ICF理论联合家庭主要照顾者赋权护理对脑卒中患者的干预效果

Impacts of ICF theory combined with empowerment intervention of main family caregivers on medication compliance,prognosis,and caregivers'discharge readiness in stroke patients

目的探讨国际功能、残疾和健康分类(ICF)理论联合家庭主要照顾者赋权干预对脑卒中患者的干预效果。方法前瞻性选取2020年5月至2022年5月陕西省第二人民医院神经内科收治的100例脑卒中患者为研究对象,随机分为两组,各50例。对照组患者男28例,女22例,年龄(58.55±10.24)岁,病程(1.85±0.77)个月,疾病类型:脑梗死30例、脑出血20例,患者与照顾者关系:夫妻关系35例、亲子关系12例、其他关系3例。观察组患者男30例,女20例,年龄(59.17±10.55)岁,病程(2.01±0.85)个月,病变类型:脑梗死32例、脑出血18例;患者与照顾者关系:夫妻关系36例、亲子关系12例、其他关系2例。对照组给予常规护理干预,观察组给予ICF理论联合家庭主要照顾者赋权干预,两组均干预至出院。比较两组患者用药依从性、预后情况及照顾者出院准备度。采用χ^(2)检验、t检验。结果观察组用药依从性优良率为90.00%(45/50),高于对照组的72.00%(36/50),差异有统计学意义(χ^(2)=5.263,P=0.022)。干预前及出院时,观察组患者ICF脑卒中核心要素量表评分分别为(82.69±13.66)分、(65.74±8.51)分,对照组分别为(83.18±13.04)分、(71.65±10.12)分,两组出院时评分均低于干预前(均P<0.05),且观察组低于对照组(t=3.161,P=0.002);观察组患者的Barthel指数(BI)、蒙特利尔认知评估量表(MoCA)、脑卒中专门化生存质量量表(SS-QOL)、照顾者出院准备度评分分别为(56.15±6.25)分、(17.07±4.16)分、(76.15±6.68)分、(73.69±3.66)分及(85.73±4.86)分、(26.43±4.87)分、(185.15±20.68)分、(83.74±4.51)分,对照组分别为(56.68±6.87)分、(16.89±3.78)分、(75.58±7.07)分、(74.18±3.74)分及(72.76±4.65)分、(21.48±4.16)分、(126.58±15.07)分、(77.65±4.12)分,两组患者出院时BI、MoCA、SS-QOL、照顾者出院准备度评分均高于干预前(均P<0.05),且观察组患者出院时各评分均高于对照组(t=13.635、5.465、16.185、7.050,均P<0.001)。结论ICF理论联合家庭主要照顾者赋权干预能够提高脑卒中患者的用药依从性,改善预后,提高照顾者出院准备度。

Objective To explore the effect of International Classification of Functioning,Disability and Health(ICF)theory combined with empowerment intervention of main family caregivers on medication compliance,prognosis,and caregivers'discharge readiness in stroke patients.Methods A total of 100 stroke patients admitted to the Department of Neurology,Shaanxi Second Provincial People's Hospital from May 2020 to May 2022 were prospectively selected as the study objects.They were randomly divided into 2 groups with 50 cases in each group.In the control group,there were 28 males and 22 females,aged(58.55±10.24)years,the duration of disease was(1.85±0.77)months,the types of lesions were cerebral infarction in 30 cases and cerebral hemorrhage in 20 cases,and the relationships between patients and caregivers were husband-wife relationship in 35 cases,parent-child relationship in 12 cases,and other relationships in 3 cases.In the observation group,there were 30 males and 20 females,aged(59.17±10.55)years,the course of disease was(2.01±0.85)months,the types of lesions were cerebral infarction in 32 cases and cerebral hemorrhage in 18 cases,and the relationships between patients and caregivers were husband-wife relationship in 36 cases,parent-child relationship in 12 cases,and other relationships in 2 cases.The control group was given routine nursing intervention,and the observation group was given ICF theory combined with empowerment intervention of main family caregivers.Both groups were intervened from admission to discharge.The medication compliance,prognosis,and caregivers'discharge readiness of the two groups were compared.t test andχ^(2)test were used.Results The excellent and good rate of medication compliance in the observation group was 90.00%(45/50),which was higher than that in the control group[72.00%(36/50)],with a statistically significant difference(χ^(2)=5.263,P=0.022).Before intervention and at discharge,the scores of ICF stroke core factor scale were(82.69±13.66)and(65.74±8.51)points in the observation group,and(83.18±13.04)and(71.65±10.12)points in the control group,respectively;the scores of ICF stroke core factor scale in both groups at discharge were lower than those before intervention(both P<0.05),and the score of ICF stroke core factor scale in the observation group was lower than that in the control group at discharge(t=3.161,P=0.002).Before intervention and at discharge,the scores of Barthel index(BI),Montreal Cognitive Assessment(MoCA),Stroke Specialized Quality of Life Scale(SS-QOL),and caregivers'discharge readiness in the observation group were(56.15±6.25),(17.07±4.16),(76.15±6.68),(73.69±3.66),(85.73±4.86),(26.43±4.87),(185.15±20.68),and(83.74±4.51)points,and those in the control group were(56.68±6.87),(16.89±3.78),(75.58±7.07),(74.18±3.74),(72.76±4.65),(21.48±4.16),(126.58±15.07),and(77.65±4.12)points;the scores of BI,MoCA,SS-QOL,and caregivers'discharge readiness in both groups at discharge were all higher than those before intervention(all P<0.05),and the scores in the observation group were higher than those in the control group at discharge(t=13.635,5.465,16.185,and 7.050,all P<0.001).Conclusion ICF theory combined with empowerment intervention of main family caregivers can improve the medication compliance in stroke patients,prognosis,and discharge readiness of caregivers.