5A模式结合知信行理论在Miles术后结肠造口并发感染患者中的应用效果

胡瑜; 封义兵; 周小莉; 孙景毅

doi:10.16766/j.cnki.issn.1674-4152.004234

5A模式结合知信行理论在Miles术后结肠造口并发感染患者中的应用效果

doi: 10.16766/j.cnki.issn.1674-4152.004234

1.
龙游县人民医院院感科，浙江衢州 324400
2.
龙游县人民医院外科
3.
龙游县人民医院胃肠外科

基金项目:

浙江省医药卫生科技计划项目 2023XY079

详细信息

通讯作者:
孙景毅，E-mail：42161711@qq.com

中图分类号: R473.6 R735.37
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- 文章访问数: 1
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出版历程
- 收稿日期: 2025-01-22

Application effect of 5A mode combined with knowledge, belief and action theory in Miles postoperative patients with colostomy complicated infection

1.
Department of Infectious Diseases, Longyou County People's Hospital, Quzhou, Zhejiang 324400, China

摘要

摘要: 目的本研究将5A模式结合知识-信念-行为理论(KAP)护理方案应用于Miles术后结肠造口并发感染患者，分析其提升患者自我护理能力及生活质量的效果，为优化结肠造口护理提供依据。方法选取2021年8月—2024年7月龙游县人民医院收治的Miles术后结肠造口并发感染146例患者作为研究对象。根据随机数字表法将其分为对照组(73例)和观察组(73例)。对照组应用常规护理，观察组应用5A模式结合知信行理论护理。比较2组患者干预前后血清降钙素原(PCT)、C-反应蛋白(CRP)水平、结肠造口压力、自我管理行为及生活质量情况。结果干预后，观察组PCT及CRP表达水平分别为(0.16±0.08)ng/mL、(7.14±1.86)μg/mL，均低于对照组[(0.23±0.10)ng/mL、(10.05±2.73)μg/mL，P＜0.05]；干预后，观察组患者结肠造口压力量表中身体状况改变所致压力、自我概念改变所致压力及结肠造口护理所致压力维度得分均低于对照组(P＜0.05)；干预后，观察组患者肠造口病人自我管理量表及造口患者生活质量量表得分分别为(107.64±10.42)分、(53.26±7.18)分，均高于对照组[(92.73±10.15)分、(47.49±6.23)分，F=7.467、4.942，P＜0.001]。结论 5A模式结合知信行理论能在常规治疗基础上有效改善Miles术后结肠造口患者感染情况，有利于降低患者结肠造口压力，提高患者造口管理能力及生活质量。
- 5A模式 /
- 知信行理论 /
- Miles术 /
- 结肠造口并发感染
Abstract: Objective The present study applied the 5A model in conjunction with the theory of knowledge-attitude-practice (KAP) nursing program was applied to patients with colostomy complicated by infection subsequent to Miles operation. The impact on enhancing the self-care capability and quality of life of patients was examined. This analysis provides a foundation for optimizing colostomy nursing. Methods A total of 146 patients with colostomy complicated with infection after Miles operation who were admitted to Longyou County People's Hospital from August 2021 to July 2024 were selected as the research objects. The patients were then divided into two groups: a control group and an observation group. The random number table method was used to assign each patient to their respective group. The control group received routine nursing care, while the observation group received 5A mode combined with knowledge, belief and action theory nursing care. A comparative analysis will be conducted to assess the levels of PCT, CRP expression, colostomy pressure, and self-management behavior between two groups of patients before and after intervention. Results Following the intervention, the expression levels of PCT and CRP in the observation group were (0.16±0.08) ng/mL and (7.14±1.86) μg/mL, respectively, which were lower than those in the control group (0.23±0.10) ng/mL and (10.05±2.73) μg/mL, respectively. A statistically significant difference was observed between the two groups (P < 0.05). Following the implementation of an intervention, the stress levels experienced by patients in the observation group due to physical conditions, self-concept changes and colostomy nursing on the Colostomy Stress Scale were found to be lower in comparison to those in the control group (P < 0.05). Following the implementation of the intervention, the scores on the self-management scale and the quality of life scale for patients with colostomy in the observation group were found to be (107.64±10.42) points and (53.26±7.18) points, respectively. These values were higher than those of the control group, which were (92.73±10.15) points and (47.49±6.23) points (F=7.467, 4.942, P < 0.001). Conclusion The 5A model, when integrated with the theory of knowledge, belief, and action, has demonstrated efficacy in enhancing the infection control outcomes for postoperative colostomy patients treated with conventional methods. This approach contributes to the mitigation of pressure associated with colostomy and the enhancement of colostomy management skills.
- 5A mode /
- Theory of knowledge-attitude-practice /
- Miles technique /
- Colonic stoma complicated with infection
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表 1 5A模式结合知信行理论护理方案内容

Table 1. A nursing intervention integrating the 5A model with the knowledge-attitude-practice framework

知信行理论	5A模式	实施方案
认知干预(入院24 h内)	询问	由护理人员主导，于示教室内对患者进行一对一访谈，访谈时长约20 min，询问患者对直肠癌、Miles术及肠造口知识了解程度，术后对生活方式的改变及是否意识到术后自我管理的必要性。
	评估	护理人员在与患者一对一访谈结束后，根据患者回答内容及疾病资料等进行综合评估，评估患者对造口相关知识了解程度、自我管理水平。
	建议	由护理人员借助《肠造口护理手册》、视频及肠造口模型对患者进行一对一知识宣教，于示教室内进行，时长约30 min，通过通俗易懂的语言向患者讲解肠造口的必要性、造口并发症观察及对症处理、认识造口袋等内容。宣教结束后与患者共同探讨造口相关知识，通过回授法了解患者知识掌握程度，倾听患者对于造口护理相关疑虑，利用模型帮助患者消除造口位置的不确定感。
	帮助	组建患者微信群，群内包括Miles术后需行结肠造口的患者、家属、心理咨询师及医护人员，护理人员于微信群内发布造口知识科普文章、造口护理及生活指导相关视频，指导患者及家属进行查阅，供其自行观看。向患者发放“结肠造口辅助袋”，包括造口袋更换流程图、造口并发感染及其他并发症监测及处理、造口用品更换日记及造口测量尺等，增强患者对于造口护理及感染观察的认知。
信念干预(术后48 h内)	询问	由心理咨询师与护理人员于病房内对患者进行一对一访谈，时长约20 min，询问患者Miles术后肠造口感受、接受程度及心理状态。
	评估	询问结束后，评估患者造口压力情况、有无不良情绪及对造口护理的信心程度。
	建议	由心理咨询师进行一对一情绪疏导，包括叙事疗法、瑜伽呼吸法、音乐冥想等方法，给予患者心理安慰及情感支持，释放压力与不良情绪。
	帮助	提高患者家庭支持度，由护理人员对患者家属进行一对一干预，干预时长约20 min，首先做好家属的心理疏导，使患者能够感受到来自家属的支持及鼓励，指导家属在患者疾病护理及生活管理中给予针对性照顾，强调造口患者自尊及被爱的感受；由护理人员在示教室内，邀请以往进行造口手术且处于康复期的患者对新造口患者进行示范指导，分享其治疗过程、健康生活方式及心得体会，帮助患者在短时间内度过情感危机，促进其身心快速康复。
行为干预(术后48 h后至出院后)	询问	由护理人员通过问答的形式在示教室内了解患者对于Miles术后肠造口并发感染的对症处理、肠造口管理的掌握程度，要求患者在造口模型上进行简单演示处理，鼓励患者表达术后佩戴造口袋的生活中有哪些不便，并发感染后有哪些护理担忧等，时长约20 min。
	评估	由护理人员评估患者肠造口并发感染后的自我管理水平。
	建议	由医护人员与患者共同制定个体化造口自我管理计划表，包括日常护理及评估、更换合适的造口袋及造口产品、清洗造口及周围皮肤、处理及清洗造口袋、观察造口周围有无感染及并发症等，鼓励家属监督患者完成造口自我管理计划表。住院期间由护理人员主导患者及家属进行情景模拟演练，演练时长约30 min，至少进行2次。首先由患者及家属共同观看造口并发感染护理方法、造口袋护理等操作视频进行学习，请患者及家属在肠造口模型上进行操作。最后由护理人员纠正错误操作并进行规范化示范，就操作中的难点进行总结。
	帮助	患者出院后，每月组织1次造口联谊会，于院内进行，每次时长约60 min，邀请造口患者分享自我管理期间面临的问题及如何克服挑战的经验，以解决造口难题为主题，病友间共同探讨克服办法，最后由医护人员进行总结指导。每周末进行1次微信线上科普指导，再次对患者造口术后管理策略进行回顾及指导，强化患者自我管理行为，并于微信群中发布造口自我管理文章及居家健康生活方式视频，每天17：00于微信群内定时回复患者问题。
	随访	护理人员每周通过微信随访，调查患者造口自我管理计划表记录及完成情况；每周通过1次电话随访了解患者造口自我管理技巧、感染观察情况，并予以指导，了解家属疾病管理支持及监督情况，提高家属对患者疾病管理的参与度；患者进行造口复诊时，对患者出院后自我管理问题进行总结及分析，并进行现场指导，鼓励患者保持健康行为。

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表 2 2组Miles术后结肠造口并发感染患者一般资料比较

Table 2. Comparison of baseline characteristics between the two groups of patients with colostomy infection after Miles surgery

项目	对照组(n=73)	观察组(n=73)	统计量	P值
性别(例)			0.445^a	0.505
男性	30	34
女性	43	39
年龄(x±s，岁)	60.72±9.85	61.13±10.56	0.243^b	0.809
受教育年限(x±s，年)	12.57±3.10	12.68±3.49	0.198^b	0.843
婚姻状况(例)			0.127^a	0.722
有配偶	49	51
无配偶	24	22
职业(例)			0.552^a	0.759
在职	30	28
退休	25	23
无业	18	22
家庭月均收入(例)			0.156^c	0.925
＜3 000元	24	22
3 000~5 000元	28	30
＞5 000元	21	21
有无化疗(例)			0.113^a	0.737
有	29	31
无	44	42
注：^a为χ²值，^b为t值，^c为Z值。

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表 3 2组Miles术后结肠造口并发感染患者感染指标比较(x±s)

Table 3. Comparison of inflammatory markers between the two groups of patients with colostomy infection after Miles surgery(x±s)

组别	例数	PCT(ng/mL)		CRP(μg/mL)
组别	例数	干预前	干预后	干预前	干预后
对照组	73	0.47±0.13	0.23±0.10^b	27.16±5.19	10.05±2.73^b
观察组	73	0.46±0.16	0.16±0.08^b	26.57±4.77	7.14±1.86^b
统计量		0.414^a	4.371^c	0.715^a	6.975^c
P值		0.679	＜0.001	0.476	＜0.001
注：^a为t值，^c为F值；与同组干预前比较，^bP < 0.05。

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表 4 2组Miles术后结肠造口并发感染患者造口压力比较(x±s，分)

Table 4. Comparison of stomal pressure between the two groups of patients with colostomy infection after Miles surgery(x±s, points)

组别	例数	身体状况改变所致压力		自我概念改变所致压力		与家人相互作用改变所致压力		结肠造口护理所致压力
组别	例数	干预前	干预后	干预前	干预后	干预前	干预后	干预前	干预后
对照组	73	28.52±4.28	20.02±4.73^b	16.73±2.79	15.91±3.04^b	19.46±4.15	15.72±3.62^b	22.79±4.25	19.03±3.81^b
观察组	73	27.93±4.11	24.68±5.06^b	16.88±2.83	13.16±2.75^b	19.22±3.83	14.83±3.57^b	22.66±3.94	16.91±3.06^b
统计量		0.850^a	5.450^c	0.322^a	4.903^c	0.363^a	1.261^c	0.192^a	5.875^c
P值		0.397	＜0.001	0.748	＜0.001	0.717	0.154	0.848	＜0.001
注：^a为t值，^c为F值；与同组干预前比较，^bP < 0.05。

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表 5 2组Miles术后结肠造口并发感染患者自我管理能力及生活质量比较(x±s，分)

Table 5. Comparison of self-management skills and quality of life between the two groups of patients with colostomy infection after Miles surgery(x±s, points)

组别	例数	肠造口病人自我管理量表		造口患者生活质量量表
组别	例数	干预前	干预后	干预前	干预后
对照组	73	67.80±7.32	92.73±10.15^b	38.78±5.49	47.49±6.23^b
观察组	73	68.74±6.91	107.64±10.42^b	38.05±6.03	53.26±7.18^b
统计量		0.798^a	7.467^c	0.765^a	4.942^c
P值		0.426	＜0.001	0.446	＜0.001
注：^a为t值，^c为F值；与同组干预前比较，^bP < 0.05。

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参考文献(18)

[1]	KORKMAZ E, ETI ASLAN F. Investigation of effects of preoperative readiness on symptom management in patients with intestinal stoma: a systematic review and meta-analysis study[J]. Asian Pac J Cancer Prev, 2023, 24(9): 2963-2972. doi: 10.31557/APJCP.2023.24.9.2963
[2]	D'AMBROSIO F, PAPPALARDO C, SCARDIGNO A, et al. Peristomal skin complications in ileostomy and colostomy patients: what we need to know from a public health perspective[J]. Int J Environ Res Public Health, 2022, 20(1): 79. DOI: 10.3390/ijerph20010079.
[3]	SIMPSON E, POURSHAHIDI K, DSVIS J, et al. Living with and without an intestinal stoma: factors that promote psychological well-being and self-care: a cross-sectional study[J]. Nurs Open, 2023, 10(12): 7811-7825. doi: 10.1002/nop2.2030
[4]	梁琪, 王冰洁, 刘洋, 等. 结直肠癌造口病人智谋的潜在剖面分析及其影响因素[J]. 护理研究, 2024, 38(20): 3621-3627. LIANG Q, WANG B J, LIU Y, et al. Potential profile analysis and influencing factors of intelligence in patients with colorectal cancer undergoing colostomy[J]. J Nurs Res, 2024, 38(20): 3621-3627.
[5]	张雪, 许佳琪, 张四维, 等. 移动健康在肠造口患者延续护理中应用的范围综述[J]. 中国护理管理, 2024, 24(10): 1526-1533. ZHANG X, XU J Q, ZHANG S W, et al. A review of the scope of application of mobile health in the continued care of patients with intestinal stomas[J]. Chinese Nursing Management, 2024, 24(10): 1526-1533.
[6]	丁密, 刘文静, 楚盼盼, 等. 基于5A模式的分阶段主动循环呼吸技术训练在胸腔镜肺叶切除术后病人康复中的应用[J]. 护理研究, 2023, 37(6): 1068-1072. DING M, LIU W J, CHU P P, et al. Application of staged active circulation breathing technique training based on 5A mode in the rehabilitation of patients after thoracoscopic lobectomy[J]. J Nurs Res, 2023, 37(6): 1068-1072.
[7]	何友燕, 夏琪, 白义凤, 等. 知识-信念-行为理论干预对结肠癌化疗患者情绪和健康行为的影响[J]. 中国健康心理学杂志, 2023, 31(10): 1489-1494. HE Y Y, XIA Q, BAI Y F, et al. The impact of knowledge belief behavior theory intervention on the emotions and health behaviors of colon cancer chemotherapy patients[J]. Chinese Journal of Health Psychology, 2023, 31(10): 1489-1494.
[8]	李杨, 刘春娥, 宋琴芬. 肠造口患者压力知觉及影响因素的研究[J]. 护士进修杂志, 2018, 33(7): 593-597. LI Y, LIU C E, SONG Q F. A study on pressure perception and influencing factors in patients with colostomy[J]. J Nurs Train, 2018, 33(7): 593-597.
[9]	薛盈川, 刘晓鸿, 陆薇, 等. 自我管理教育对永久性结肠造口患者自我护理能力的影响[J]. 中华护理杂志, 2011, 46(8): 753-755. XUE Y C, LIU X H, LU W, et al. The impact of self-management education on the self-care ability of patients with permanent colostomy[J]. Chin J of Nurs, 2011, 46(8): 753-755.
[10]	吴雪, 金晓燕, 尚少梅, 等. 造口病人生活质量量表中文译本的信度、效度分析[J]. 中国护理管理, 2011, 11(7): 23-25. WU X, JIN X Y, SHANG S M, et al. Reliability and validity analysis of the Chinese translation of the Quality of Life Scale for ostomy patients[J]. Chinese Nursing Management, 2011, 11(7): 23-25.
[11]	LIU Y N, WANG L, ZHU L P. The impact of stoma management education on the self-care abilities of individuals with an intestinal stoma[J]. Br J Nurs, 2023, 32(6): S28-S33. doi: 10.12968/bjon.2023.32.6.S28
[12]	张颜, 康春博, 贺姗杉, 等. 基于5A模式的分级干预对低位直肠癌结肠造口患者的影响研究[J]. 消化肿瘤杂志(电子版), 2023, 15(3): 241-247. ZHANG Y, KANG C B, HE S S, et al. Study on the impact of graded intervention based on 5A mode on patients with low rectal cancer and colostomy[J]. Journal of Digestive Oncology (Electronic Edition), 2023, 15(3): 241-247.
[13]	王青青, 刘丽丽, 张海红. 直肠癌术后永久性结肠造口患者行基于知信行理论的护理对其心理适应及自我护理能力的影响[J]. 中国医药导报, 2024, 21(16): 161-164. WANG Q Q, LIU L L, ZHANG H H. The impact of nursing based on the theory of knowledge, belief, and action on psychological adaptation and self-care ability in patients with permanent colostomy after rectal cancer surgery[J]. Chin Med Herald, 2024, 21(16): 161-164.
[14]	常子梦, 赵翠芬, 周彩虹, 等. 认知行为联合信息支持干预对早期肠造口病人益处发现和生活质量的影响[J]. 护理研究, 2023, 37(23): 4346-4351. CHANG Z M, ZHAO C F, ZHOU C H, et al. The impact of cognitive-behavioral combined information support intervention on the discovery of benefits and quality of life in early colostomy patients[J]. J Nurs Res, 2023, 37(23): 4346-4351.
[15]	王芝晶, 何小杰, 房佳, 等. 认知-行为理念的五E护理在肠造口患者中的应用[J]. 中日友好医院学报, 2024, 38(1): 35-38. WANG Z J, HE X J, FANG J, et al. The application of "Five E" nursing of cognition behavior concept in enterostomy patients[J]. Journal of China-Japan Friendship Hospital, 2024, 38(1): 35-38.
[16]	夏丽敏, 王婧玥, 陈晓萱, 等. 基于信息-动机-行为技巧模型的健康教育对永久性肠造口患者出院准备度及出院早期造口并发症的影响[J]. 中华现代护理杂志, 2023, 29(13): 1752-1758. XIA LM, WANG J Y, CHEN X X, et al. The impact of health education based on the information motivation behavioral skills model on the discharge readiness and early complications of permanent colostomy patients[J]. Chinese Journal of Modern Nursing, 2023, 29(13): 1752-1758.
[17]	齐琳娜, 宋利芳, 端木艳丽, 等. 基于达标理论的支持性照护方案在Miles术后结肠造口并发感染临床护理中的应用效果[J]. 中华医院感染学杂志, 2023, 33(21): 3353-3356. QI L N, SONG L F, DUANMU Y L, et al. Application effect of supportive care plan based on standard theory in clinical nursing of Miles postoperative colostomy complicated infection[J]. Chinese Journal of Hospital Infection, 2023, 33(21): 3353-3356.
[18]	周洁, 鲍向英. 基于同质医疗服务理念的护理模式对结直肠癌造口患者情绪及生存质量的影响[J]. 中华全科医学, 2022, 20(4): 713-717. doi: 10.16766/j.cnki.issn.1674-4152.002437 ZHOU J, BAO X Y. The impact of a nursing model based on the concept of homogeneous medical services on the emotions and quality of life of patients with colorectal cancer stoma[J]. Chinese Journal of General Practice, 2022, 20(4): 713-717. doi: 10.16766/j.cnki.issn.1674-4152.002437