基于计划行为理论的护理管理对脑卒中恢复期患者自我效能、健康态度及健康行为的影响

doi:10.16138/j.1673-6087.2024.06.08

摘要/Abstract

摘要：

目的：探讨基于计划行为理论的护理管理对脑卒中恢复期患者自我效能、健康态度及健康行为的影响。方法：选取本院2022年10月至2023年4月脑卒中恢复期患者，随机分为观察组与对照组，每组各51例。对照组给予常规护理干预，观察组在对照组的基础上给予基于计划行为理论的护理管理，干预6个月后，比较2组认知功能、肢体功能[简易智力状态检查量表(mini-mental state examination，MMSE)、简式Fugl-Meyer 评估（Fugl-Meyer assessment，FMA）]、健康信念[Champion健康信念模式量表(Champion health belief model scale，CHBMS)]、自我效能[脑卒中康复自我效能量表（stoke self-efficacy questionnaire， SSEQ）]、健康行为[健康促进生活方式量表（health promotion lifestyle profile，HPLP）]、服药依从性与生活方式依从性、心理状态[汉密尔顿焦虑量表（Hamilton anxiety scale，HAMA)、汉密尔顿抑郁量表（Hamilton depression scale，HAMD）]。结果：观察组干预后认知功能MMSE量表、运动功能FMA量表评分高于对照组（均P<0.05）；观察组干预后健康信念CHBMS量表评分、自我效能SSEQ量表评分高于对照组（均P<0.05）；观察组干预后健康行为HPLP量表评分高于对照组（均P<0.05）；观察组用药、饮食控制、戒烟戒酒、适当运动比例分别为96.08%、90.20%、96.08%、82.35%，均高于对照组（80.39%、72.55%、80.39%、56.86%）（P<0.05）；观察组干预后HAMA、HAMD量表评分低于对照组（均P<0.05）。结论：基于计划行为理论的护理管理有利于提高脑卒中恢复期患者健康态度，提升自我效能，从而增强患者行为控制，促进其健康行为保持，减轻不良心理情绪，促进健康管理。

关键词: 脑卒中恢复期, 护理管理, 计划行为理论, 自我效能, 健康态度, 健康行为

Abstract:

Objective To explore the effects of nursing management based on theory of planned behavior (TPB) on self-efficacy, health attitude and health behaviors in patients during stroke convalescence. Methods A total of 102 patients during stroke convalescence in the hospital from October 2022 to April 2023 were enrolled and randomly divided into observation group and control group, and each group had 51 patients. The control group was given routine nursing, while observation group was additionally given TPB-based nursing management. After 6 months of observation, the indexes including cognitive function, limb function [mini-mental state examination (MMSE), Fugl-Meyer assessment (FMA)], health belief [Champion health belief model scale (CHBMS)], self-efficacy [stroke self-efficacy questionnaire (SSEQ)], health behaviors [health promotion lifestyle profile (HPLP)], compliance of medication and life-style, and psychological state [Hamilton anxiety scale (HAMA), Hamilton depression scale (HAMD)] in the two groups were compared. Results After intervention, scores of MMSE, FMA, CHBMS, SSEQ and HPLP were higher in observation group than those in control group (all P<0.05). The compliance rates of medication (96.08%), diet control (90.20%), stopping smoking and drinking (96.08%), and appropriate exercise (82.35%) in observation group were respectively higher than those in control group (80.39%, 72.55%, 80.39%, 56.86%) (all P<0.05), while the score of HAMA and HAMD were lower in observation group than those in control group (all P<0.05). Conclusions TPB-based nursing management is beneficial to improve health attitude and self-efficacy in patients during stroke convalescence, thereby enhancing behavior control, promoting the maintenance of healthy behaviors, relieving negative psychological emotions and promoting health management.

Key words: Stroke convalescence, Nursing management, Theory of planned behavior, Self-efficacy, Health attitude, Health behavior

中图分类号:

R541.75

李玲玲, 刘敏, 章丽鹃, 王晓平. 基于计划行为理论的护理管理对脑卒中恢复期患者自我效能、健康态度及健康行为的影响[J]. 内科理论与实践, 2024, 19(06): 399-404.

LI Lingling, LIU Min, ZHANG Lijuan, WANG Xiaoping. Effects of nursing management based on theory of planned behavior on self-efficacy, health attitude and health behaviors in patients during stroke convalescence[J]. Journal of Internal Medicine Concepts & Practice, 2024, 19(06): 399-404.

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参考文献 11

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项目	对照组	观察组	t	P
MMSE量表
干预前	17.55±1.88	17.08±2.06	1.206	0.231
干预后	24.20±2.52¹⁾	26.27±2.40¹⁾	4.263	<0.001
FMA量表
干预前	37.61±6.64	37.57±6.33	0.031	2.520
干预后	63.53±7.34¹⁾	67.29±7.74¹⁾	0.976	0.013

项目	对照组	观察组	t	P
健康动力
干预前	3.54±0.40	3.62±0.47	0.944	0.348
干预后	3.89±0.39¹⁾	4.27±0.34¹⁾	5.170	<0.001
感知到的益处
干预前	3.24±0.50	3.33±0.46	0.904	0.368
干预后	3.86±0.49¹⁾	4.18±0.46¹⁾	3.439	<0.001
感知到的障碍
干预前	3.23±0.43	3.15±0.38	0.993	0.323
干预后	3.75±0.37¹⁾	4.09±0.38¹⁾	4.624	<0.001
自我效能
干预前	3.24±0.34	3.19±0.42	0.664	0.508
干预后	3.80±0.30¹⁾	4.11±0.38¹⁾	4.553	<0.001
感知到的严重性
干预前	2.74±0.40	2.78±0.45	0.425	0.672
干预后	3.31±0.43¹⁾	3.66±0.47¹⁾	3.912	<0.001
感知到的易感性
干预前	2.16±0.35	2.20±0.39	0.525	0.601
干预后	2.97±0.41¹⁾	3.29±0.41¹⁾	3.948	<0.001
总分
干预前	3.02±0.16	3.05±0.18	0.543	0.588
干预后	3.60±0.19¹⁾	3.93±0.17¹⁾	9.635	<0.001

项目	对照组	观察组	t	P
活动功能
干预前	40.37±3.20	40.78±4.55	0.528	0.598
干预后	48.37±3.20¹⁾	52.25±3.94¹⁾	5.464	<0.001
自我管理
干预前	24.94±2.15	24.82±2.87	0.234	3.554
干预后	30.49±2.43¹⁾	32.51±3.25¹⁾	0.815	0.001
总分
干预前	65.31±4.01	65.61±5.27	0.317	0.752
干预后	78.86±3.73¹⁾	84.76±5.07¹⁾	6.699	<0.001

项目	对照组	观察组	t	P
营养
干预前	2.77±0.36	2.84±0.41	0.920	0.360
干预后	3.14±0.35¹⁾	3.48±0.30¹⁾	5.259	<0.001
人际关系
干预前	2.63±0.34	2.57±0.44	0.815	3.426
干预后	3.03±0.29¹⁾	3.27±0.40¹⁾	0.417	0.001
压力管理
干预前	2.51±0.38	2.54±0.38	0.440	0.661
干预后	3.03±0.41¹⁾	3.32±0.35¹⁾	3.877	<0.001
健康责任感
干预前	2.46±0.33	2.51±0.30	0.864	0.390
干预后	3.10±0.33¹⁾	3.40±0.27¹⁾	5.074	<0.001
自我实现
干预前	2.15±0.28	2.18±0.25	0.690	0.492
干预后	2.56±0.25¹⁾	2.74±0.28¹⁾	3.286	0.001
运动
干预前	2.06±0.30	2.02±0.23	0.852	0.396
干预后	2.73±0.31¹⁾	2.97±0.30¹⁾	3.873	<0.001
总分
干预前	2.43±0.14	2.44±0.15	0.472	0.638
干预后	2.93±0.15¹⁾	3.20±0.14¹⁾	9.419	<0.001

项目	对照组	观察组	χ²	P
用药依从性	41（80）	49（96）	4.628	0.031
饮食调节	37（72）	46（90）	5.239	0.022
戒烟戒酒	41（80）	49（96）	4.628	0.031
适量运动	29（56）	42（82）	7.832	0.005