基于ICF的家庭赋权方案在心力衰竭病人居家护理中的应用

Effects of ICF-based family empowerment program on home care of patients with heart failure

目的探讨基于《国际功能、残疾和健康分类》(ICF)的家庭赋权方案对居家心力衰竭(心衰)病人的健康状态、疾病预后和主要照顾者疾病照护负担的影响。方法采用方便抽样法,选取2018年11月至2019年7月在江苏省某三甲医院心内科住院的104名心衰病人及其主要照顾者为干预对象,对照组采用常规护理,试验组在对照组基础上采用基于ICF的家庭赋权方案。采用慢性心力衰竭病人照顾者客观负担量表评估照顾者照护负担,比较2组出院后第1、3个月病人再入院率与全因死亡率。结果最终纳入试验组48例、对照组45例,出院前及出院1个月后,2组病人各ICF功能分级比较,差异均无统计学意义(P>0.05)。出院3个月后,2组病人水、矿物质和电解质平衡功能、情感功能、睡眠功能、再入院率、全因死亡率差异均有统计学意义。2组主要照顾者慢性心力衰竭病人照顾者客观负担量表各维度得分在出院时差异无统计学意义(P>0.05),出院1个月后个人照顾维度差异具有统计学意义(P<0.01),出院3个月后,除激励支持维度,其他维度差异均有统计学意义。结论基于ICF家庭赋权方案的应用,能在改善心衰病人功能状态与疾病预后的同时,减轻其主要照顾者的疾病照护负担,对病人、家属双方均有益。

Objective To explore the effects of ICF-based family empowerment program on the patients’function status and prognosis and the care burden of primary caregivers in home care of patients with heart failure.Methods From November 2018 to July 2019,we selected 104 patients with heart failure and their main caregivers as subjects by convenience sampling.All of the subjects were divided into control group and experimental group with the method of random number table.Patients in the control group carried out routine nursing.On the basis of control group,experimental group applied family empowerment program based on ICF.Dutch Objective Burden Inventory was used to assess caregivers'burden.The readmission rate and all-cause mortality were compared between the two groups one and three months after discharge.Results Finally,a total of 48 cases were included in experimental group and 45 included in control group.There was no statistically significant difference between the two groups in the ICF assessment function grades before and one month after discharge(P>0.05).After three months,mineral,water and electrolyte balance function,emotional function,sleep function,readmission rate and all-cause mortality were statistically significant between the two groups.The main caregivers burden score of each dimension in the two groups at discharge were of no statistical difference(P>0.05).One month later,the difference in dimension of personal care was statistically significant(P<0.01),and three months later,except for the incentive support dimension,the differences in the other dimensions were all statistically significant between the two groups.Conclusions Appling the family empowerment scheme based on ICF in the home care for heart failure can not only improve patients'functional status and disease prognosis,but also reducing the burden of disease care for primary caregivers,which is beneficial to both patients and their families.