0.05);干预后观察组上述评分高于对照组,差异有统计学意义(P<0.05)。干预前,两组患者各项医嘱执行力评分比较,差异无统计学意义(P>0.05);干预后,观察组患者的医嘱执行力评分高于对照组,差异有统计学意义(P<0.05)。干预后观察组的焦虑评分(SAS)量表和抑郁评分(SDS)量表评分低于对照组,差异有统计学意义(P<0.05)。两组干预前的物质生活、社会功能、躯体功能、心理功能、生活质量评分比较,差异无统计学意义(P>0.05);干预后两组上述评分均增高,且观察组显著高于对照组,差异有统计学意义(P<0.05)。结论:对狼疮性肾炎患者实施SDM模式结合个体化管理,有助于加强患者的自我管理行为,提高医嘱执行力,改善患者的焦虑、抑郁情绪,生活质量更高。

Objective:To explore the effects of shared decision-making(SDM)model combined with individualized management on self-management behaviors,execution of doctor's orders and quality of life of patients with lupus nephritis.Methods:A total of 100 patients with lupus nephritis who were treated at the hospital between January 2019 and June 2020 were divided into control group and observation group by random number table method,50 cases in each group.The control group was given routine nursing intervention,and the observation group was given SDM model combined with individualized management.Self-management behaviors,execution of doctor’s orders,anxiety and depression scores and quality of life were compared between the two groups before and after intervention.Results:There were no significant differences symptom management,emotion management,self-efficacy,daily life management and information management scores between the two groups before intervention(P>0.05).After intervention,the above scores of observation group were higher than those of the control group(P<0.05).Befcre the intervention,there was no statistically significant difference in the scores of execution of doctor's orscores between two groups(P>0.05).After intervention,the scores of execution of doctor's orders of observation group were higher than those of the control group(P<0.05).Self-rating anxiety scale(SAS)and self-rating depression scale(SDS)of the observation group were significantly better than those of the control group after intervention(P<0.05).There were no significant differences in material life,social function,physical function,psychological function and quality of life scores between the two groups before intervention(P>0.05).After intervention,the above scores increased,which of the observation group were significantly higher than the control group(P<0.05).Conclusion:The implementation of SDM model combined with individualized management intervention in patients with lupus nephritis can help strengthen patients'self-management behaviors,improve their execution of doctor's orders,relieve anxiety and depression,and improve quality of life.