叙事护理模式对进展期胰腺炎并发糖尿病患者自我管理能力和生活质量的影响

Effect of narrative nursing model on self-management ability and quality of life of patients with advanced pancreatitis and diabetes

背景胰腺炎症会造成患者胰岛β细胞破坏、减少,产生应激性高血糖情况,诱发糖尿病等并发症,不仅延长病程,且会降低患者生活质量.因此,在治疗同时加强护理干预在提升进展期胰腺炎并发糖尿病患者生活质量具有重要意义.目的评价叙事护理模式对进展期胰腺炎并发糖尿病患者自我管理能力和生活质量的影响.方法本研究为单中心、前瞻性、随机对照研究,将2019-03/2021-02就诊的48例进展期胰腺炎并发糖尿病患者纳入研究,按照患者入院时间统一依次编号,根据随机数字表法分为对照组、试验组,各24例.两组均接受常规护理,试验组在此基础上开展叙事护理模式.对比两组疾病恢复情况、肠功能障碍及血糖控制情况、健康行为能力、健康生活方式、心理弹性、自我管理能力、生活质量、并发症.结果试验组尿淀粉酶恢复正常、腹痛腹胀消退、体温恢复正常、首次排便及住院所用时间均短于对照组(P<0.05);试验组护理后肠功能障碍评分、糖尿病生存质量特异性量表评分(diabetes quality of life specific scale,DSQL)及空腹血糖(fasting blood glucose,FBG)、餐后2 h血糖(blood glucose 2 h after meal,2hPG)、糖化血红蛋白(glycosylated hemoglobin,HbAlc)水平均比对照组低,健康行为能力自评量表(self-rated abilities health practices scale,SRAHP)、健康促进生活方式量表Ⅱ(health promoting lifestyle profile-Ⅱ,HPLP-Ⅱ)、心理韧性量表(mental resilience scale,RS)-14评分均比对照组高(P<0.05);试验组并发症发生率略低于对照组(8.33%vs 16.67%),但差异无统计学意义(P<0.05).结论针对进展期胰腺炎并发糖尿病患者实施叙事护理模式的效果显著,有助于提升自我管理能力、健康行为能力,缓解临床症状体征,控制血糖水平,改善健康,促进生活方式及生活质量.

BACKGROUND Pancreatic inflammation can cause the destruction and reduction of pancreatic isletβcells in patients,elicit stress-induced hyperglycemia,and induce complications such as diabetes,which not only prolongs the course of the disease,but also reduces the patient’s quality of life.Therefore,strengthening nursing interventions during treatment to improve the quality of life of patients with advanced pancreatitis and diabetes is of great significance.AIM To evaluate the impact of narrative nursing mode on the self-management ability and quality of life of patients with advanced pancreatitis and diabetes.METHODS This study is a single-center,prospective,randomized controlled study.Forty-eight patients with advanced pancreatitis and diabetes who were admitted to our hospital from March 2019 to February 2021 were included in the study.The patients were numbered in sequence according to the time of admission.The digital table method was used to divide the patients randomly into a control group and an experimental group,each with 24 cases.Both groups received routine nursing,and the experimental group received a narrative nursing model on this basis.The two groups were compared for disease recovery,intestinal dysfunction,blood sugar control,healthy behavior ability,healthy lifestyle,mental flexibility,self-management ability,quality of life,and complications.RESULTS In the experimental group,urinary amylase returned to normal,abdominal pain and bloating subsided,body temperature returned to normal,and the time to the first defecation and hospitalization were shorter compared with the control group(P<0.05).After nursing care,intestinal dysfunction and diabetes quality of life specific scale scores,fasting blood glucose,2 h postprandial blood glucose,and glycosylated hemoglobin levels were significantly lower,and Self-rating Health Behavior Ability Scale,Health Promotion Lifestyle Scale II,and Psychological Resilience Scale scores were significantly higher in the experimental group than in the control group(P<0.05).The incidence of complications in the experimental group was slightly lower than that in the control group(8.33%vs 16.67%),but the difference was not statistically significant(P<0.05).CONCLUSION The implementation of narrative care mode for patients with advanced pancreatitis and diabetes has a significant effect,which helps to improve self-management ability and healthy behavior ability,relieve clinical symptoms and signs,control blood sugar level,improve health,and promote lifestyle and quality of life.