基于奥马哈系统居家访视模式对社区慢性病患者社会心理问题的干预

摘要

目的 探讨居家访视护理对社区慢性病患者社会心理领域问题的访视效果,以期促进人们更多关注慢性病患者的社会心理层面.方法 引进美国标准化护理语言——奥马哈系统,构建居家访视流程和评价访视成效的模式,随机选择60例居家慢性病患者(脑卒中、高血压、糖尿病患者各20例)进行访视.应用居家访视效果评分表,对患者存在问题认知、行为及状况进行评分,排列问题的优先顺序后进行干预.采用Friedman M检验比较访视前后得分的差异.结果 58例患者完成研究.在社会心理领域里,慢性病患者存在与社区资源的沟通问题最为多见,占62％,其次为精神健康问题(5％)、社交问题(3％)和人际关系问题(3％),未发现患者有角色转变、性、哀伤、忽略、虐待5个方面的问题.访视1个月,58例患者在与社区资源的沟通问题上,认知、行为、状况的评分改变,差异有统计学意义(P＜0.05),其他问题访视前后评分改变,差异无统计学意义.结论 通过居家访视,能改善慢性病患者的与社区资源的沟通问题;针对其他社会心理领域问题,社区护士评估困难,且缺乏其他职业团队合作,访视效果较差.%Objective To evaluate the effect of home visiting by nurses on socio-psychological problems in patients with chronic disease,and to promote people's awareness to pay more attention to psychological problems of patients with chronic diseases.Methods With the Omaha System,home visiting process and effect-evaluation mode were constructed,and then home visiting for 60 patients with stroke,hypertension,or diabetes (each disease with 20 participants) was carried out.Effect-evaluation rating scale was used to score psychological problems in terms of patients' knowledge,behaviors,and status.Interventions were taken according to the priority of problems.Friedman M test was used to analyze the difference of the score.Results Altogether 58 patients completed the study.Top psychological problem was communication with community resources (62％),followed by mental health (5％),social contact (3％) and interpersonal relationship (3％).Other problems such as role change,sexuality,grief,neglect and abuse were not found in the research.The patients exhibited significant differences in K-B-S score related to communication with community resources (P＜0.05).The K-B-S score related to social contact,interpersonal relationship,mental health changed with the increase of home visiting times,but without statistical differences.Conclusion Home visiting by community nurses can improve patients' communication with community resources.But it is difficult for nurses to conduct assessment for other social psychological problems.Meanwhile,owing to lack of cooperation from other fields,effect of home visiting needs to be improved.