Impact of tiered preventive nursing based on Neuman systems model on psychological state and self-management ability in corneal transplantation patients
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摘要:
目的 本研究构建基于纽曼系统模式的分级预防护理模式，探讨其对角膜移植术后患者心理状态、自我管理能力及生活质量的改善效果，为优化眼科角膜移植术后护理方案提供实践依据。 方法 选取2023年12月—2024年11月于温州医科大学附属眼视光医院就诊的182例角膜移植术患者作为研究对象，采用随机数字表法将其分为对照组与观察组，每组91例。对照组实施常规护理措施，观察组在常规护理基础上，应用基于纽曼系统模式的分级预防护理。比较2组患者干预前后心理状态、自我管理能力及生活质量，统计2组患者术后并发症发生情况。 结果 干预后，观察组患者焦虑自评量表(SAS)、抑郁自评量表(SDS）得分分别为（44.66±4.23）分、（40.37±5.74）分，低于对照组[（52.32±6.78）分、（49.25±6.11）分，P＜0.05]；观察组术后用药管理、症状管理及生活管理等自我管理能力得分均高于对照组（P＜0.05）；观察组患者中文版国家眼科研究所视功能问卷-25项（NEI-VFQ-25）得分为（83.25±4.16）分，高于对照组[（78.41±5.67）分，P＜0.05]；观察组术后并发症发生率较对照组更低，但差异无统计学意义（P＞0.05）。 结论 基于纽曼系统模式的分级预防护理能有效改善角膜移植术后患者焦虑、抑郁等不良情绪，对提高患者术后自我管理能力及生活质量具有一定的积极作用。 Abstract:Objective To develop a tiered preventive nursing model based on Neuman systems model and evaluate its effects on psychological status, self-management ability, and quality of life in patients after corneal transplantation, thereby providing practical evidence for optimizing postoperative care in ophthalmology. Methods A total of 182 patients who underwent corneal transplantation at the Affiliated Eye and Vision Hospital of Wenzhou Medical University between December 2023 and November 2024 were enrolled as participants in this study. These patients were randomly assigned to either a control group or an observation group, with 91 patients in each group. Patients in the control group received routine nursing care, while those in the observation group were provided with preventive nursing based on Neuman systems model in addition to routine care. The psychological status, self-management ability, and quality of life were assessed before and after the intervention, and the postoperative complications were recorded in both groups. Results After the intervention, the scores on the self-rating anxiety scale (SAS) and self-rating depression scale (SDS) in the observation group were (44.66±4.23) points and (40.37±5.74) points, respectively, which were lower than those in the control group (52.32±6.78) points and (49.25±6.11) points (P < 0.05). Additionally, the observation group demonstrated significantly better self-management ability, reflected in higher scores for medication adherence, symptom control, and daily living management (P < 0.05). The Chinese version of the National Institute of Ophthalmology visual function questionnaire (NEI-VFQ-25) score was higher in the observation group [(83.25±4.16) points vs. (78.41±5.67) points, P < 0.05]. Although the incidence of postoperative complications was lower in the observation group, the difference was not statistically significance (P>0.05). Conclusion Tiered preventive nursing based on Neuman systems model can effectively alleviate anxiety and depression in patients after corneal transplantation and has positive effect on improving self-management ability and quality of life. -
Key words:
- Corneal transplantation /
- Neuman systems model /
- Anxiety /
- Depression /
- Psychological state /
- Self-management ability
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表 1 2组角膜移植患者一般资料比较
Table 1. Comparison of general data of 2 groups of corneal transplant patients
组别 例数 性别(例) 年龄(x±s，岁) 移植类型(例) 文化程度(例) 男性 女性 穿透性角膜移植 深板层角膜移植 角膜内皮移植 初中及以下 高中/中专 大专及以上 对照组 91 51 40 48.76±5.43 37 35 19 26 28 37 观察组 91 56 35 48.53±4.92 40 34 17 22 33 36 统计量 0.567a 0.299b 0.243a 0.227c P值 0.451 0.765 0.886 0.821 注：a为χ2值，b为t值, c为Z值。 
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表 2 2组角膜移植患者干预前后心理状态比较(x±s，分)
Table 2. Comparison of psychological states before and after intervention in 2 groups of corneal transplant patients(x±s, points)
组别 例数 SAS SDS 干预前 干预后 干预前 干预后 对照组 91 60.21±10.75 52.32±6.78b 57.58±7.46 49.25±6.11b 观察组 91 59.42±11.13 44.66±4.23b 56.85±8.20 40.37±5.74b 统计量 0.487a 8.763c 0.628a 9.205c P值 0.627 ＜0.001 0.531 ＜0.001 注：a为t值，c为F值。与同组干预前比较，bP < 0.05。
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表 3 2组角膜移植患者干预前后自我管理能力比较(x±s，分)
Table 3. Comparison of self-management abilities before and after intervention in 2 groups of corneal transplant patients(x±s, points)
组别 例数 用药管理 症状管理 干预前 干预后 干预前 干预后 对照组 91 10.72±2.16 11.23±1.96b 9.47±1.86 11.85±2.53b 观察组 91 10.38±1.94 13.59±2.25b 9.83±2.07 14.13±1.67b 统计量 1.117a 6.144c 1.234a 6.297c P值 0.265 ＜0.001 0.219 ＜0.001 组别 例数 生活管理 总分 干预前 干预后 干预前 干预后 对照组 91 12.35±2.41 12.70±2.26 33.82±4.74 35.05±4.28b 观察组 91 11.84±1.82 14.91±2.33b 34.43±4.54 43.16±3.71b 统计量 1.611a 5.582c 0.887a 11.938c P值 0.109 ＜0.001 0.376 ＜0.001 注：a为t值，c为F值。与同组干预前比较，bP < 0.05。
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表 4 2组角膜移植患者干预前后生活质量比较(x±s，分)
Table 4. Comparison of quality of life before and after intervention in 2 groups of corneal transplant patients(x±s, points)
组别 例数 NEI-VFQ-25量表 干预前 干预后 对照组 91 60.62±7.57 78.41±5.67 观察组 91 61.04±7.43 83.25±4.16 统计量 0.378a 6.037b P值 0.706 ＜0.001 注：a为t值，b为F值。
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[1] 董泽英, 杨青青, 潘艳, 等. IVR+PRP联合PPV治疗PDR对患者眼表功能、屈光状态及肾功能的影响[J]. 中华全科医学, 2024, 22(4): 592-596. doi: 10.16766/j.cnki.issn.1674-4152.003458DONG Z Y, YANG Q Q, PAN Y, et al. Effect of IVR+PRP combined with PPV on ocular surface function, refractive status and renal function in patients with PDR[J]. Chinese Journal of General Practice, 2024, 22(4): 592-596. doi: 10.16766/j.cnki.issn.1674-4152.003458 [2] 郭小璐, 曹梅娟. 纽曼系统模式应用进展[J]. 护理学杂志, 2012, 27(13): 92-94.GUO X L, CAO M J. Application progress of Neuman systems model[J]. Journal of Nursing Science, 2012, 27(13): 92-94. [3] 刘璇, 白玉树, 李明, 等. 基于纽曼系统模式指导的护理在青少年特发性脊柱侧凸手术患者中的应用效果[J]. 海军军医大学学报, 2025, 46(3): 318-324.LIU X, BAI Y S, LI M, et al. Application effect of nursing guided by Neuman systems model in adolescent patients with idiopathic scoliosis undergoing surgery[J]. Academic Journal of Naval Medical University, 2025, 46(3): 318-324. [4] 张森森, 丁凤琴, 李宁, 等. 焦虑与抑郁的共病: 基于交叉滞后路径模型和网络分析的纵向研究[J]. 心理科学, 2025, 48(3): 732-742.ZHANG S S, DING F Q, LI N, et al. Comorbidity of anxiety and depression: A longitudinal study based on cross-lagged path model and network analysis[J]. Journal of Psychological Science, 2025, 48(3): 732-742. [5] 李彤, 刘永瑞, 张芬, 等. 基于纽曼系统模式的Nustep-t4运动训练在脑卒中偏瘫病人康复中的应用[J]. 护理研究, 2023, 37(24): 4458-4464.LI T, LIU Y R, ZHANG F, et al. Application of Nustep-t4 exercise training based on Neuman systems model in rehabilitation of stroke patients with hemiplegia[J]. Chinese Nursing Research, 2023, 37(24): 4458-4464. [6] 吴晓云, 毕清泉, 周桂琴, 等. 心理弹性在角膜移植患者情绪创造力与创伤后成长中的中介作用[J]. 护理学报, 2022, 29(6): 11-14.WU X Y, BI Q Q, ZHOU G Q, et al. Mediating role of psychological resilience between emotional creativity and post-traumatic growth in corneal transplant patients[J]. Journal of Nursing (China), 2022, 29(6): 11-14. [7] 林晓鸿, 方嘉欣, 刘红霞. 基于纽曼系统模式的护理中域理论发展及应用的文献研究[J]. 中华护理教育, 2024, 21(9): 1147-1152.LIN X H, FANG J X, LIU H X. Literature study on development and application of mid-range nursing theory based on Neuman systems model[J]. Chinese Journal of Nursing Education, 2024, 21(9): 1147-1152. [8] 楼月惠, 孙丽. 纽曼系统护理与人文关怀在血液透析患者中的应用价值[J]. 国际护理学杂志, 2023, 42(13): 2436-2439.LOU Y H, SUN L. Application value of Neuman system nursing and humanistic care in hemodialysis patients[J]. International Journal of Nursing, 2023, 42(13): 2436-2439. [9] 桂金敏, 赵东红, 刘青林, 等. 纽曼系统护理在颈动脉狭窄支架植入术后患者中的应用效果[J]. 中国医药导报, 2023, 20(17): 153-156.GUI J M, ZHAO D H, LIU Q L, et al. Application effect of Neuman system nursing in patients after carotid artery stenting[J]. China Medical Herald, 2023, 20(17): 153-156. [10] 张心怡, 许木子, 郑艳, 等. 健康焦虑及其网络认知行为干预的研究进展[J]. 中国全科医学, 2023, 26(23): 2936-2942.ZHANG X Y, XU M Z, ZHENG Y, et al. Health anxiety and internet-based cognitive behavioral therapy: a review[J]. Chinese General Practice, 2023, 26(23): 2936-2942. [11] 张继涛, 张宣, 王东娜, 等. 正念减压联合认知行为疗法对广泛性焦虑障碍伴失眠患者情绪及睡眠质量的影响[J]. 国际精神病学杂志, 2025, 52(2): 501-504.ZHANG J T, ZHANG X, WANG D N, et al. Effects of mindfulness-based stress reduction combined with cognitive behavioral therapy on emotion and sleep quality in patients with generalized anxiety disorder and insomnia[J]. Journal of International Psychiatry, 2025, 52(2): 501-504. [12] 林晓鸿, 方嘉欣, 刘红霞. 基于纽曼系统模式的护理中域理论发展及应用的文献研究[J]. 中华护理教育, 2024, 21(9): 1147-1152.LIN X H, FANG J X, LIU H X. Literature study on development and application of mid-range nursing theory based on Neuman systems model[J]. Chinese Journal of Nursing Education, 2024, 21(9): 1147-1152. [13] 北京护理学会眼科专业委员会. 人工角膜移植围手术期中西医结合护理临床实践专家共识[J]. 中国中医眼科杂志, 2025, 35(8): 701-707.Ophthalmology Professional Committee of Beijing Nursing Association. Expert consensus on clinical practice of integrated traditional Chinese and Western medicine nursing during perioperative period of artificial corneal transplantation[J]. Chinese Journal of Chinese Ophthalmology, 2025, 35(8): 701-707. [14] 曾湘纹, 李燕, 卓德义, 等. 人工角膜移植术后患者视觉相关生活质量的研究[J]. 联勤军事医学, 2025, 39(6): 493-498.ZENG X W, LI Y, ZHUO D Y, et al. Study on vision-related quality of life in patients after artificial corneal transplantation[J]. Military Medicine of Joint Logistics, 2025, 39(6): 493-498. [15] 鲍琳, 王敏敏. 基于霍桑效应理论的个性化护理对角膜移植术后患者心理弹性、创伤后成长的影响[J]. 国际护理学杂志, 2025, 44(5): 874-878.BAO L, WANG M M. Effect of personalized nursing based on Hawthorne effect theory on psychological resilience and post-traumatic growth of patients after corneal transplantation[J]. International Journal of Nursing, 2025, 44(5): 874-878. [16] 张冰姿, 任静. 角膜移植术后并发干眼症的危险因素分析及预测模型构建[J]. 现代医学, 2025, 53(5): 797-803.ZHANG B Z, REN J. Risk factor analysis and prediction model construction for dry eye after corneal transplantation[J]. Modern Medical Journal, 2025, 53(5): 797-803.
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