Application of nursing based on shared decision making in maintenance period of comprehensive detumescence therapy for lower-extremity lymphedema (共享决策护理模式在下肢淋巴水肿患者综合消肿治疗维持期中的应用效果观察)

Abstract

Objective To investigate the intervention effect of nursing based on shared decision making (SDM) in maintenance period of comprehensive detumescence therapy (CDT)for lower-extremity lymphedema, and to investigate its influence on patient self-management skills. Methods Totally 27 patients were randomly divided into two groups on even or odd numbers according to the order of hospitalization: control group (n=14) included the patients with odd numbers and observation group (n=13) included the patients with even numbers. In the control group, lymphedema therapist implemented CDT for lower-extremity lymphedema, 10 days as a course of treatment, two consecutive courses. Self-identification of symptoms and signs of lymphedema and basic routine nursing measures were carried out during hospitalization. Before discharge, patients were educated with knowledge about skin care, lymphatic drainage, use of pressure gradient socks and functional exercise during the maintenance period of CDT treatment. In addition to routine care, nursing interventions based on a five-step process of shared decision making were carried out in the observation group during hospitalization and within 3 months after discharge. The patient self-management skills and satisfaction with nursing service were evaluated at discharge time, 1 month and 3 months after discharge. Results Scores of Self-management Behavior Assessment Scale and Newcastle Satisfaction with Nursing Scale (NSNS) decreased at 1 month and 3 months after discharge, and scores of the observation group were significantly higher than those of the control group(P＜0. 01). Conclusion The application of SDM-based nursing interventions in maintenance period of CDT for lower-extremity lymphedema is effective to improve patient satisfaction, enhance the ability of home self-management and compliance, reduce the occurrence of recurrence and complications, and improve the quality of life of patients. (目的 探讨共享决策模护理模式在下肢淋巴水肿患者综合消肿治疗(CDT)维持期中的干预效果, 以及对患者自我管理能力的影响。方法 根据患者入院时间顺序单双号, 单号14例患者纳入对照组, 由淋巴水肿治疗师实施下肢淋巴水肿CDT治疗, 10 d为1个疗程, 连续2个疗程。住院期间落实患者自我识别淋巴水肿的症状、体征和基本的常规护理措施, 出院前对患者进行CDT治疗维持期的皮肤护理、淋巴引流和压力梯度袜使用及功能锻炼的指导。双号13例患者纳入观察组, 观察组实在对照组常规护理的基础上, 采用共享决策护理模式进行干预, 实施基于共享决策5步骤的护理干预过程至出院后3个月。分别在出院时、出院后1个月和3个月, 对患者进行自我管理行为和护理满意度进行评估。结果 出院1个月和3个月后, 两组自我管理行为量表评分和纽卡斯尔护理满意度量表(NSNS)评分均较出院时升高, 且观察组得分优于对照组, 差异有统计学意义(P＜0. 01)。结论 共享决策护理模式应用于下肢淋巴水肿患者CDT治疗维持期中, 能提高护理满意度, 增强患者居家自我管理的能力和依从性, 降低复发和并发症的发生风险, 从而提高患者的生活质量。)

Keywords

• lymphedema
• shared decision making
• comprehensive detumescence therapy
• self-management skills
• satisfaction
• 淋巴水肿
• 共享决策
• 综合消肿治疗
• 自我管理能力
• 满意度