自我管理为导向的5A护理模式在老年哮喘患者中的应用

Application of self-management-oriented 5A nursing model in elderly patients with asthma

目的研究自我管理为导向的5A护理模式在老年哮喘患者中的应用。方法本研究为随机对照试验。选取2019年1月至2022年1月于蒙阴县人民医院呼吸内科就诊的老年哮喘患者120例,随机数字表法分为对照组和试验组,每组60例。对照组男34例、女26例,年龄(70.57±2.04)岁,采用常规护理模式;试验组男36例、女24例,年龄(71.03±2.08)岁,采用自我管理为导向的5A护理模式。比较两组Orem自我护理能力测定量表(ESCA)、自我管理行为量表、哮喘控制测试(ACT)、自知力与治疗态度问卷(ITAQ)及成人哮喘生活质量量表(AQLQ)评分。计数资料采用χ^(2)检验,计量资料采用t检验。结果两组患者干预后自护能力各项评分及总分均高于干预前(均P<0.05),其中试验组ESCA的健康知识[(45.28±4.17)分]、自护责任感[(21.16±1.24)分]、自护技能[(30.22±4.02)分]、自我概念评分[(25.29±2.41)分]及总分[(121.95±11.8)分]均高于对照组[(36.02±3.11)分、(16.92±3.20)分、(23.51±3.71)分、(18.53±3.07)分、(94.98±13.09)分](t=13.788、9.570、9.501、13.416、11.835,均P<0.001)。两组患者干预后自我管理行为量表各项评分及总分均高于干预前(均P<0.05),其中试验组按时就诊[(29.86±4.11)分]、避免诱发因素[(29.67±4.58)分]、病情监控[(29.89±3.20)分]、用药依从性[(30.74±4.23)分]、症状发作的识别与应对评分[(30.82±4.16)分]及总分[(150.98±9.12)分]均高于对照组[(25.48±3.69)分、(25.53±4.06)分、(25.72±3.61)分、(24.18±4.01)分、(26.64±3.88)分、(127.55±12.25)分](t=6.124、5.239、6.695、8.717、5.691、11.883,均P<0.001)。两组患者干预后ACT及ITAQ评分均高于干预前(均P<0.05),其中试验组ACT[(20.17±2.03)分]、ITAQ评分[(18.22±1.27)分]均高于对照组[(17.34±2.10)分、(14.63±2.15)分](t=7.505、9.092,均P<0.001)。两组患者干预后AQLQ各项评分及总分均高于干预前(均P<0.05),其中试验组哮喘症状[(26.89±4.25)分]、对自己健康的关心[(26.78±3.94)分]、心理状况[(26.48±3.88)分]、对于应激源的反应[(26.82±3.91)分]、活动受限评分[(27.68±4.11)分]及总分[(134.65±13.29)分]均高于对照组[(23.69±3.66)分、(24.05±3.77)分、(23.38±3.55)分、(24.29±3.64)分、(24.63±4.05)分、(120.05±13.05)分](t=4.419、3.877、4.565、3.668、4.094、6.071,均P<0.001)。结论自我管理为导向的5A护理模式可有效提升老年哮喘患者自护能力和自我效能,控制哮喘症状,改善其生活质量。

Objective To study the application of self-management-oriented 5A nursing model in elderly patients with asthma.Methods It was a randomized controlled trial.A total of 120 elderly patients with asthma who were treated in Department of Respiratory Medicine,Mengyin County People's Hospital from January 2019 to January 2022 were selected.They were assigned to a control group and an experimental group by the random number table method with 60 cases in each group.In the control group,34 males and 26 females,aged(70.57±2.04)years,received routine nursing;in the experimental group,36 males and 24 females,aged(71.03±2.08)years,received self-management-oriented 5A nursing model.The scores of Orem's Exercise of Self-Care Agency Scale(ESCA),Self-management Behavior Scale,Asthma Control Test(ACT),Insight and Treatment Attitude Questionnaire(ITAQ),and Adult Asthma Quality of Life Questionnaire(AQLQ)were compared between the two groups.χ^(2) test was used for the count data and t test was used for the measurement data.Results After intervention,the scores of different domains and total score of self-care ability in both groups were higher than those before intervention(all P<0.05);the scores of health knowledge[(45.28±4.17)points],self-care responsibility[(21.16±1.24)points],self-care skills[(30.22±4.02)points],and self-concept[(25.29±2.41)points]and total score[(121.95±11.8)points]of ESCA in the experimental group were higher than those in the control group[(36.02±3.11),(16.92±3.20),(23.51±3.71),(18.53±3.07),(94.98±13.09)points](t=13.788,9.570,9.501,13.416,and 11.835;all P<0.001).After intervention,the scores of different domains and total score of Self-management Behavior Scale in both groups were higher than those before intervention(all P<0.05);the scores of visiting the doctor on time[(29.86±4.11)points],avoiding the predisposing factors[(29.67±4.58)points],monitoring the condition[(29.89±3.20)points],medication compliance[(30.74±4.23)points],and identification and response to symptom attack[(30.82±4.16)points]and total score[(150.98±9.12)points]in the experimental group were higher than those in the control group[(25.48±3.69),(25.53±4.06),(25.72±3.61),(24.18±4.01),(26.64±3.88),and(127.55±12.25)points](t=6.124,5.239,6.695,8.717,5.691,and 11.883;all P<0.001).After intervention,the scores of ACT and ITAQ in both groups were higher than those before intervention(all P<0.05);the scores of ACT[(20.17±2.03)points]and ITAQ[(18.22±1.27)points]in the experimental group were higher than those in the control group[(17.34±2.10)and(14.63±2.15)points](t=7.505 and 9.092;both P<0.001).After intervention,the scores of different domains and total score of AQLQ in both groups were higher than those before intervention(all P<0.05);the scores of asthma symptoms[(26.89±4.25)points],concern for their own health[(26.78±3.94)points],psychological status[(26.48±3.88)points],response to stressors[(26.82±3.91)points],and limitation of motion[(27.68±4.11)points]and total score[(134.65±13.29)points]in the experimental group were higher than those in the control group[(23.69±3.66),(24.05±3.77),(23.38±3.55),(24.29±3.64),(24.63±4.05),and(120.05±13.05)points](t=4.419,3.877,4.565,3.668,4.094,and 6.071;all P<0.001).Conclusion The self-management-oriented 5A nursing model can effectively improve the self-care ability and self-efficacy in elderly patients with asthma,and control the asthma symptoms,thereby improving the quality of life.