经外周静脉置入中心静脉导管带管出院患者基于LEARNS模式健康教育的效果

Effect of health education based on LEARNING model on discharged patients with peripherally inserted central catheter

目的观察LEARNS[聆听(listen,L),建立(establish,E),应用(adopt,A),提高(reinforce,R),反馈教学(name,N),强化(strengthen,S)]模式健康教育在经外周静脉置入中心静脉导管(PICC)带管出院患者中的应用效果.方法选择2020年6月至2021年6月于右江民族医学院附属医院肿瘤科进行PICC穿刺的193例带管出院患者作为研究对象.按随机数字表法将患者分为观察组(95例)和对照组(98例).对照组进行常规健康教育,持续随访3个月;观察组在对照组基础上结合基于LEARNS模式于带管出院的2、4、8、12周构建并实施健康教育.比较两组PICC相关并发症、PICC相关不良事件发生率,采用肿瘤患者PICC自我管理能力量表(CPPSMS)评价自我管理能力,采用健康促进策略量表(SUPPH)评价患者的自我效能.结果观察组PICC相关并发症发生率和不良事件发生率均明显低于对照组[11.58%(11/95)比40.82%(40/98)和6.32%(6/95)比22.45%(22/98),均P<0.05].观察组干预前CPPSMS(日常导管观察、维护依从性、管理信心、异常处理、信息获取、带管运动、带管日常生活)评分及SUPPH(正性态度、自我减压、自我决策)评分比较差异均无统计学意义,干预后上述评分均较干预前提高,且观察组干预后上述评分均明显高于对照组[CPPSMS评分总分(分):131.37±27.20比92.41±23.89,日常导管观察评分(分)为26.02±6.04比18.27±5.43,维护依从性评分(分)为18.45±4.36比13.28±3.12,管理信心评分(分)为17.69±3.37比13.81±3.65,异常处理评分(分)为15.01±3.46比10.25±2.74,信息获取评分(分)为11.98±2.56比7.84±2.07,带管运动评分(分)为15.94±3.46比10.28±2.78,带管日常生活评分(分)为26.28±5.19比18.68±4.46,均P<0.05;SUPPH评分总分(分):106.54±20.84比93.93±18.50,正性态度评分(分)为56.89±11.45比49.34±10.56,自我减压评分(分)为38.25±8.73比34.76±6.28,自我决策评分(分)为11.40±2.57比9.83±2.96,均P<0.05].结论对PICC带管出院患者实施基于LEARNS模式的健康教育,可提高其自我管理能力及自我效能,改善临床预后.

Objective To evaluate the effect of LEARNS[listen(L),establish(E),adopt(A),reinforce(R),name(N),strengthen(S)]model health education for patients with peripherally inserted central catheter(PICC)after discharge.Methods From June 2020 to June 2021,193 discharged patients with PICC were selected as the study objects.They were divided into observation group(95 cases)and control group(98 cases)according to random number table method.The control group received routine health education and continued follow-up for 3 months.In the observation group,health education was constructed and implemented at 2,4,8 and 12 weeks afer discharge based on the control group and the basis of LEARNS model.The incidence of PICC-related complications and PICC-related adverse events were compared between the two groups,and self-management ability was evaluated using cancer patients PICC self-management scale(CPPSMS)score,strategies used by people to promote health(SUPPH)were used to evaluate self-efficacy.Results The incidence of PICC-related complications and adverse events in the observation group were significantly lower than those in the control group[11.58%(11/95)vs.40.82%(40/98)and 6.32%(6/95)vs.22.45%(22/98),both P<0.05].There were no statistically significant differences in CPPSMS scores(daily catheter observation,maintenance compliance,management confidence,anomaly handling,information acquisition,tubeed exercise,and tubeed daily life)and SUPPH scores(positive attitude,self-stress reduction,and self-decision-making)in the two groups before intervention,and the above scores were higher than those before intervention.Afer intervention,the above scores in the observation group were significantly higher than those in the control group(CPPSMS total score was 131.37±27.20 vs.92.41±23.89,daily catheter observation score was 26.02±6.04 vs.18.27±5.43,maintenance compliance score was 18.45±4.36 vs.13.28±3.12,and management confidence score was 17.69±3.37 vs.13.81±3.65,anomaly processing score was 15.01±3.46 vs.10.25±2.74,information acquisition score was 11.98±2.56 vs.7.84±2.07,tube motion score was 15.94±3.46 vs.10.28±2.78,daily life with tubes score was 26.28±5.19 vs.18.68±4.46,all P<0.05:SUPPH total score was 106.54±20.84 vs.93.93±18.50,positive attitude score was 56.89±11.45 vs.49.34±10.56,self-stress reduction score was 38.25±8.73 vs.34.76±6.28,the selfdecision-making score was 11.40±2.57 vs.9.83±2.96,all P<0.05).Conclusion The implementation of health education based on LEARNS model in discharged patients with PICC tube can improve their self-management ability and self-efficacy,and improve clinical prognosis.