基于时机理论的家庭肠内管饲患儿照顾者照护能力提升方案的构建与应用研究  

Construction and application of a program for improving care ability of caregivers for children with home enteral tube feeding based on timing theory

作　　者：张银雪 顾莺 余卓文[3] 杨玉霞 周壹文 陆春梅 Zhang Yinxue;Gu Ying;Yu Zhuowen;Yang Yuxia;Zhou Yiwen;Lu Chunmei(School of Nursing,Fudan University,Shanghai 200433,China;Nursing Department,Children's Hospital of Fudan University,Shanghai 201102,China;Department of Digestive Hepatology,Children's Hospital of Fudan University,Shanghai 201102,China;Pediatric Intensive Care Unit,Children's Hospital of Fudan University,Shanghai 201102,China;Department of Neonatology,Children's Hospital of Fudan University,Shanghai 201102,China)

机构地区：[1]复旦大学护理学院,上海200433 [2]复旦大学附属儿科医院护理部,上海201102 [3]复旦大学附属儿科医院消化肝病科,上海201102 [4]复旦大学附属儿科医院PICU,上海201102 [5]复旦大学附属儿科医院新生儿科,上海201102

出　　处：《中华现代护理杂志》2024年第22期2957-2966,共10页Chinese Journal of Modern Nursing

摘　　要：目的构建基于时机理论的家庭肠内管饲(HETF)患儿照顾者照护能力提升方案并探讨其初步应用效果。方法以时机理论为框架,在文献回顾的基础上,提取并总结提高HETF患儿照顾者照护能力的干预措施,形成方案初稿。对14名有HETF患儿照顾经验的照顾者进行质性访谈以补充方案内容,再通过专家会议法对方案内容进行修订,形成方案终稿。采用非同期对照法,连续纳入2022年3月—2023年2月复旦大学附属儿科医院收治的89例HETF患儿及其照顾者89名为研究对象,其中2022年3—8月纳入的患儿及照顾者为对照组(n=42),2022年9月—2023年2月纳入的患儿及照顾者为干预组(n=47),初步应用方案。采用家庭照顾者照护能力测量量表(FCTI)评价方案对提高照顾者照护能力的影响;以年龄别体重z值、身高别体重z值、并发症为评价指标,评价方案对患儿生长发育情况及管饲并发症发生率的影响,在入组时、出院后1、2、3个月分别采集相关数据。结果最终完成全部研究过程的患儿为66例,其中对照组和干预组患儿各33例,照顾者各33名。应用结果显示,干预组FCTI总分从入组时的(25.91±2.94)分降至出院后3个月的(5.85±2.60)分,对照组FCTI总分从入组时的(26.12±4.34)分降至出院后3个月的(12.52±3.60)分,两组FCTI总分随时间变化均有下降。在出院后1、2、3个月时,干预组FCTI总分均低于对照组,差异具有统计学意义(P<0.05)。至出院后3个月,干预组HETF患儿并发症发生率低于对照组,差异有统计学意义(P<0.05)。结论基于时机理论的HETF患儿照顾者照护能力提升方案具有科学性,为居家管饲患儿的管理提供经验。方案能够提高照顾者的照护能力,降低HETF患儿的并发症发生率,但对改善患儿短期生长状况的作用尚不明确。ObjectiveTo construct a program for improving care ability of caregivers for children with home enteral tube feeding(HETF)based on timing theory,and explore its preliminary effects.MethodsBased on the framework of timing theory and literature review,intervention measures to improve the care ability of caregivers for children with HETF were extracted and summarized to form a preliminary program draft.Fourteen caregivers with experience in caring for children with HETF were subjected to qualitative interviews to supplement the content of the program,and the program was revised through expert meetings to form the final draft.Non-synchronous control method was adopted,and 89 children with HETF and 89 caregivers of them admitted to the Children's Hospital of Fudan University from March 2022 to February 2023 were continuously included as study subjects.The children and their caregivers included from March to August 2022 were in control group(n=42),and the children and their caregivers included from September 2022 to February 2023 were in intervention group(n=47),and the plan was preliminarily applied.Family Caregiver Task Inventory(FCTI)was used to evaluate the impact of the program on improving caregiver care ability.Age specific body weight z-values,height specific body weight z-values,and complications were used to evaluate the impact of the program on the growth and development of children and the incidence of tube feeding complications.The data was collected at the time of enrollment and one,two,and three months after discharge.ResultsThere were 66 children who completed the whole study,including 33 children in the control group and the intervention group,and 33 caregivers in each group.The application results showed that the total score of FCTI in the intervention group decreased from(25.91±2.94)at enrollment to(5.85±2.60)at three months after discharge,while the total score of FCTI in the control group decreased from(26.12±4.34)at enrollment to(12.52±3.60)at three months after discharge,and the total score o

关 键 词：儿童 家庭肠内管饲 时机理论 照护能力 

分 类 号：R473.72[医药卫生—护理学]