压疮患者主要照顾者照顾行为及照顾负担的干预研究
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摘要
目的了解压疮患者主要照顾者照顾行为和照顾负担现状；分析主要照顾者照顾行为和照顾负担影响因素；评价以压力-应对理论跨行动模式为基础、参照最佳护理实践指南制定的干预措施的效果。
方法本研究分为两个阶段。第一阶段为横断面调查,以压疮患者及其主要照顾者一般资料调查表、照顾行为问卷、照顾负担量表(Caregiver burden inventory, CBI)、主要照顾者压疮认知问卷和一般自我效能量表(General self-efficacy scale, GSES)为研究工具,调查上海市1家二级医院及2家三级医院门诊就诊或新入院带入压疮患者的主要照顾者146例,了解其照顾行为和照顾负担现状并分析影响因素。第二阶段为干预性研究,选取符合第二阶段纳入标准且愿意参加本研究的压疮患者主要照顾者46例,以随机数字表法随机分为干预组和对照组,每组各23例。对照组接受门诊常规护理教育；干预组在门诊常规护理教育的基础上,实施以压力应对理论跨行动模式为指导、参照最佳护理实践指南制定的干预方案,为期3个月,每个研究对象包括2次个别指导,1次家庭访视,平均6-7次电话咨询或随访。以主要照顾者照顾行为、照顾负担、压疮相关知识、感知到易感性、感知到的严重性、一般自我效能、主要照顾者翻身行为评分、换药行为评分、压疮患者压疮愈合率和再发生率作为评价指标,于干预后1周、1个月和3个月分别进行干预效果评价。统计方法包括t检验、X2检验、Fisher's精确概率检验和重复测量方差分析等。
结果第一阶段横断面调查结果：①主要照顾者压疮认知问卷中,相关知识维度得分16.89±4.23,感知到的易感性维度得分10.27±2.38,感知到的严重性维度得分19.38±3.49。GSES得分2.47±0.68,最低分为1分,最高分为4分。②照顾行为总分平均39.98±6.33,其中翻身行为维度得分最低(条目均分1.86),其次依次为创面护理(1.91)、营养支持(1.93)和皮肤护理(2.48)维度。③照顾者CBI总分平均35.51±14.15,其中时间依赖性负担得分最高(条目均分2.8),其次依次为身体性负担(1.87)、发展受限性负担(1.71)、社交性负担(0.85)和情感性负担(0.35)。④多元线性回归结果显示,影响主要照顾者照顾行为的因素有感知到的严重性、自我效能、感知到的易感性等6个变量,可以解释主要照顾者照顾行为37.5%的变异；影响主要照顾者照顾负担的因素有照顾者平均每日照顾时间、感知到的易感性等4个变量,可以解释照顾负担23.6%的变异。第二阶段干预性研究结果：①干预后1周干预组主要照顾者翻身行为评分、换药行为评分总均分明显高于对照组(P<0.001,P<0.01)。②重复测量方差分析的结果显示,干预组和对照组间主要照顾者压疮相关知识得分差异有统计学意义(P<0.01),主要照顾者压疮相关知识得分有随时间变化的趋势(P<0.001),时间和分组这两个因素间存在交互作用(P<0.001)；多元方差分析结果显示,干预后1个月、干预后3个月干预组主要照顾者压疮相关知识均高于对照组,差异均有统计学意义(P<0.001)。③重复测量方差分析结果显示,干预组和对照组间主要照顾者感知到的易感性差异无统计学意义(P>0.05),主要照顾者感知到的易感性得分随时间变化而变化,差异有统计学意义(P<0.001),时间和分组这两个因素间无交互作用(P>0.05)；多元方差分析的结果示,干预后1个月干预组感知到的易感性得分高于对照组,差异有统计学意义(P<0.05),干预后3个月干预组和对照组主要照顾者感知到的易感性差异无统计学意义(P>0.05)。④重复测量方差分析结果显示,干预组和对照组间主要照顾者感知到的严重性得分差异有统计学意义(P<0.05),主要照顾者感知到的严重性得分有随时间变化的趋势(P<0.001),时间和分组这两个因素间存在交互作用(P<0.01)；多元方差分析结果显示,干预后1个月、干预后3个月干预组主要照顾者感知到的严重性得分均高于对照组,差异均有统计学意义(P<0.01)。⑤重复测量方差分析结果显示,干预组和对照组间主要照顾者一般自我效能得分差异无统计学意义(P>0.05)；主要照顾者一般自我效能得分随时间变化的差异无统计学意义(P>0.05)；时间和分组这两个因素间不存在交互作用(P>0.05)。⑥重复测量方差分析结果显示,干预组和对照组间主要照顾者照顾行为得分差异有统计学意义(P<0.01)；主要照顾者照顾行为得分有随时间变化的趋势(P<0.001)；时间和分组这两个因素间存在交互作用(P<0.001)；多元方差分析结果显示,干预后1个月、干预后3个月干预组主要照顾者照顾行为得分均高于对照组,差异均有统计学意义(P<0.001)。⑦重复测量方差分析结果显示,干预组和对照组间照顾负担得分差异无统计学意义(P>0.05)；主要照顾者照顾负担得分随时间变化而变化,差异有统计学意义(P<0.01),时间和分组这两个因素间无交互作用(P>0.05)；多元方差分析的结果示,干预组和对照组主要照顾者照顾负担在干预后1个月和3个月差异均无统计学意义(P>0.05)。⑧干预后3个月干预组患者压疮愈合率和再发生率与对照组差异均无统计学意义(P>0.05)。
结论压疮患者主要照顾者照顾行为存在不足和误区,照顾负担较重。以压力应对理论跨行动模式为指导、参照最佳护理实践指南制定的干预方案,通过提高主要照顾者压疮相关知识,增强其压疮易感性和严重性的感知,可改善照顾行为；干预方案对减轻主要照顾者照顾负担、降低压疮患者压疮再发生率、提高压疮愈合率的影响有待进一步研究。
Objective To investigate caring behavior and caregiver burden of caregivers of patients with pressure ulcer, and analyze their influencing factors. To explore the effects on caring behavior and caregiver burden of an intervention program that is designed based on the Transaction Model of Stress and Coping and guidelines of Best Practice.
Methods This research was performed in two consecutive phases.In the first phase,a total of 146 caregivers of patients with pressure ulcer were recruited by convenience sampling method.They were investigated with Pressure Ulcer Caring Behaviors Questionnaire,Caregiver Burden Inventory(CBI),Caregivers' Knowledge about Pressure Ulcer Questionnaire,and General Self-Efficacy Scale(GSES).In the second phase,a quasi-experimental study was designed.46 caregivers of patients with pressure ulcer were recruited by convenience sampling method and randomly assigned to intervention group(n=23) or control group(n=23).There were no statistically significant differences in demographic data and information about pressure ulcer and caring between two groups(P> 0.05).The caregivers in the control group received routine out-patient education care.The caregivers in the intervention group received a 3-month intervention program in addition to the routine education care, which included two individual guidances, one home-visit,and six to seven telephone-consultations. The effects of the intervention were evaluated by Pressure Ulcer Caring Behaviors Questionnaire, CBI,Caregivers' Knowledge about Pressure Ulcer Questionnaire,GSES,the Score of transposition sheet and wound-cleaning sheet,the healing rate and recurrence rate of pressure ulcer at 1 week,1 month and 3 months later.
Results In the first phase, the results were as follows.①For each dimension of Caregivers'Knowledge about Pressure Ulcer Questionnaire, the mean score of knowledge about pressure ulcer was 16.89±4.23, caregivers' perceived susceptibility to pressure ulcer was 10.27±2.38, perceived severity of patient's pressure ulcer was 19.38±3.49. The mean score of GSES was 2.47±0.68.②The mean score of Pressure Ulcer Caring Behaviors Questionnaire was 39.98±6.33.For each dimension of it, position care exhibited the lowest score, followed by wound care, nutritional support and skin care.③The mean score of CBI was 35.51±14.15. For each dimension of it,time dependence burden exhibited the highest score, followed by physical burden developmental burden,social burden and emotional burden.④Multiple stepwise regression analysis demonstrated that caregivers'perceived severity of patient's pressure ulcer,self-efficacy,perceived susceptibility to pressure ulcer,and other three factors accounted for 37.5% of the variance in caring behaviors; caring time per day,caregivers' perceptions of susceptibility to pressure ulcer,and other two factors accounted for 23.6% of the variance in caregiver burden.In the second phase,①both the mean score of transposition sheet and wound-cleaning sheet in the intervention group significantly increased compared with the control group 1 week after intervention(P<0.001, P< 0.01).②Analysis of variance of repeated measure and multivariate analysis of variance showed that the mean score of knowledge about pressure ulcer in the intervention group significantly increased compared with the control group (P<0.01).③)Analysis of variance of repeated measure showed that the mean score of caregivers' perceptions of susceptibility to pressure ulcer had a trend of changing with time (P <0.001),but the trend was not different in different group(P>0.05). Multivariate analysis of variance showed the score of caregivers' perceptions of susceptibility to pressure ulcer in the intervention group significantly increased compared with the control group after 1 month((P< 0.05). There was no statistically significant difference between two groups after 3 month(P> 0.05).④Analysis of variance of repeated measure and multivariate analysis of variance showed that the mean score of caregivers' perceived severity of patient's pressure ulcer in the intervention group significantly increased compared with the control group (P< 0.05).⑤Analysis of variance of repeated measure showed that the mean score of GSES had no significant difference between two groups (P>0.05).⑥Analysis of variance of repeated measure and multivariate analysis of variance showed that the mean score of Caring Behaviors Questionnaire in the intervention group significantly increased compared with the control group (P<0.001).⑦Analysis of variance of repeated measure showed that the mean score of CBI had a trend of changing with time (P<0.01),but the trend was not different in different group(P >0.05).⑧There were no statistically significant differences both in the healing rate and the recurrence rate of pressure ulcer between two groups(P>0.05).
Conclusion The caring behavior of caregivers of patients with pressure ulcer was not enough and they had moderate caregiver burden.The intervention program designed using the Transaction Model of Stress and Coping as the theoretical foundation and following guidelines of Best Practice was effective for improving caregivers'caring behaviors through increasing caregivers' knowledge about pressure ulcer, perceived susceptibility to pressure ulcer and perceived severity of patient's pressure ulcer.Its effects on caregiver burden,the healing rate and recurrence rate of pressure ulcer need to confirm in the future study.
方法本研究分为两个阶段。第一阶段为横断面调查,以压疮患者及其主要照顾者一般资料调查表、照顾行为问卷、照顾负担量表(Caregiver burden inventory, CBI)、主要照顾者压疮认知问卷和一般自我效能量表(General self-efficacy scale, GSES)为研究工具,调查上海市1家二级医院及2家三级医院门诊就诊或新入院带入压疮患者的主要照顾者146例,了解其照顾行为和照顾负担现状并分析影响因素。第二阶段为干预性研究,选取符合第二阶段纳入标准且愿意参加本研究的压疮患者主要照顾者46例,以随机数字表法随机分为干预组和对照组,每组各23例。对照组接受门诊常规护理教育；干预组在门诊常规护理教育的基础上,实施以压力应对理论跨行动模式为指导、参照最佳护理实践指南制定的干预方案,为期3个月,每个研究对象包括2次个别指导,1次家庭访视,平均6-7次电话咨询或随访。以主要照顾者照顾行为、照顾负担、压疮相关知识、感知到易感性、感知到的严重性、一般自我效能、主要照顾者翻身行为评分、换药行为评分、压疮患者压疮愈合率和再发生率作为评价指标,于干预后1周、1个月和3个月分别进行干预效果评价。统计方法包括t检验、X2检验、Fisher's精确概率检验和重复测量方差分析等。
结果第一阶段横断面调查结果：①主要照顾者压疮认知问卷中,相关知识维度得分16.89±4.23,感知到的易感性维度得分10.27±2.38,感知到的严重性维度得分19.38±3.49。GSES得分2.47±0.68,最低分为1分,最高分为4分。②照顾行为总分平均39.98±6.33,其中翻身行为维度得分最低(条目均分1.86),其次依次为创面护理(1.91)、营养支持(1.93)和皮肤护理(2.48)维度。③照顾者CBI总分平均35.51±14.15,其中时间依赖性负担得分最高(条目均分2.8),其次依次为身体性负担(1.87)、发展受限性负担(1.71)、社交性负担(0.85)和情感性负担(0.35)。④多元线性回归结果显示,影响主要照顾者照顾行为的因素有感知到的严重性、自我效能、感知到的易感性等6个变量,可以解释主要照顾者照顾行为37.5%的变异；影响主要照顾者照顾负担的因素有照顾者平均每日照顾时间、感知到的易感性等4个变量,可以解释照顾负担23.6%的变异。第二阶段干预性研究结果：①干预后1周干预组主要照顾者翻身行为评分、换药行为评分总均分明显高于对照组(P<0.001,P<0.01)。②重复测量方差分析的结果显示,干预组和对照组间主要照顾者压疮相关知识得分差异有统计学意义(P<0.01),主要照顾者压疮相关知识得分有随时间变化的趋势(P<0.001),时间和分组这两个因素间存在交互作用(P<0.001)；多元方差分析结果显示,干预后1个月、干预后3个月干预组主要照顾者压疮相关知识均高于对照组,差异均有统计学意义(P<0.001)。③重复测量方差分析结果显示,干预组和对照组间主要照顾者感知到的易感性差异无统计学意义(P>0.05),主要照顾者感知到的易感性得分随时间变化而变化,差异有统计学意义(P<0.001),时间和分组这两个因素间无交互作用(P>0.05)；多元方差分析的结果示,干预后1个月干预组感知到的易感性得分高于对照组,差异有统计学意义(P<0.05),干预后3个月干预组和对照组主要照顾者感知到的易感性差异无统计学意义(P>0.05)。④重复测量方差分析结果显示,干预组和对照组间主要照顾者感知到的严重性得分差异有统计学意义(P<0.05),主要照顾者感知到的严重性得分有随时间变化的趋势(P<0.001),时间和分组这两个因素间存在交互作用(P<0.01)；多元方差分析结果显示,干预后1个月、干预后3个月干预组主要照顾者感知到的严重性得分均高于对照组,差异均有统计学意义(P<0.01)。⑤重复测量方差分析结果显示,干预组和对照组间主要照顾者一般自我效能得分差异无统计学意义(P>0.05)；主要照顾者一般自我效能得分随时间变化的差异无统计学意义(P>0.05)；时间和分组这两个因素间不存在交互作用(P>0.05)。⑥重复测量方差分析结果显示,干预组和对照组间主要照顾者照顾行为得分差异有统计学意义(P<0.01)；主要照顾者照顾行为得分有随时间变化的趋势(P<0.001)；时间和分组这两个因素间存在交互作用(P<0.001)；多元方差分析结果显示,干预后1个月、干预后3个月干预组主要照顾者照顾行为得分均高于对照组,差异均有统计学意义(P<0.001)。⑦重复测量方差分析结果显示,干预组和对照组间照顾负担得分差异无统计学意义(P>0.05)；主要照顾者照顾负担得分随时间变化而变化,差异有统计学意义(P<0.01),时间和分组这两个因素间无交互作用(P>0.05)；多元方差分析的结果示,干预组和对照组主要照顾者照顾负担在干预后1个月和3个月差异均无统计学意义(P>0.05)。⑧干预后3个月干预组患者压疮愈合率和再发生率与对照组差异均无统计学意义(P>0.05)。
结论压疮患者主要照顾者照顾行为存在不足和误区,照顾负担较重。以压力应对理论跨行动模式为指导、参照最佳护理实践指南制定的干预方案,通过提高主要照顾者压疮相关知识,增强其压疮易感性和严重性的感知,可改善照顾行为；干预方案对减轻主要照顾者照顾负担、降低压疮患者压疮再发生率、提高压疮愈合率的影响有待进一步研究。
Objective To investigate caring behavior and caregiver burden of caregivers of patients with pressure ulcer, and analyze their influencing factors. To explore the effects on caring behavior and caregiver burden of an intervention program that is designed based on the Transaction Model of Stress and Coping and guidelines of Best Practice.
Methods This research was performed in two consecutive phases.In the first phase,a total of 146 caregivers of patients with pressure ulcer were recruited by convenience sampling method.They were investigated with Pressure Ulcer Caring Behaviors Questionnaire,Caregiver Burden Inventory(CBI),Caregivers' Knowledge about Pressure Ulcer Questionnaire,and General Self-Efficacy Scale(GSES).In the second phase,a quasi-experimental study was designed.46 caregivers of patients with pressure ulcer were recruited by convenience sampling method and randomly assigned to intervention group(n=23) or control group(n=23).There were no statistically significant differences in demographic data and information about pressure ulcer and caring between two groups(P> 0.05).The caregivers in the control group received routine out-patient education care.The caregivers in the intervention group received a 3-month intervention program in addition to the routine education care, which included two individual guidances, one home-visit,and six to seven telephone-consultations. The effects of the intervention were evaluated by Pressure Ulcer Caring Behaviors Questionnaire, CBI,Caregivers' Knowledge about Pressure Ulcer Questionnaire,GSES,the Score of transposition sheet and wound-cleaning sheet,the healing rate and recurrence rate of pressure ulcer at 1 week,1 month and 3 months later.
Results In the first phase, the results were as follows.①For each dimension of Caregivers'Knowledge about Pressure Ulcer Questionnaire, the mean score of knowledge about pressure ulcer was 16.89±4.23, caregivers' perceived susceptibility to pressure ulcer was 10.27±2.38, perceived severity of patient's pressure ulcer was 19.38±3.49. The mean score of GSES was 2.47±0.68.②The mean score of Pressure Ulcer Caring Behaviors Questionnaire was 39.98±6.33.For each dimension of it, position care exhibited the lowest score, followed by wound care, nutritional support and skin care.③The mean score of CBI was 35.51±14.15. For each dimension of it,time dependence burden exhibited the highest score, followed by physical burden developmental burden,social burden and emotional burden.④Multiple stepwise regression analysis demonstrated that caregivers'perceived severity of patient's pressure ulcer,self-efficacy,perceived susceptibility to pressure ulcer,and other three factors accounted for 37.5% of the variance in caring behaviors; caring time per day,caregivers' perceptions of susceptibility to pressure ulcer,and other two factors accounted for 23.6% of the variance in caregiver burden.In the second phase,①both the mean score of transposition sheet and wound-cleaning sheet in the intervention group significantly increased compared with the control group 1 week after intervention(P<0.001, P< 0.01).②Analysis of variance of repeated measure and multivariate analysis of variance showed that the mean score of knowledge about pressure ulcer in the intervention group significantly increased compared with the control group (P<0.01).③)Analysis of variance of repeated measure showed that the mean score of caregivers' perceptions of susceptibility to pressure ulcer had a trend of changing with time (P <0.001),but the trend was not different in different group(P>0.05). Multivariate analysis of variance showed the score of caregivers' perceptions of susceptibility to pressure ulcer in the intervention group significantly increased compared with the control group after 1 month((P< 0.05). There was no statistically significant difference between two groups after 3 month(P> 0.05).④Analysis of variance of repeated measure and multivariate analysis of variance showed that the mean score of caregivers' perceived severity of patient's pressure ulcer in the intervention group significantly increased compared with the control group (P< 0.05).⑤Analysis of variance of repeated measure showed that the mean score of GSES had no significant difference between two groups (P>0.05).⑥Analysis of variance of repeated measure and multivariate analysis of variance showed that the mean score of Caring Behaviors Questionnaire in the intervention group significantly increased compared with the control group (P<0.001).⑦Analysis of variance of repeated measure showed that the mean score of CBI had a trend of changing with time (P<0.01),but the trend was not different in different group(P >0.05).⑧There were no statistically significant differences both in the healing rate and the recurrence rate of pressure ulcer between two groups(P>0.05).
Conclusion The caring behavior of caregivers of patients with pressure ulcer was not enough and they had moderate caregiver burden.The intervention program designed using the Transaction Model of Stress and Coping as the theoretical foundation and following guidelines of Best Practice was effective for improving caregivers'caring behaviors through increasing caregivers' knowledge about pressure ulcer, perceived susceptibility to pressure ulcer and perceived severity of patient's pressure ulcer.Its effects on caregiver burden,the healing rate and recurrence rate of pressure ulcer need to confirm in the future study.
引文
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