回授法饮食管理对腹膜透析患者饮食依从性及营养状况的影响
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摘要
目的探讨回授法饮食管理对改善腹膜透析患者饮食依从性及营养状况的效果。方法采用抽签法,将新院区腹膜透析患者纳入试验组,老院区患者纳入对照组,分别便利抽取40例,试验组在常规饮食管理的基础上,实施回授法饮食管理,对照组实施常规饮食管理。结果干预3个月后,试验组饮食依从态度总分、饮食依从行为总分均高于对照组,差异有统计学意义(P<0.001);3日饮食日记结果中蛋白质、饮食热量、总热量、钠、钾、液体摄入量等与对照组相比,差异均有统计学意义(P<0.05);与对照组相比,试验组营养不良发生率降低(χ2=6.646,P=0.010),血红蛋白(t=2.247,P=0.036)、白蛋白水平(t=2.547,P=0.017)有所改善。结论将回授法应用到腹膜透析患者的饮食管理中可提高患者的饮食依从性,督促患者形成良好的饮食行为,改善患者的营养状况。
Objective To explore the effects of teach-back method on improving dietary adherence and nutritional status in peritoneal dialysis patients. Methods The lottery method was used to randomly determine patients with peritoneal dialysis in the new hospital district as the experimental group and patients in the old district as the control group,and 40 cases were conveniently selected in each group. The experimental group was applied with diet management based on teach-back method as well as routine diet management. The control group was applied with only routine diet management. Results Three months after discharge,there were significant differences in total scores of Renal Adherence Attitudes Questionnaire(RAAQ) and Renal Adherence Behaviour Questionnaire(RABQ)(t=5.856,P<0.001;t=6.168,P<0.001) between two groups,the intakes in three-day diet diary such as protein(t=4.124,P<0.001),dietary calories(t=-2.033,P=0.045),total calories(t=-2.061,P=0.043),sodium(t=-5.918,P<0.001),potassium(t=-2.352,P=0.021) and drinking water(t=-3.448,P=0.001) were significantly improved. The score of Subjective Global Assessment( χ~2=6.646,P=0.010),the nutritional indicators such as hemoglobin(t=2.247,P=0.036) and albumin(t=2.547,P=0.017) were significantly improved. Conclusion Applying teach-back method into diet management among peritoneal dialysis patients can improve patients' dietary adherence,form a good diet behavior,and improve nutritional status.
Objective To explore the effects of teach-back method on improving dietary adherence and nutritional status in peritoneal dialysis patients. Methods The lottery method was used to randomly determine patients with peritoneal dialysis in the new hospital district as the experimental group and patients in the old district as the control group,and 40 cases were conveniently selected in each group. The experimental group was applied with diet management based on teach-back method as well as routine diet management. The control group was applied with only routine diet management. Results Three months after discharge,there were significant differences in total scores of Renal Adherence Attitudes Questionnaire(RAAQ) and Renal Adherence Behaviour Questionnaire(RABQ)(t=5.856,P<0.001;t=6.168,P<0.001) between two groups,the intakes in three-day diet diary such as protein(t=4.124,P<0.001),dietary calories(t=-2.033,P=0.045),total calories(t=-2.061,P=0.043),sodium(t=-5.918,P<0.001),potassium(t=-2.352,P=0.021) and drinking water(t=-3.448,P=0.001) were significantly improved. The score of Subjective Global Assessment( χ~2=6.646,P=0.010),the nutritional indicators such as hemoglobin(t=2.247,P=0.036) and albumin(t=2.547,P=0.017) were significantly improved. Conclusion Applying teach-back method into diet management among peritoneal dialysis patients can improve patients' dietary adherence,form a good diet behavior,and improve nutritional status.
引文
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[2] Mehrotra R. Peritoneal dialysis education:challenges and innovation[J]. Semin Dial,2018,31(2):107-110.
[3] Minstry of Health. Chinese national renal data system[EB/OL].[2018-09-14]. http://www.Cnrds. Net.
[4]董捷.浅谈透析患者蛋白质能量消耗的诊治进展[J].肾脏病与透析肾移植杂志,2016,25(3):255-256.
[5] Davies SJ,Davenport A. The role of bioimpeddance and biomarkers in helping to aid clinical decision-making of volume assessments in dialysis patients[J]. Kidney Int,2014,8(6):489-496.
[6]杨杰,赵慧,张建梅,等. Teach-back健康教育模式在脊髓损伤行清洁间歇导尿患者中的应用及效果观察[J].检验医学与临床,2018,15(18):2765-2767.
[7]常立阳,徐佳美,张红梅.慢性肾脏病3~5期患者营养门诊复诊依从性及影响因素研究[J].中国护理管理,2015,15(7):857-860.
[8] Kornburger C,Gibson C,Sadowski S,et al. Using “teach-back”to promote a safe trasition from hospital to home:an evidencebased approach to improving the discharge process[J]. J Pediatr Nurs,2013,28(3):282-292.
[9] Bahri N,Saljooghi S,Noghabi AD,et al. Effectiveness of the teach-back method in improving self-care activities in postmenopausal women[J]. Prz Menopauzalny,2018,17(1):5-10.
[10]黄丽,王晓霞,张娟.回馈教学对食管癌开胸手术患者呼吸功能锻炼依从性的研究[J].中华护理杂志,2016,51(1):26-28.
[11]孙彪.中西医结合肾病临床营养学[M].北京:人民卫生出版社,2013.
[12] Sirin J,Rajnish M. Chapter 33-nutritional management of endstage renal disease patients treated with peritoneal dialysis[M]. NewYork:Nutritional Management of Renal Disease,2013:539-561.
[13] Rushe H,McGee HM. Assessing adherence to dietary recommendations for hemodialysis patients:the Renal Adherence Attitudes Questionnaire(RAAQ)and the Renal Adherence Behaviour Questionnaire(RABQ)[J]. J Psychosom Res,1998,45(2):149-157.
[14]顾爱萍,黄佳颖,姜娜. 3日饮食日记干预在腹膜透析患者中的应用效果[J].中华护理杂志,2014,49(2):157-160.
[15] Detsky AS,McLaughtin JR,Baker JP,et a1. What is subjective global assessment of nutritional status[J]. JPEN,1987,11(1):8-13.
[16] Visser R,Dekker FW,Boeschoten EW,et al. Reliability of the7-point Subjective Global Assessment Scale in assessing nutritional status of dialysis patients[J]. Adv Perit Dial,1999,15(2):222-225.
[17] Griva K,Lai AY,Lim HA,et al. Nonadherence in patients on peritoneal dialysis:a systematic review[J].PLoS One,2014,9(2):e89001.
[18]刘惠,童小珍,傅立哲.门诊慢性肾脏病患者饮食知识的调查分析[J].中医药导报,2013,3(3):124-125.
[19] Johnson CE,Jilla AM,Danhauer JL. Developing foundational counseling skills for addressing adherence issues in auditory rehabilitation[J]. Semin Hear,2018,39(1):13-31.
[20] Becky AS,Huang YJ,Preeti D. The impact of teach-back method on retention of key domains of emergency department discharge instructions[J]. J Emerg Med,2017,53(5):e59-e65.
[21] Kosaku N,Ken T. Recent advance in the pathophsiology and management of protein-energy wasting in chronic kidney disease[J]. Ren Replace Ther,2016,1(2):1-12.
[22]吕阳,屈清荣,何卫芳,等.回授法在胃癌术后化疗的农村患者营养教育中的应用[J].中华护理教育,2018,15(11):828-833.
[23]杜爱燕,周薇,范建桢,等.授权饮食教育对维持性血液透析患者饮食依从性及生活质量的影响[J].重庆医学,2017,46(16):2273-2276.
[24]张静娟,薛芃石,赵白雪,等.饮食干预对腹膜透析患者营养状况的影响[J].中华护理杂志,2015,50(1):62-65.
[25]赵静,赵秋利,王丽敏,等. 2型糖尿病患者饮食行为改变特征的研究[J].中华护理杂志,2018,53(2):139-143.
[2] Mehrotra R. Peritoneal dialysis education:challenges and innovation[J]. Semin Dial,2018,31(2):107-110.
[3] Minstry of Health. Chinese national renal data system[EB/OL].[2018-09-14]. http://www.Cnrds. Net.
[4]董捷.浅谈透析患者蛋白质能量消耗的诊治进展[J].肾脏病与透析肾移植杂志,2016,25(3):255-256.
[5] Davies SJ,Davenport A. The role of bioimpeddance and biomarkers in helping to aid clinical decision-making of volume assessments in dialysis patients[J]. Kidney Int,2014,8(6):489-496.
[6]杨杰,赵慧,张建梅,等. Teach-back健康教育模式在脊髓损伤行清洁间歇导尿患者中的应用及效果观察[J].检验医学与临床,2018,15(18):2765-2767.
[7]常立阳,徐佳美,张红梅.慢性肾脏病3~5期患者营养门诊复诊依从性及影响因素研究[J].中国护理管理,2015,15(7):857-860.
[8] Kornburger C,Gibson C,Sadowski S,et al. Using “teach-back”to promote a safe trasition from hospital to home:an evidencebased approach to improving the discharge process[J]. J Pediatr Nurs,2013,28(3):282-292.
[9] Bahri N,Saljooghi S,Noghabi AD,et al. Effectiveness of the teach-back method in improving self-care activities in postmenopausal women[J]. Prz Menopauzalny,2018,17(1):5-10.
[10]黄丽,王晓霞,张娟.回馈教学对食管癌开胸手术患者呼吸功能锻炼依从性的研究[J].中华护理杂志,2016,51(1):26-28.
[11]孙彪.中西医结合肾病临床营养学[M].北京:人民卫生出版社,2013.
[12] Sirin J,Rajnish M. Chapter 33-nutritional management of endstage renal disease patients treated with peritoneal dialysis[M]. NewYork:Nutritional Management of Renal Disease,2013:539-561.
[13] Rushe H,McGee HM. Assessing adherence to dietary recommendations for hemodialysis patients:the Renal Adherence Attitudes Questionnaire(RAAQ)and the Renal Adherence Behaviour Questionnaire(RABQ)[J]. J Psychosom Res,1998,45(2):149-157.
[14]顾爱萍,黄佳颖,姜娜. 3日饮食日记干预在腹膜透析患者中的应用效果[J].中华护理杂志,2014,49(2):157-160.
[15] Detsky AS,McLaughtin JR,Baker JP,et a1. What is subjective global assessment of nutritional status[J]. JPEN,1987,11(1):8-13.
[16] Visser R,Dekker FW,Boeschoten EW,et al. Reliability of the7-point Subjective Global Assessment Scale in assessing nutritional status of dialysis patients[J]. Adv Perit Dial,1999,15(2):222-225.
[17] Griva K,Lai AY,Lim HA,et al. Nonadherence in patients on peritoneal dialysis:a systematic review[J].PLoS One,2014,9(2):e89001.
[18]刘惠,童小珍,傅立哲.门诊慢性肾脏病患者饮食知识的调查分析[J].中医药导报,2013,3(3):124-125.
[19] Johnson CE,Jilla AM,Danhauer JL. Developing foundational counseling skills for addressing adherence issues in auditory rehabilitation[J]. Semin Hear,2018,39(1):13-31.
[20] Becky AS,Huang YJ,Preeti D. The impact of teach-back method on retention of key domains of emergency department discharge instructions[J]. J Emerg Med,2017,53(5):e59-e65.
[21] Kosaku N,Ken T. Recent advance in the pathophsiology and management of protein-energy wasting in chronic kidney disease[J]. Ren Replace Ther,2016,1(2):1-12.
[22]吕阳,屈清荣,何卫芳,等.回授法在胃癌术后化疗的农村患者营养教育中的应用[J].中华护理教育,2018,15(11):828-833.
[23]杜爱燕,周薇,范建桢,等.授权饮食教育对维持性血液透析患者饮食依从性及生活质量的影响[J].重庆医学,2017,46(16):2273-2276.
[24]张静娟,薛芃石,赵白雪,等.饮食干预对腹膜透析患者营养状况的影响[J].中华护理杂志,2015,50(1):62-65.
[25]赵静,赵秋利,王丽敏,等. 2型糖尿病患者饮食行为改变特征的研究[J].中华护理杂志,2018,53(2):139-143.