维持性血液透析患者基于助推策略的饮食管理  

Diet management for maintenance hemodialysis patients based on the nudge strategy

作　　者：钟静静 梁志金[2] 吴国凤 吴林梅 刘瑞杰 卢秋芳[3] Zhong Jingjing;Liang Zhijin;Wu Guofeng;Wu Linmei;Liu Ruijie;Lu Qiufang(School of Nursing,Guangxi University of Traditional Chinese Medicine,Nanning 530001,China)

机构地区：[1]广西中医药大学护理学院,广西南宁530001 [2]广西中医药大学附属瑞康医院急诊科 [3]广西中医药大学附属瑞康医院血液净化中心

出　　处：《护理学杂志》2024年第10期107-112,共6页Journal of Nursing Science

基　　金：广西医疗卫生适宜技术开发与推广应用项目(S2022057);广西壮族自治区卫生健康委员会自筹经费科研课题(Z-A20220913)。

摘　　要：目的构建基于证据及助推策略的维持性血液透析患者透析期间饮食管理方案,并评价其应用效果。方法以证据为基础,通过制定审查指标并进行基线调查、分析障碍因素,构建基于助推策略的透析期间饮食管理方案,并应用于50例维持性血液透析患者,采用中断时间序列设计,比较方案实施前后审查指标执行率,患者低血压、低血糖及胃肠道反应发生率,患者透析饮食知信行得分。结果基线调查显示12条审查指标执行率未达标,方案实施后,指标2、3、4的执行率为100%,除指标11外,涉及医护人员及患者的审查指标执行率显著高于实施前(均P<0.05);患者低血压和低血糖发生率显著低于方案实施前(均P<0.05);患者透析饮食知识、信念、行为得分及总分显著高于实施前(均P<0.05)。结论基于助推策略科学构建并实施维持性血液透析患者透析期间饮食管理方案,可以有效促进证据在临床中的转化应用,降低透析过程中低血压和低血糖发生率,提高患者透析饮食的知识、信念和行为水平。Objective To construct a diet management program based on evidence and nudge strategy for maintenance of hemodialysis patients during dialysis,and to evaluate its application effect.Methods Based on the published evidence,a diet management program during dialysis based on the nudge strategy was constructed by formulating review indicators,conducting a baseline survey and analyzing obstacle factors.The diet management program was applied to 50 maintenance hemodialysis patients,and the interruption time series design was used to compare the implementation rate of review indicators,the incidence rates of hypotension,hypoglycemia and gastrointestinal reactions,and the scores of dialysis diet knowledge,attitude and practice of patients before and after the implementation of the program.Results The baseline survey showed that the implementation rate of 12 review indicators did not reach the standard.After the implementation of the program,the implementation rate of indicators 2,3,4 was 100%;except indicator 11,the implementation rates of the patient-associated or staff-associated indicators were significantly higher than those before(all P<0.05);the incidence rates of hypotension and hypoglycemia in patients were lower than before,and the differences were statistically significant(all P<0.05).The scores of knowledge,attitude,practice and total score of dialysis diet in patients were significantly higher than those before implementation(all P<0.05).Conclusion The scientific construction of a diet management plan for maintenance hemodialysis patients during dialysis based on nudge strategy can effectively promote the transformation and application of evidence in clinical practice,reduce the incidence of hypotension and hypoglycemia during dialysis,and improve the knowledge,attitude and practice scores of patients′dialysis diet.

关 键 词：维持性血液透析 饮食管理 助推策略 证据转化 低血压 低血糖 知信行 循证护理 

分 类 号：R473.5[医药卫生—护理学] R459.3[医药卫生—临床医学]