Effect of "one point, two sources" adaptive nursing strategy on self-efficacy, treatment compliance and blood glucose level in diabetic foot patients
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摘要:
目的 糖尿病足存在诸多护理难点，致残率高。本研究探讨了“一点二源”适应性护理策略对糖尿病足患者自我效能、治疗依从性和血糖水平的影响。 方法 选取2020年3月—2022年3月就诊于绍兴市人民医院内分泌门诊的糖尿病足患者84例，采用抽签法将其分为2组，对照组42例，予以常规护理；观察组42例，在常规护理基础上予以“一点二源”适应性护理，均护理3个月。比较2组自我效能感、治疗依从性以及血糖水平。 方法 2组护理后自我效能感(DSES)各维度(饮食、药物、运动、疾病监测、足部护理及急症处理)评分和总分均较护理前升高(P＜0.05)，且观察组评分高于对照组(P＜0.05)；观察组护理后治疗依从性高于对照组(P＜0.05)；2组护理后空腹血糖(FPG)、餐后2 h血糖(2hPG)以及糖化血红蛋白(HbA1c)均较护理前下降(P＜0.05)，且观察组上述指标参数分别为(6.44±1.32)mmol/L、(9.24±2.10)mmol/L和(5.80±0.57)%，明显低于对照组[(7.13±1.45)mmol/L、(11.02±3.23)mmol/L和(6.19±0.56)%，P＜0.05]。 结论 对糖尿病足患者实施“一点二源”适应性护理策略能有效提高患者自我效能水平和治疗依从性，并降低血糖水平，效果理想。 Abstract:Objective There are many nursing difficulties in diabetic foot, and the disability rate is high. This study investigated the effect of "one point, two sources" adaptive nursing strategy on self-efficacy, treatment compliance and blood glucose level in diabetic foot patients. Methods A total of 84 patients with diabetic foot who were admitted to the Endocrine Clinic of Shaoxing People ' s Hospital from March 2020 to March 2022 were selected and divided into control group (42 cases) and observation group (42 cases) by drawing lots. The control group was given routine care, and the observation group was given "one point, two sources" adaptive nusing on the basis of routine care for 3 months. Self-efficacy, treatment compliance and blood glucose levels were compared between the two groups. Results The score and total score of self-efficacy (diabetes self-efficacy scale, DSES, diet, medication, exercise, disease monitoring, foot care and emergency management) were higher than before care (P < 0.05), and the scores of the observation group were higher than that of the control group (P < 0.05). Post-care treatment compliance in the observation group was higher than that of the control group (P < 0.05). Fasting blood glucose (FPG), 2 h postprandial blood glucose (2hPG) and glycosylated hemoglobin (HbA1c) were decreased compared with before care [(6.44±1.32) mmol/L, (9.24±2.10) mmol/L and (5.80±0.57) % vs. (7.13±1.45) mmol/L, (11.02±3.23) mmol/L and (6.19±0.56) %, P < 0.05]. Conclusion The implementation of "one point, two sources" adaptive nursing strategy for diabetic foot patients can effectively improve the level of self-efficacy and treatment compliance, and reduce the level of blood glucose, the effect is ideal. -
Key words:
- Diabetic foot /
- One point /
- two sources /
- Adaptive nursing strategy /
- Self-efficacy /
- Compliance /
- Fasting blood glucose
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表 1 2组糖尿病足患者一般资料比较
Table 1. Comparison of general data of diabetic foot patients in 2 groups
组别 例数 性别(男性/女性，例) 年龄(x±s，岁) 糖尿病病程(x±s，年) 受教育年限(x±s，年) 糖尿病足Wagner分级(例) Ⅰ Ⅱ Ⅲ Ⅳ 对照组 42 23/19 58.78±7.89 9.56±1.34 10.23±2.41 14 19 6 3 观察组 42 18/24 59.23±9.10 9.34±2.10 9.78±1.20 17 14 9 2 统计量 1.191a 0.242b 0.572b 1.083b 0.276c P值 0.275 0.809 0.569 0.282 0.782 注：a为χ2值，b为t值，c为Z值。 
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表 2 “一点二源”适应性护理策略
Table 2. "One-point, two-source" adaptive care strategies
人格类型 关注点 压力源 动力源 护理策略 完美型 原则性较强追求完美 要求高易挑剔 坚持不懈言出必行 每2周电话访视1次，每次15~20 min，了解患者情况，提供细致的护理指导；劝其以平和心态接受现状；通过沟通了解其需求并合理满足 助人型 在意他人忽略自己 自信不足易听信他人 善良温和具有奉献精神 每2周电话访视1次，每次15~20 min，了解患者自我管理情况，及时赞赏和表扬其良好行为；为其创造帮助和支持其他患者的机会，比如不定期开展讲座，邀请表现良好的患者分享自我管理心得等 成就型 重视成功表现 爱竞争 精力充沛积极进取 满足其受尊重心理，引导发挥自信优势；每月设置1次护理目标，下月初微信线上评估患者完成情况，每完成一项给予口头表扬或物质奖励 自我型 追求独特我行我素情绪化 难以相处固执己见 具有探索精神 每2周电话访视1次，每次15~20 min，了解其情况；利用微信多沟通(每周至少3次，每次至少10 min)，沟通过程中密切关注其情绪变化，在愉快的氛围中给予指导和建议 思考型 善思考学识渊博 冷淡疏离保守固执 求知欲强理性持重 通过发放宣传册，每周一、三、五晚20：00微信群推送糖尿病相关知识的方式，加深其对疾病的认识；每2周电话访视，了解其困惑，及时解答疑惑。在沟通交流过程中注意人际交往“界限”，不要越界 忠诚型 小心谨慎多疑 悲观逃避安于现状 尽心尽力 增加电话随访(每周1次，每次15~20 min)次数，多关心和指导患者，并利用微信群多沟通交流，如每日早晚问候以建立信任；为其制定饮食、运动计划，通过微信提醒的方式督促其完成，并每日打卡 欢乐型 追求快乐心神不安 缺乏耐性喜新厌旧 精力充沛富感染力和创造力 提供多种形式的护理，包括健康讲座(每月1次，线上开展，每次45 min)、糖尿病相关知识和自我管理视频(每周2次，微信群推送)等，加强患者的危机感和重视程度，提高治疗依从性 领袖型 绝对自信喜掌控 攻击性强爱指挥 意志坚强敢说敢做 每周微信群列举2次既往血糖控制良好案例，为其树立学习榜样；在团体活动中，注意发挥其领导才能；多夸赞其积极行为；维护其面子，不揭短 和平型 追求和谐 缺乏立场优柔寡断 不喜冲突容易相处 每2周电话访视，鼓励患者家属参与治疗决策，每周开展1次微信答疑活动，为其提供专业护理指导
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表 3 2组糖尿病足患者DSES评分比较(x±s，分)
Table 3. Comparison of DSES scores between two groups of diabetic foot patients(x±s, points)
组别 例数 饮食 药物 运动 疾病监测 护理前 护理3个月 护理前 护理3个月 护理前 护理3个月 护理前 护理3个月 对照组 42 12.34±2.04 16.09±3.25b 8.12±2.10 9.97±2.34b 7.09±1.34 9.56±2.34b 6.78±1.23 8.09±1.75b 观察组 42 12.78±3.17 22.09±4.23b 8.09±2.04 13.12±2.19b 7.23±1.56 12.89±3.10b 6.59±1.45 11.34±2.41b 统计量 0.756a 9.145c 0.066a 8.906c 0.441a 7.884c 0.648a 8.954c P值 0.452 < 0.001 0.947 < 0.001 0.660 < 0.001 0.519 < 0.001 组别 例数 足部护理 急症处理 总分 护理前 护理3个月 护理前 护理3个月 护理前 护理3个月 对照组 42 7.23±1.06 9.77±2.03b 9.09±2.19 11.06±2.27b 50.65±7.89 64.54±9.14b 观察组 42 7.19±1.24 12.98±2.45b 9.11±2.16 14.56±2.30b 50.99±9.67 86.98±10.23b 统计量 0.159a 7.808c 0.042a 8.676c 0.177a 12.457c P值 0.874 < 0.001 0.967 < 0.001 0.860 < 0.001 注：a为t值，c为F值；与同组护理前比较，bP＜0.05。
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表 4 2组糖尿病足患者治疗依从性比较[例(%)]
Table 4. Comparison of treatment compliance between the two groups of diabetic foot patients[cases(%)]
组别 例数 依从 基本依从 不依从 对照组 42 17(40.48) 13(30.95) 12(28.57) 观察组 42 25(59.52) 14(33.33) 3(7.14) 注：2组治疗依从性比较，Z=2.275，P=0.023。
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表 5 2组糖尿病足患者血糖控制情况比较(x±s)
Table 5. Comparison of glycemic control in two groups of diabetic foot patients(x±s)
组别 例数 HbA1c(%) FPG(mmol/L) 2hPG(mmol/L) 护理前 护理3个月 护理前 护理3个月 护理前 护理3个月 对照组 42 7.01±0.78 6.19±0.56b 8.90±1.23 7.13±1.45b 14.45±2.10 11.02±3.23b 观察组 42 7.05±0.92 5.80±0.57b 8.56±1.07 6.44±1.32b 14.76±2.39 9.24±2.10b 统计量 0.215a 7.560c 1.352a 4.909c 0.631a 4.689c P值 0.830 0.002 0.180 0.025 0.530 0.004 注：a为t值，c为F值；与同组护理前比较，bP＜0.05。
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