以时机理论为中心的延续性护理模式在抑郁症患者中的应用效果

陈新霞; 周苏明; 董奇芳; 冯虹

doi:10.16766/j.cnki.issn.1674-4152.003271

以时机理论为中心的延续性护理模式在抑郁症患者中的应用效果

doi: 10.16766/j.cnki.issn.1674-4152.003271

1.
绍兴市第七人民医院精神科，浙江绍兴 312000
2.
绍兴市第七人民医院心身障碍科

基金项目:

浙江省医药卫生科技计划项目 2022RC279

详细信息

通讯作者:
陈新霞, E-mail: chenxinxiacxx@163.com

中图分类号: R473.74R749.41
计量
- 文章访问数: 117
- HTML全文浏览量: 42
- PDF下载量: 7
- 被引次数: 0
出版历程
- 收稿日期: 2023-06-15
- 网络出版日期: 2024-01-13

Application effect of a continuous nursing care centered on timing theory in patients with depression

1.
Psychiatric Department, Shaoxing Seventh People's Hospital, Shaoxing, Zhejiang 312000, China

摘要

摘要: 目的分析以时机理论为中心的延续性护理模式在抑郁症患者中的应用效果，探讨其对患者抑郁症状、自我效能感、生活质量及服药依从性的影响，为临床护理提供新思路。方法选取2022年4月—2023年3月绍兴市第七人民医院收治的116例抑郁症患者作为研究对象，根据随机数字表法将其分为对照组(58例)和观察组(58例)，对照组应用常规护理，观察组在对照组基础上应用以时机理论为中心的延续性护理模式。比较2组患者干预前后抑郁症状、自我效能感、生活质量及服药依从性情况。结果干预后，观察组患者汉密尔顿抑郁量表得分为(10.15±2.05)分，明显低于对照组[(13.28±2.27)分，P＜0.05]；干预后，观察组症状管理自我效能及疾病共性管理自我效能评分分别为(18.13±2.16)分、(20.29±1.03)分，均高于对照组[(15.62±2.39)分、(16.55±2.74)分，均P＜0.05]；干预后，观察组患者健康调查量表各维度得分均高于对照组(均P＜0.05)；观察组服药依从性为94.8%(55/58)，高于对照组的81.0%(47/58, P＜0.05)。结论以时机理论为中心的延续性护理模式能改善抑郁症患者抑郁症状，提高患者自我效能感及生活质量，对患者提高服药依从性具有积极的作用。
- 抑郁症 /
- 时机理论 /
- 延续性护理 /
- 服药依从性 /
- 生活质量
Abstract: Objective To analyze the application effect of the continuity nursing model based on timing theory in patients with depression. To explore its influence on patients' depressive symptoms, self-efficacy, quality of life and medication compliance, and to provide new ideas for clinical nursing. Methods A total of 116 patients with depression who were admitted to the Seventh People's Hospital in Shaoxing from April 2022 to March 2023 were selected as the research subjects. They were divided into a control group and an observation group according to the random number table method, with 58 cases in each group. The control group applied conventional care, and the observation group applied the continuous care model based on the timing theory on the basis of the control group. To compare the depressive symptoms, self-efficacy, quality of life, and medication adherence of two groups of patients before and after intervention. Results After intervention, the Hamilton depression scale (HAMD-24) score of the observation group was (10.15±2.05) points, which was significantly lower than that in control group [(13.28±2.27) points, P < 0.05]. After intervention, the symptom management self-efficacy and disease commonality management self-efficacy scores of the observation group were (18.13±2.16) points and (20.29±1.03) points, respectively, which were higher than those in the control group [(15.62±2.39) points, (16.55±2.74) points, all P < 0.05]. After intervention, the scores of all dimensions of the 36-item short form health survey were higher in the observation group than in the control group (P < 0.05). Medication adherence in the observation group was 94.8% (55/58), which was higher than 81.0% (47/58) in the control group (P < 0.05). Conclusion The continuous care model based on timing theory can improve depression symptoms, increase self-efficacy and quality of life in patients with depression, and have a positive effect on medication compliance.
- Depression /
- Timing theory /
- Continuing care /
- Medication adherence /
- Quality of life

HTML全文

表 1 2组抑郁症患者一般情况比较

Table 1. Comparison of general situation between two groups of patients with depression

组别	例数	性别(例)		年龄(x±s，岁)	病程(x±s，月)	文化程度(例)
组别	例数	男性	女性	年龄(x±s，岁)	病程(x±s，月)	初中	中专/高中	大专/大学及以上
对照组	58	25	33	35.27±4.66	14.25±3.92	8	20	30
观察组	58	28	30	35.33±4.81	14.20±4.25	10	23	25
统计量		0.313^a		0.068^b	0.066^b	0.886^a
P值		0.576		0.946	0.948	0.642
注：^a为χ²值，^b为t值。

下载: 导出CSV

表 2 2组抑郁症患者干预前后抑郁症状评分比较(x±s，分)

Table 2. Comparison of depression symptom scores between two groups of patients with depression before and after intervention (x±s, points)

组别	例数	干预前	干预后
对照组	58	26.55±4.14	13.28±2.27^a
观察组	58	26.63±4.27	10.15±2.05^a
t值		0.102	7.624
P值		0.919	< 0.001
注：与同组干预前比较，^aP < 0.05。

下载: 导出CSV

表 3 2组抑郁症患者干预前后自我效能评分比较(x±s，分)

Table 3. Comparison of self-efficacy scores between two groups of patients with depression before and after intervention (x±s, points)

组别	例数	症状管理自我效能		疾病共性管理自我效能
组别	例数	干预前	干预后	干预前	干预后
对照组	58	8.72±1.16	15.62±2.39^a	7.66±1.34	16.55±2.74^a
观察组	58	8.77±1.21	18.13±2.16^a	7.61±1.25	20.29±1.03^a
t值		0.227	5.934	0.208	9.730
P值		0.921	< 0.001	0.836	< 0.001
注：与同组干预前比较，^aP < 0.05。

下载: 导出CSV

表 4 2组抑郁症患者干预前后生活质量评分比较(x±s，分)

Table 4. Comparison of quality of life scores between two groups of patients with depression before and after intervention (x±s, points)

组别	例数	生理机能		生理职能		躯体疼痛		一般健康状况
组别	例数	干预前	干预后	干预前	干预后	干预前	干预后	干预前	干预后
对照组	58	75.13±4.82	79.00±5.14^a	77.51±4.12	80.42±5.19^a	73.82±3.96	74.14±4.07	78.99±3.95	83.15±4.01^a
观察组	58	75.07±4.31	83.15±4.22^a	77.60±3.86	84.75±4.20^a	73.91±4.13	77.65±3.82^a	79.14±4.23	85.87±3.29^a
t值		0.071	4.752	0.121	4.939	0.117	4.789	0.197	3.528
P值		0.944	< 0.001	0.904	< 0.001	0.907	< 0.001	0.844	0.001

组别	例数	精力		社会功能		情感职能		精神健康
组别	例数	干预前	干预后	干预前	干预后	干预前	干预后	干预前	干预后
对照组	58	72.19±4.18	81.33±3.94^a	73.11±4.13	79.89±6.10^a	75.41±4.38	79.88±3.91^a	70.33±3.46	78.81±3.72^a
观察组	58	72.26±4.40	86.72±3.75^a	73.02±3.99	85.47±5.54^a	75.33±3.72	84.15±4.03^a	70.24±3.85	83.14±3.11^a
t值		0.088	7.547	0.119	5.157	0.106	5.791	0.132	6.801
P值		0.930	< 0.001	0.905	< 0.001	0.916	< 0.001	0.895	< 0.001
注：与同组干预前比较，^aP < 0.05。

下载: 导出CSV

表 5 2组抑郁症患者服药依从性比较

Table 5. Comparison of medication adherence between two groups of patients with depression

组别	例数	良好 [例(%)]	中等 [例(%)]	差 [例(%)]	服药依从性 (%)
对照组	58	34(58.6)	13(22.4)	11(19.0)	81.0(47/58)
观察组	58	40(69.0)	15(25.9)	3(5.2)	94.8(55/58)
注：2组服药依从性比较，χ²=5.199，P=0.023。

下载: 导出CSV

参考文献(21)

[1]	RHEE T G, SHIM S R, FORESTER B P, et al. Efficacy and safety of ketamine vs electroconvulsive therapy among patients with major depressive episode: a systematic review and meta-analysis[J]. JAMA Psychiatry, 2022, 79(12): 1162-1172. doi: 10.1001/jamapsychiatry.2022.3352
[2]	王建刚, 闫换妮, 张珂, 等. 解郁清心安神汤对抑郁症患者不良情绪产生及QOL评分的影响[J]. 中华全科医学, 2023, 21(4): 681-684. doi: 10.16766/j.cnki.issn.1674-4152.002959 WANG J G, YAN H N, ZHANG K, et al. The effect of Jieyu Qingxin Anshen Tang on the generation of negative emotions and QOL scores in patients with depression[J]. Chinese Journal of General Practice, 2023, 21(4): 681-684. doi: 10.16766/j.cnki.issn.1674-4152.002959
[3]	中华医学会行为医学分会, 中华医学会行为医学分会认知应对治疗学组. 抑郁症治疗与管理的专家推荐意见(2022年)[J]. 中华行为医学与脑科学杂志, 2023, 32(3): 193-202. doi: 10.3760/cma.j.cn371468-20220921-00563 Chinese Society of Behavioral Medicine, Cognitive Coping Therapy Group, Chinese Society of Behavioral Medicine. Expert recommendations on the treatment and management of major depressive disorder (2022)[J]. Chinese Journal of Behavioral Medicine and Brain Science, 2023, 32(3): 193-202. doi: 10.3760/cma.j.cn371468-20220921-00563
[4]	符巍, 刘小林. 多学科团队网络随访对抑郁症患者服药依从性的影响[J]. 中国药业, 2020, 29(8): 80-83. FU W, LIU X L. The impact of multidisciplinary team network follow-up on medication compliance in patients with depression[J]. China Pharmaceutical, 2020, 29(8): 80-83.
[5]	冯威, 于泽, 王刚, 等. 抑郁症急性期疗效与巩固期服药依从性的多中心队列研究[J]. 临床精神医学杂志, 2021, 31(5): 342-346. doi: 10.3969/j.issn.1005-3220.2021.05.002 FENG W, YU Z, WANG G, et al. A multicenter cohort study on the efficacy and medication adherence in the acute phase and consolidation phase of depression[J]. Journal of Clinical Psychiatry, 2021, 31(5): 342-346. doi: 10.3969/j.issn.1005-3220.2021.05.002
[6]	周凤飞, 夏晓宏, 张蓉, 等. 基于时机理论的家庭护理在老年糖尿病患者中的应用价值研究[J]. 海军医学杂志, 2022, 43(12): 1354-1358. doi: 10.3969/j.issn.1009-0754.2022.12.018 ZHOU F F, XIA X H, ZAHNG R, et al. Research on the application value of family nursing based on the timing theory in elderly patients with diabetes[J]. Journal of Naval Medicine, 2022, 43(12): 1354-1358. doi: 10.3969/j.issn.1009-0754.2022.12.018
[7]	张丽霞, 徐加萍, 张丹枫, 等. 基于时机理论以家庭为中心的护理模式对急性脑出血患者照顾者照顾能力的影响[J]. 现代临床护理, 2021, 20(3): 40-45. doi: 10.3969/j.issn.1671-8283.2021.03.007 ZAHNG L X, XU J P, ZAHNG D F, et al. The impact of a family centered nursing model based on timing theory on the care ability of caregivers for acute cerebral hemorrhage patients[J]. Modern Clinical Nursing, 2021, 20(3): 40-45. doi: 10.3969/j.issn.1671-8283.2021.03.007
[8]	FIEGL S, LAHMANN C, O ' ROURKE T, et al. Depression according to ICD-10 clinical interview vs. depression according to the epidemiologic studies depression scale to predict pain therapy outcomes[J]. Front Psychol, 2019, 10: 1862. doi: 10.3389/fpsyg.2019.01862
[9]	汪向东, 王希林, 马弘, 等. 心理卫生评定量表手册[M]. 北京: 中国心理卫生杂志社, 1999: 88-100. WANG X D, WANG X L, MA H, et al. Handbook of mental health assessment scales[M]. Beijing: China Journal of Mental Health, 1999: 88-100.
[10]	沙璐璐, 刘长红, 刘鸿, 等. 心脏瓣膜置换术后自我效能感量表评分的影响因素分析及心理干预应用价值[J]. 实用医院临床杂志, 2022, 19(4): 71-74. SHA L L, LIU C H, LIU H, et al. Analysis of influencing factors and application value of psychological intervention on self-efficacy scale scores after heart valve replacement surgery[J]. Journal of Practical Hospital Clinical Practice, 2022, 19(4): 71-74.
[11]	李鲁, 王红妹, 沈毅. SF-36健康调查量表中文版的研制及其性能测试[J]. 中华预防医学杂志, 2002, 36(2): 109-113. LI L, WANG H M, SHEN Y. Development and performance testing of the Chinese version of the SF-36 health survey scale[J]. Chinese Journal of Preventive Medicine, 2002, 36(2): 109-113.
[12]	许卫华, 王奇, 梁伟雄. 慢性疾病患者服药依从性测量量表的编制[J]. 中国慢性病预防与控制, 2008, 16(6): 558-560, 567. XU W H, WANG Q, LIIANG W X. Development of a medication compliance measurement scale for patients with chronic diseases[J]. Chinese Journal of Chronic Disease Prevention and Control, 2008, 16(6): 558-560, 567.
[13]	MARWAHA S, PALMER E, SUPPES T, et al. Novel and emerging treatments for major depression[J]. Lancet, 2023, 401(10371): 141-153.
[14]	HUSSAIN-SHAMSY N, SHAH A, VIGOD S N, et al. Mobile health for perinatal depression and anxiety: scoping review[J]. J Med Internet Res, 2020, 22(4): e17011. DOI: 10.2196/17011.
[15]	银萍, 汪立, 邓懿阳, 等. 基于时机理论的延续护理对异位妊娠患者术后焦虑、抑郁及自我护理能力的影响[J]. 中华现代护理杂志, 2022, 28(2): 224-228. YIN P, WANG L, DENG Y Y, et al. The impact of continuous nursing based on timing theory on postoperative anxiety, depression, and self-care ability of ectopic pregnancy patients[J]. Chinese Journal of Modern Nursing, 2022, 28(2): 224-228.
[16]	李君利, 赵翔斌, 郭晓慧, 等. 基于时机理论的延续性护理在首发抑郁症男性患者中的应用效果[J]. 中华现代护理杂志, 2022, 28(25): 3422-3427. LI J L, ZHAO X B, GUO X H, et al. The application effect of continuity nursing based on timing theory in male patients with first-episode depression[J]. Chinese Journal of Modern Nursing, 2022, 28(25): 3422-3427.
[17]	王莹澄, 桂彩红, 毛芳. 以时机理论为中心的延续性护理模式在冠心病PCI术后患者中的应用[J]. 检验医学与临床, 2022, 19(6): 755-757. WANG Y C, GUI C H, MAO F. The application of a continuous nursing model centered on timing theory in patients with coronary heart disease after PCI[J]. Laboratory Medicine and Clinical, 2022, 19(6): 755-757.
[18]	罗春雪, 袁朝霞, 金翠梅, 等. 多元联动护理对抑郁症患者服药依从性的干预研究[J]. 护理管理杂志, 2022, 22(8): 550-554. LUO C X, YUAN Z X, JIN C M, et al. Intervention study on medication compliance in patients with depression through multiple linkage nursing[J]. Journal of Nursing Management, 2022, 22(8): 550-554.
[19]	张婷婷, 米雪, 于宏丽. 基于时机理论的延续护理对阿尔茨海默病病人照顾者心理负担及生活质量的影响[J]. 护理研究, 2017, 31(33): 4238-4243. ZHANG T T, MI X, YU H L. The impact of continuous care based on timing theory on the psychological burden and quality of life of caregivers for Alzheimer's disease patients[J]. Nursing Research, 2017, 31(33): 4238-4243.
[20]	符晓艳, 王华, 马瑞雪, 等. 抑郁症患者服药依从性及其相关影响因素的研究[J]. 中国医师杂志, 2019, 21(11): 1663-1666. FU X Y, WANG H, MA R X, et al. Factors associated with medication adherence among with depressive disorder[J]. Journal of Chinese Physician\|J Chin Physician, 2019, 21(11): 1663-1666.
[21]	惠望春, 牟改变. 基于时机理论的家庭护理模式在急性心肌梗死患者护理中对家属照顾能力及生活质量的影响[J]. 贵州医药, 2020, 44(10): 1658-1660. HUI W C, MU G B. The impact of home care model based on timing theory on the care ability and quality of life of family members in acute myocardial infarction patients[J]. Guizhou Medical Journal, 2020, 44(10): 1658-1660.