专科护士主导的2型糖尿病患者共享门诊的构建及应用

doi:10.3761/j.issn.0254-1769.2022.01.002

摘要/Abstract

摘要：

目的建立专科护士主导的2型糖尿病患者共享门诊,分析其对患者代谢指标、自我管理行为、自我管理效能及生活质量的影响。方法构建专科护士主导的2型糖尿病患者共享门诊,并应用于2020年9月—12月在某三级甲等医院内分泌门诊就诊的30例2型糖尿病患者中。比较干预前和干预3个月后血糖达标率、各项生化指标、糖尿病患者自我管理行为量表得分、糖尿病患者管理自我效能量表得分及生存质量特异性量表得分的差异。结果干预3个月后,患者的血糖达标率与干预前相比,差异无统计学意义 (P=0.310) 。干预3个月后患者的腰围、总胆固醇、甘油三酯低于干预前 (P<0.05) ;患者的自我管理行为量表总分以及饮食管理和足部管理2个维度得分及自我效能量表得分高于干预前 (P<0.05) ;患者的糖尿病生存质量特异性量表总分及生理维度、心理维度、社会关系维度3个维度得分较干预前降低 (P<0.05) 。结论由专科护士主导的共享门诊能够有效降低2型糖尿病患者的腰围、总胆固醇和甘油三酯,提高患者的自我管理行为和自我管理效能,改善患者的生存质量。

关键词: 共享门诊, 2型糖尿病, 自我管理能力, 管理模式, 护理

Abstract:

Objective To evaluate the effectiveness of the shared medical appointments (SMA) in the management of type 2 diabetes mellitus (T2DM) and its impact on self-management behavior and efficacy and quality of life led by specialist nurses. Methods 30 patients with T2DM going to the endocrine clinic of a hospital from September to December 2020 were selected to participate in the SMA. The body mass index,Summary of Diabetes Self-care Activities (SDSCA) scale and Diabetes Management Self-efficacy Scale (DMSES) and Diabetes Specific Quality of Life (DSQL) scale were compared before the intervention and 3 months after the intervention. Results After 3 months of intervention,there was no statistical significance in the control rate of blood glucose compared with that before intervention (P=0.310). Waist circumference,total cholesterol and triglycerides of the patients after the intervention were significantly lower than those before the intervention (P<0.05). The total scores and the score of each dimension (diet,foot care) in SDSCA,and the DMSES score after the intervention were higher than those before (P<0.05). After the intervention,the total scores of DSQL and the scores of physiological dimension,psychological dimension and social relationship dimension were significantly lower than those before the intervention (P<0.05). Conclusion The SMA can effectively improve the waist circumference,total cholesterol and triglycerides of diabetic patients,improve the self-management ability,self-management efficiency,and the quality of life of patients with type 2 diabetes.

Key words: Shared Medical Appointments, Type 2 Diabetes, Self-Management, Care Model, Nursing Care

李逗逗, 姚瑶, 曹琳, 郑仁东, 何志伟, 姚平, 王雅琳, 孙宇, 朱登月, 刘超. 专科护士主导的2型糖尿病患者共享门诊的构建及应用[J]. 中华护理杂志, 2022, 57(1): 17-22.

LI Doudou, YAO Yao, CAO Lin, ZHENG Rendong, HE Zhiwei, YAO Ping, WANG Yalin, SUN Yu, ZHU Dengyue, LIU Chao. Construction and application of shared medical appointments for patients with type 2 diabetes led by specialist nurses[J]. Chinese Journal of Nursing, 2022, 57(1): 17-22.

图/表 5

表1 专科护士主导的2型糖尿病患者共享门诊工作流程

Table 1 Standard process of shared medical appointments for diabetes led by specialist nurses

表2 共享门诊主题讨论内容

Table 2 shared medical appointments discussion Content

表3 干预前后生化指标及其他相关指标的比较 (n=26)

Table 3 Comparison of indicators and other relevant indicators before and after intervention (n=26)

表4 干预前后糖尿病患者自我管理行为量表得分比较 (n=26,分,$\bar{x}±s$)

Table 4 Comparison the scores of Summary of Diabetes Self-Care Activities before and after intervention (n=26,scores,$\bar{x}±s$)

表5 干预前后糖尿病患者生存质量特异性量表得分比较 (n=26,分,$\bar{x}±s$)

Table 5 Comparison the scores of Diabetes Specific Quality of Life Scale before and after intervention (n=26,scores,$\bar{x}±s$)

参考文献 18

[1]	Reusch JE, Manson JE. Management of type 2 diabetes in 2017:getting to goal[J]. JAMA, 2017, 317(10):1015-1016. DOI PMID
[2]	薛文俊, 牛晓丹, 王艳红. 老年2型糖尿病患者医院-家庭过渡期用药偏差的调查研究[J]. 中华护理杂志, 2021, 56(2):225-232.
	Xue WJ, Niu XD, Wang YH. Research on the condition of medication discrepancy in hospital-family transitional period in elderly patients with type 2 diabetes mellitus[J]. Chin J Nurs, 2021, 56(2):225-232.
[3]	袁晓丹, 陈雪, 胡佳琪, 等. 个案管理平台在2型糖尿病患者中的应用研究[J]. 中华护理杂志, 2020, 55(11):1653-1659.
	Yuan XD, Chen X, Hu JQ, et al. Effects of mobile health application based on case management on self-care behavior and empowerment ability of patients with Type 2 diabetes mellitus[J]. Chin J Nurs, 2020, 55(11):1653-1659.
[4]	姚瑶, 郑仁东, 刘超. 共享门诊:新型糖尿病管理模式[J]. 中华糖尿病杂志, 2019, 11(9):577-580.
	Yao Y, Zheng RD, Liu C. Shared medical appointments:new diabetes management model[J]. Chin J Diabetes Mellit, 2019, 11(9):577-580.
[5]	Kahkoska AR, Brazeau NF, Lynch KA, et al. Implementation and evaluation of shared medical appointments for type 2 diabetes at a Free,Student-Run Clinic in Alamance County,North Carolina[J]. J Med Educ Train, 2018, 1:32.
[6]	Heyworth L, Rozenblum R, Burgess JF, et al. Influence of shared medical appointments on patient satisfaction:a retrospective 3-year study[J]. Ann Fam Med, 2014, 12(4):324-330. DOI PMID
[7]	万巧琴, 尚少梅, 来小彬, 等. 2型糖尿病患者自我管理行为量表的信、效度研究[J]. 中国实用护理杂志, 2008, 24(7):26-27.
	Wan QQ, Shang SM, Lai XB, et al. Study on the reliability and validity of Summary of Diabetes Self-Care Activities for type 2 diabetes patients[J]. Chin J Pract Nurs, 2008, 24(7):26-27.
[8]	彭鑫, 崔焱, 李燕, 等. 糖尿病管理自我效能量表在2型糖尿病病人应用中的效果评价[J]. 全科护理, 2010, 8(11):946-947.
	Peng X, Cui Y, Li Y, et al. Evaluation of Diabetes Management Self-Efficacy Scale in patients with type 2 diabetes[J]. Chin Gener Nurs, 2010, 8(11):946-947.
[9]	周凤琼. 行为医学量表手册[M]. 北京: 中华医学音像出版社, 2005:114-115.
	Zhou FQ. Manual of behavioral medicine scales[M]. Beijing: China Medical Audio and Video, 2005:114-115.
[10]	Edelman D, Gierisch JM, McDuffie JR, et al. Shared medical appointments for patients with diabetes mellitus:a systematic review[J]. J Gen Intern Med, 2015, 30(1):99-106. DOI PMID
[11]	Noya CE, Chesla C, Waters C, et al. Shared medical appointments:an innovative model to reduce health disparities among latinxs with type-2 diabetes[J]. West J Nurs Res, 2020, 42(2):117-124. DOI URL
[12]	Ee C, de Courten B, Avard N, et al. Shared medical appointments and mindfulness for type 2 diabetes-a mixed-methods feasibility study[J]. Front Endocrinol, 2020, 11:570777. DOI URL
[13]	Hartzler ML, Shenk M, Williams J, et al. Impact of collaborative shared medical appointments on diabetes outcomes in a family medicine clinic[J]. Diabetes Educ, 2018, 44(4):361-372. DOI PMID
[14]	Leung AK, Buckley K, Kurtz J. Sustainability of clinical benefits gained during a multidisciplinary diabetes shared medical appointment after patients return to usual care[J]. Clin Diabetes, 2018, 36(3):226-231. DOI URL
[15]	赵芳, 袁丽, 张明霞, 等. 我国糖尿病专科护士培养现状调查[J]. 中华护理杂志, 2020, 55(4):590-594.
	Zhao F, Yuan L, Zhang MX, et al. Investigation on the status of training of diabetes specialist nurses in China[J]. Chin J Nurs, 2020, 55(4):590-594.
[16]	Housden LM, Wong ST. Using group medical visits with those who have diabetes:examining the evidence[J]. Curr Diab Rep, 2016, 16(12):134. DOI URL
[17]	Riley SB. Improving diabetes outcomes by an innovative group visit model:a pilot study[J]. J Am Assoc Nurse Pract, 2013, 25(9):466-472.
[18]	Menon K, Mousa A, de Courten MP, et al. Shared medical appointments may be effective for improving clinical and behavioral outcomes in type 2 diabetes: a narrative review[J]. Front Endocrinol, 2017, 8:263. DOI URL