斯金纳程序式教学理论在糖尿病足中高危患者健康教育中的应用

苏巧丹; 诸葛福媛; 王俊; 屠昕

doi:10.16766/j.cnki.issn.1674-4152.003844

斯金纳程序式教学理论在糖尿病足中高危患者健康教育中的应用

doi: 10.16766/j.cnki.issn.1674-4152.003844

绍兴市人民医院内分泌代谢科，浙江绍兴 312000

基金项目:

浙江省医药卫生科技计划项目 2022RC274

浙江省中医药科技计划项目 2022ZB363

详细信息

通讯作者:
苏巧丹，E-mail：suqiaodan2022@163.com

中图分类号: R587.2
计量
- 文章访问数: 31
- HTML全文浏览量: 17
- PDF下载量: 1
- 被引次数: 0
出版历程
- 收稿日期: 2024-05-18
- 网络出版日期: 2025-02-13

Application of Skinner' s procedural teaching theory in health education for high-risk patients with diabetic foot

Department of Endocrinology and Metabolism, Shaoxing People' s Hospital, Shaoxing, Zhejiang 312000, China

摘要

摘要: 目的健康教育是预防糖尿病足的重要举措，本研究探讨了斯金纳程序式教学理论在糖尿病足中高危患者健康教育中的应用效果，旨在降低糖尿病足发生风险，提高患者生活质量。方法选取2022年1月—2023年10月在绍兴市人民医院就诊的糖尿病足中高危患者102例，采用随机数字表法分为对照组(51例)和试验组(51例)。对照组和试验组最终各48例、47例完成研究。对照组予以常规健康教育，试验组在健康教育中运用斯金纳程序式教学理论，持续干预3个月，比较2组足部护理知识和自护行为评分、血糖水平及足部皮肤状况。结果试验组健康教育后足部检查、足部日常护理、足部趾甲修剪、足部皮肤干燥、鞋袜选择及足部问题治疗知识评分均高于对照组(P＜0.05)，足部自护行为除“在过去1周内，你有几天洗了脚”项外，其余各项行为评分均高于对照组(P＜0.05)，空腹血糖、餐后2h血糖及糖化血红蛋白均低于对照组(P＜0.05)，健康教育后对照组和试验组足部总体状况均较健康教育前改善(P＜0.05)，且试验组总改善情况(OR=2.765，95% CI：1.561~4.891, P＜0.001)优于对照组(χ²=5.902，P＜0.05)。结论相比常规健康教育，将斯金纳程序式教学理论用于糖尿病足中高危患者健康教育中，可提高患者足部护理知识水平，增强足部自护行为、控制血糖水平，改善足部皮肤状况，对预防糖尿病足的发生有积极意义。
- 糖尿病 /
- 糖尿病足 /
- 健康教育 /
- 斯金纳程序式教学理论 /
- 足部护理知识 /
- 足部自护行为 /
- 血糖
Abstract: Objective Health education plays an important role in preventing diabetic foot. This study discusses the application of Skinner' s procedural teaching theory in the health education of high-risk patients with diabetic foot, aiming to reduce the risk of diabetic foot occurrence and improve the quality of life of patients. Methods From January 2022 to October 2023, a total of 102 high-risk patients with diabetic foot from Shaoxing People' s Hospital were randomly divided into a control group (n=51) and an experimental group (n=51). The study was completed by 48 patients in the control group and 47 in the experimental group, respectively. The control group was given routine health education, while the experimental group was given Skinner' s procedural teaching theory, followed by an intervention for 3 months. Foot care knowledge, self-care behavior score, blood glucose level, and foot skin condition were compared between the two groups. Results Scores of foot examination, daily foot care, toenail trimming, foot skin dryness, footwear selection, and foot problem treatment knowledge after health education in experimental groups were higher than those in the control group (P < 0.05). Scores of foot self-care behavior were also higher in the experimental group than those in control group (P < 0.05), except for the item "frequency of foot washing in the past week". Additionally, fasting blood glucose, 2-hour postprandial blood glucose, and glycated hemoglobin levels were significantly lower in the experimental group than those in the control group (P < 0.05). After health education, general condition of the foot of both control group and experimental group were improved compared with that before health education (P < 0.05), and the total improvement of experimental group (OR=2.765, 95% CI: 1.561-4.891, P < 0.001) was better than that of control group (χ²=5.902, P < 0.05). Conclusion Compared with the conventional health education, the application of Skinner' s procedural teaching theory in the health education of high-risk patients with diabetic foot improves the knowledge level of foot care, enhances the self-care behavior of foot, regulates the blood sugar levels, and improves the food skin conditions. This approach has positive significance in preventing the occurrence of diabetic foot.
- Diabetes /
- Diabetic foot /
- Health education /
- Skinner' s procedural teaching theory /
- Foot care knowledge /
- Foot self-care behavior /
- Blood glucose

HTML全文

表 1 2组糖尿病足中高危患者一般资料比较

Table 1. Comparison of general data between two groups of high-risk patients with diabetic foot

项目	对照组(n=48)	试验组(n=47)	统计量	P值
性别(男性/女性，例)	21/27	24/23	0.510^a	0.475
年龄(x±s，岁)	58.98±5.12	59.02±6.77	0.033^b	0.974
已婚/未婚/离异或丧偶(例)	38/4/6	40/4/3	1.041^a	0.594
糖尿病病程(x±s，年)	5.16±1.34	5.27±1.72	0.348^b	0.729
中/高危足(例)	20/28	28/19	3.047^a	0.081
空腹血糖(x±s，mmol/L)	9.40±1.15	9.56±1.34	0.625^b	0.534
餐后2h血糖(x±s，mmol/L)	14.56±2.07	14.78±2.15	0.508^b	0.613
糖化血红蛋白(x±s，%)	8.56±1.17	8.74±1.45	0.667^b	0.507
舒张压(x±s，mmHg)	79.98±8.23	80.11±7.44	0.081^b	0.936
收缩压(x±s，mmHg)	125.67±7.12	124.90±8.17	0.490^b	0.625
总胆固醇(x±s，mmol/L)	4.40±1.87	4.36±1.21	0.123^b	0.902
甘油三酯(x±s，mmol/L)	2.11±0.57	2.14±0.88	0.198^b	0.844
低密度脂蛋白胆固醇(x±s，mmol/L)	3.00±0.88	3.04±0.95	0.213^b	0.832
尿微量白蛋白/肌酐比值(x±s，mg/g)	20.98±5.12	21.09±6.24	0.094^b	0.925
注：^a为χ²值，^b为t值。1 mmHg=0.133 kPa。

下载: 导出CSV

表 2 糖尿病足中高危患者健康教育内容及实施流程

Table 2. Content and implementation process of health education for high-risk patients with diabetic foot

健康教育模块	内容	患者达标要求	首次健康教育参考时间
1.认识糖尿病及糖尿病足	1.什么是糖尿病和糖尿病足；	能简要说出什么是糖尿病、糖尿病足及其发生机制、危害等。	入院时，教育时间为10~20 min。
	2.糖尿病足发生机制；
	3.血糖控制在预防糖尿病足中的作用；
	4.糖尿病足的表现和危害。
2.糖尿病足风险度评估	学习Gavin's糖尿病足危险因素加权值积分法。	能熟练利用Gavin's足危险因素加权值积分评估糖尿病足的危险程度，中危足为4~8分，高危足为9~13分。	出院前1 d，教育时间为15 min。
3.如何预防糖尿病足的发生	1.血糖控制：通过运动、饮食、药物等方式积极控制血糖，保持糖化血红蛋白＜7%；	能熟练说出血糖控制方法、避免足部外伤等足部护理要点；能准确识别不正确的足部护理行为或习惯。	出院时，教育时间为45 min。
	2.足部筛查：中危足每3个月筛查1次，高危足每月筛查1次；
	3.戒烟；
	4.足部日常护理：每日检查鞋子里面和足部；每日洗脚，洗脚后擦干皮肤；趾甲剪为“一”字型；使用润肤霜润滑干燥皮肤；避免用化学制剂去除胼胝；
	5.避免足部外伤：不要赤脚行走或只穿袜子行走；
	6.选择合适鞋袜：选择适应脚形的治疗鞋，若有足部畸形可定制鞋或鞋垫；
	7.运动指导：中危患者可每周进行3~5次足部锻炼；
	8.足部溃疡前病变的处理：若出现胼胝、感染、足部水疱等情况，及时向专业人士寻求帮助；
	9.足部紧急事件处理：24 h内到专业医疗机构诊疗。

下载: 导出CSV

表 3 2组糖尿病足中高危患者健康教育前后足部护理知识评分比较(x±s，分)

Table 3. Comparison of foot care knowledge scores before and after health education in high-risk patients with diabetic foot in two groups(x±s, points)

组别	例数	足部检查		足部日常护理		足部趾甲修剪		足部皮肤干燥		鞋袜选择		足部问题治疗
组别	例数	健康教育前	健康教育后	健康教育前	健康教育后	健康教育前	健康教育后	健康教育前	健康教育后	健康教育前	健康教育后	健康教育前	健康教育后
对照组	48	1.56±0.34	2.51±0.68^b	2.34±0.57	3.56±0.61^b	0.78±0.23	1.18±0.45^b	1.61±0.43	2.21±0.45^b	1.77±0.34	3.25±0.77^b	1.44±0.31	2.24±0.56^b
试验组	47	1.67±0.51	3.44±0.39^b	2.22±0.48	4.33±0.54^b	0.70±0.25	1.56±0.37^b	1.57±0.58	3.11±0.51^b	1.69±0.45	4.11±0.77^b	1.39±0.26	3.15±0.67^b
统计量		1.239^a	17.341^c	1.109^a	18.519^c	1.624^a	14.519^c	0.382^a	16.741^c	0.979^a	18.091^c	0.851^a	18.441^c
P值		0.218	＜0.001	0.270	＜0.001	0.108	＜0.001	0.703	＜0.001	0.330	＜0.001	0.397	＜0.001
注：^a为t值，^c为F值；与同组健康教育前比较，^bP＜0.05。

下载: 导出CSV

表 4 2组糖尿病足中高危患者足部自护行为评分比较(x±s，分)

Table 4. Comparison of foot self-care behavior scores before and after health education in high-risk diabetic foot patients in two groups(x±s, points)

组别	例数	条目a		条目b		条目c		条目d		条目e
组别	例数	健康教育前	健康教育后	健康教育前	健康教育后	健康教育前	健康教育后	健康教育前	健康教育后	健康教育前	健康教育后
对照组	48	2.45±0.56	3.66±1.14^b	1.77±0.38	2.88±0.71^b	4.56±1.14	5.37±0.90^b	2.95±0.76	3.77±1.11^b	1.45±0.34	2.66±0.59^b
试验组	47	2.30±0.69	4.90±1.35^b	1.90±0.56	3.57±0.81^b	4.34±0.90	5.48±1.14^b	3.02±0.65	4.69±1.29^b	1.57±0.41	3.98±1.11^b
统计量		1.165^a	18.902^c	1.326^a	17.451^c	1.043^a	1.241^c	0.482^a	16.231^c	1.554^a	19.031^c
P值		0.247	＜0.001	0.188	＜0.001	0.300	0.141	0.631	＜0.001	0.124	＜0.001
注：^a为t值，^c为F值；与同组健康教育前比较，^bP＜0.05。

下载: 导出CSV

表 5 2组糖尿病足中高危患者健康教育前后血糖情况比较(x±s)

Table 5. Comparison of blood glucose level in high-risk patients with diabetic foot before and after health education in two groups(x±s)

组别	例数	空腹血糖(mmol/L)		餐后2h血糖(mmol/L)		糖化血红蛋白(%)
组别	例数	健康教育前	健康教育后	健康教育前	健康教育后	健康教育前	健康教育后
对照组	48	9.40±1.15	8.56±1.11^b	14.56±2.07	12.56±2.37^b	8.56±1.17	7.94±1.25^b
试验组	47	9.56±1.34	7.34±1.53^b	14.78±2.15	11.09±2.14^b	8.74±1.45	7.01±1.14^b
统计量		0.625^a	18.901^c	0.508^a	15.632^c	0.667^a	14.231^c
P值		0.534	＜0.001	0.613	＜0.001	0.507	＜0.001
注：^a为t值，^c为F值；与同组健康教育前比较，^bP＜0.05。

下载: 导出CSV

表 6 2组糖尿病足中高危患者健康教育前后足部状况比较

Table 6. Comparison of foot condition in high-risk patients with diabetic foot before and after health education in two groups

组别	例数	时间点	皮肤干燥	趾甲增厚	水肿	皲裂	感染	胼胝	合计
对照组	48	健康教育前	23	5	4	1	3	0	36
		健康教育后	15	4	3	1	2	0	25^a
试验组	47	健康教育前	25	2	3	0	4	1	35
		健康教育后	8	2	1	0	1	1	13^ab
Waldχ²/P值		组间	29.091/＜0.001	34.123/＜0.001	20.091/＜0.001	26.371/＜0.001	34.781/＜0.001	20.091/＜0.001	39.084/＜0.001
		时间	98.231/＜0.001	88.751/＜0.001	67.451/＜0.001	90.092/＜0.001	95.456/＜0.001	97.251/＜0.001	100.230/＜0.001
		交互	50.091/＜0.001	60.091/＜0.001	34.567/＜0.001	67.435/＜0.001	56.454/＜0.001	66.321/＜0.001	63.890/＜0.001
注：与同组健康教育前比较，^aP＜0.05；与对照组比较，^bP＜0.05。

下载: 导出CSV

参考文献(18)

[1]	吴道爱, 金国玺, 时照明, 等. 葡萄糖在目标范围内时间和糖尿病足的相关性研究[J]. 中华全科医学, 2024, 22(3): 414-417. doi: 10.16766/j.cnki.issn.1674-4152.003415 WU D A, JIN G X, SHI Z M, et al. Correlation between time in range and diabetic foot in patients with type 2 diabetes mellitus[J]. Chinese Journal of General Practice, 2024, 22(3): 414-417. doi: 10.16766/j.cnki.issn.1674-4152.003415
[2]	朱翠, 陈雷, 朱婷婷. 基于斯金纳程序教学理论的健康教育对PICC置管肿瘤患者自我管理能力的影响[J]. 护理实践与研究, 2020, 17(15): 140-142. doi: 10.3969/j.issn.1672-9676.2020.15.052 ZHU C, CHEN L, ZHU T T. Effect of health education based on Skinner' s procedure teaching theory on self-management ability of tumor patients with PICC catheterization[J]. Nursing Practice and Research, 2020, 17(15): 140-142. doi: 10.3969/j.issn.1672-9676.2020.15.052
[3]	吴佳梅, 王柏欣, 邢天容, 等. 延伸斯金纳程序教学理论在病理生理学教学中的应用[J]. 中国继续医学教育, 2024, 16(8): 1-5. doi: 10.3969/j.issn.1674-9308.2024.08.001 WU J M, WANG B X, XING T R, et al. Application of Extended Skinner Procedural Teaching Theory in Pathophysiology Teaching[J]. China Continuing Medical Education, 2024, 16(8): 1-5. doi: 10.3969/j.issn.1674-9308.2024.08.001
[4]	王文婧, 钟兆绘. 基于斯金纳程序教学理论的健康教育在子宫全切术患者中的应用效果研究[J]. 重庆医学, 2020, 49(18): 3139-3141. doi: 10.3969/j.issn.1671-8348.2020.18.037 WANG W J, ZHONG Z H. Study on the application effect of health education based on Skinner procedure teaching theory in patients undergoing total hysterectomy[J]. Chongqing Medicine, 2020, 49(18): 3139-3141. doi: 10.3969/j.issn.1671-8348.2020.18.037
[5]	蔡璟浩, 周健. 《2021年美国糖尿病学会糖尿病医学诊疗标准》解读[J]. 中国医学前沿杂志(电子版), 2021, 13(2): 13-23. CAI J H, ZHOU J. Interpretation of Standards of Medical Care in Diabetes-2021[J]. Chinese Journal of the Frontiers of Medical Science(Electronic Version), 2021, 13(2): 13-23.
[6]	王秀问. 老年糖尿病足[M]. 北京: 人民卫生出版社, 1995: 77-88. WANG X W. Elderly diabetic foot[M]. Beijing: People' s Medical Publishing House, 1995: 77-88.
[7]	胡鹏, 于晓霞. 糖尿病足高危因素评分量表的信效度研究[J]. 护理学报, 2013, 20(9): 1-4. HU P, YU X X. Validity and Reliability of Scale of High Risk Factors of Diabetic Foot[J]. Journal of Nursing(China), 2013, 20(9): 1-4.
[8]	谢珍惠, 朱玉宸. PDCA循环延续护理对糖尿病足患者足部护理知识与自我管理能力的影响[J]. 中国医药导报, 2023, 20(2): 164-167. XIE Z H, ZHU Y C. Effect of PDCA cycle continuation care on foot care knowledge and selfmanagement ability in diabetic foot patients[J]. China Medical Herald, 2023, 20(2): 164-167.
[9]	张琳娜, 卢明, 杨阳, 等. 糖尿病足高危患者足部自我护理行为现状调查及影响因素分析[J]. 中华现代护理杂志, 2022, 28(32): 4529-4533. ZHANG L N, LU M, YANG Y, et al. Status quo and influencing factors of foot self-care behavior in high-risk patients with diabetic foot[J]. Chinese Journal of Modern Nursing, 2022, 28(32): 4529-4533.
[10]	MONTESI L, RAMÍREZ-ROJAS M G, ELIZARRARÉS-RIVAS J. Health care delays and social suffering among indigenous people with diabetic foot complications in Mexico[J]. Med Anthropol, 2024, 12(12): 1-17.
[11]	MENSINK M. Dietary protein, amino acids and type 2 diabetes mellitus: a short review[J]. Front Nut, 2024, 24(11): 1445981. DOI: 10.3389/fnut.2024.1445981.
[12]	LU S, TIAN J W, ZHAO S Y, et al. Amide proton transfer weighted contrast has diagnostic capacity in detecting diabetic foot: an mri-based case-control study[J]. Front Endocrinol (Lausanne), 2024, 21(15): 1287930. DOI: 10.3389/fendo.2024.1287930.
[13]	ABABNEH M, AL AYED M Y, ROBERT A A, et al. Micronutrient status in patients with diabetic foot ulcers: a cross-sectional study in saudi arabia[J]. J Family Med Prim Care, 2024, 13(1): 356-362.
[14]	叶莹, 韩辉武, 许景灿, 等. 健康教育影响糖尿病足患者依从性的研究进展[J]. 护理实践与研究, 2022, 19(11): 1611-1615. YE Y, HAN H W, XU J C, et al. Research progress infl uence of health education on the compliance of diabetic foot patients[J]. Nursing Practice and Research, 2022, 19(11): 1611-1615.
[15]	司芬, 王琳. 脑卒中合并2型糖尿病患者基于斯金纳教学理论健康教育的效果观察[J]. 护理学报, 2021, 28(19): 72-78. SI F, WANG L. Effect of health education on stroke patients with type 2 diabetes mellitus based on Skinner teaching theory[J]. Journal of Nursing(China), 2021, 28(19): 72-78.
[16]	LOPES G S G, LANDEIRO M J L, SOUSA M R M G C. Needs and preferences regarding a mobile application to support diabetic foot self-care[J]. Rev Gaucha Enferm, 2024, 22(45): e20230165. DOI: 10.1590/1983-1447.2024.20230165.
[17]	王毅, 薛芳, 林少娜, 等. 糖尿病足患者网膜素-1和血管内皮生长因子水平与局部高压氧治疗后溃疡创面修复效果的关系[J]. 中华实用诊断与治疗杂志, 2023, 37(7): 727-732. WANG Y, XUE F, LIN S N, et al. Relationships of omentin-1 and vascular endothelial growth factor levels with ulcer healing after local hyperbaric oxygen therapy in diabetic foot patients[J]. Journal of Chinese Practical Diagnosis and Therapy, 2023, 37(7): 727-732.
[18]	宋瑞芳, 张伟娟, 董运婷. 基于斯金纳程序教学理论的健康教育对慢性心力衰竭患者自我管理行为和心肺功能的影响[J]. 河南医学研究, 2022, 31(5): 936-939. SONG R F, ZHANG W J, DONG Y T. Effect of Health Education Based on Skinner's Program Teaching Theory on Self-Management Behavior and Cardiopulmonary Function in Patients with Chronic Heart Failure[J]. Henan Medical Research, 2022, 31(5): 936-939.