基于COM-B模型的自我管理方案在维持性血液透析病人中的应用

    Application effects of the self-management scheme based on COM-B model in maintenance hemodialysis patients

    • 摘要:
      目的  探讨基于COM-B模型的自我管理方案在维持性血液透析病人中的应用效果。
      方法  选取进行规律血透的64例病人为研究对象,根据掷硬币法随机分成观察组和对照组各32例。对照组采用透析常规护理方法,观察组在对照组的基础上采用基于COM-B模型的自我管理方案,比较2组病人干预前后自我管理行为、自我感受负担和透析前后体质量增加值。
      结果  干预后观察组的自我管理总分及各维度分均随时间延长而提高,自我感受负担总分及身体负担、情感负担维度分和体质量增加值均随时间延长而降低(P < 0.01),对照组干预前后自我管理、自我负担和体质量增加值比较,差异均无统计学意义(P>0.05)。干预2个月观察组在执行自我管理和情绪处理维度得分高于对照组(P < 0.05)。干预3个月观察组自我管理总分及各维度分均高于对照组,自我感受负担总分及各维度分、体质量增加值均低于对照组(P < 0.05~P < 0.01)。
      结论  基于COM-B模型的自我管理方案在维持性血液透析病人中的应用效果显著,能够提升病人自我管理行为、降低自我感受负担,有效降低体重增长值,值得在临床进行干预。

       

      Abstract:
      Objective  To explore the application effects of self-management scheme based on COM-B model in maintenance hemodialysis patients.
      Methods  Sixty-four patients treated with regular hemodialysis were selected as the study subjects, and randomly divided into the observation group and control group(32 cases in each group) according to the coin toss method.The control group was treated with the routine dialysis nursing, while the observation group was treated with the self-management scheme based on COM-B model on the basis of the control group.The self-management behavior, self-perceived burden and weight gain before and after dialysis were compared between two groups.
      Results  After intervention, the total score of self-management and scores of each dimension in the observation group increased with the extension of time, while the total score of self-perceived burden, scores of physical burden, emotional burden dimension and weight gain decreased with the extension of time(P < 0.01).There was no statistical significance in the self-management, self-burden and weight gain in the control group between before and after intervention(P>0.05).After 2 months of intervention, the scores of executive self-management and emotional processing in the observation group were higher than those in control group(P < 0.05).After 3 months of intervention, the total score of self-management and scores of all dimensions in the observation group were higher than those in control group, and the total score of self-perceived burden, scores of all dimensions and weight gain in the observation group were lower than those in control group(P < 0.05 to P < 0.01).
      Conclusions  The self-management scheme based on the COM-B model has a remarkable effect in the application of maintenance hemodialysis patients, which can improve the self-management behavior of patients, reduce the self-perceived burden, effectively reduce the weight gain, and is worthy of clinical intervention.

       

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