The Effects of Compass Nursing Model Based on Health Action Process Approach Theory in Young and Middle-Aged Patients with the First Stroke

doi:10.3969/j.issn.1673-5765.2023.11.010

Abstract

Abstract: Objective To investigate the effects of compass nursing model based on health action process approach (HAPA) theory in young and middle-aged patients with the first stroke.
Methods Patients aged 18-45 years with the first stroke admitted to Beijing Tiantan Hospital, Capital Medical University, were prospectively and continuously enrolled from June 2021 to December 2021. The patients were randomly assigned to one of the two groups: control or intervention group. The control group received routine nursing and extended nursing, while the intervention group was implemented a compass nursing model based on HAPA theory for three months. The improvements in each dimensional score and total score of the self-management behavior scale for stroke, the stroke specific quality of life scale, the self-rating anxiety scale, and the self-rating depression scale were compared between the two groups after intervention.
Results 104 young and middle-aged patients with the first stroke were enrolled in the study, and 6 cases dropped out. 49 patients were assigned to the intervention group and 49 were assigned to the control group finally. The intervention group had higher total scores on the self-management behavior scale for stroke and the stroke specific quality of life scale than the control group (P<0.001, P=0.025). The intervention group had lower total scores on the self-rating anxiety scale and the self-rating depression scale than the control group (P=0.001, P<0.001).
Conclusions The compass nursing model based on HAPA theory can effectively improve the self-management ability of patients, relieve their anxiety and depression, and improve their quality of life.

Key words: Health action process approach; Compass nursing; Stroke; Self management; Quality of life

摘要： 目的探讨基于健康行动过程取向（health action process approach，HAPA）理论的罗盘式护理模式在中青年首发卒中患者中的应用效果。
方法前瞻性、连续入组2021年6—12月首都医科大学附属北京天坛医院收治的18～45岁的首次卒中患者，将患者随机分为对照组和干预组。对照组实施常规护理及延续性护理，干预组在对照组基础上实施基于HAPA理论的罗盘式护理模式3个月，比较两组患者干预后的卒中自我管理行为量表各维度得分及总分、卒中专用生活质量量表总分、焦虑自评量表总分、抑郁自评量表总分的改善情况。
结果共计104例中青年首发卒中患者入组，脱落6例，最终干预组、对照组各纳入49例。干预组卒中自我管理行为量表总分、卒中专用生活质量量表总分均高于对照组（P<0.001，P=0.025）；干预组焦虑自评量表总分、抑郁自评量表总分均低于对照组（P=0.001，P＜0.001）。
结论基于HAPA理论的罗盘式护理模式可有效提高患者自我管理能力，缓解患者的焦虑、抑郁情绪，提高其生活质量。

关键词: 健康行动过程取向; 罗盘式护理; 卒中; 自我管理; 生活质量

SUN Jinju, ZHOU Xuejiao, DENG Yongmei, CHEN Qingqing, JIA Qian, ZHANG Zhe. The Effects of Compass Nursing Model Based on Health Action Process Approach Theory in Young and Middle-Aged Patients with the First Stroke [J]. Chinese Journal of Stroke, 2023, 18(11): 1282-1288.

孙金菊, 周雪姣, 邓永梅, 陈晴晴, 贾茜, 张哲. 基于健康行动过程取向理论的罗盘式护理模式对中青年首发卒中患者的影响[J]. 中国卒中杂志, 2023, 18(11): 1282-1288.

References

[1] 《中国脑卒中防治报告2018》编写组. 我国脑卒中防治仍面临巨大挑战——《中国脑卒中防治报告2018》概要[J]. 中国循环杂志，2019，34（2）：105-119.
The Compiling Group of the Report on Stroke Prevention and Treatment in China 2018. The prevention and treatment of stroke still face huge challenges——brief report on stroke prevention and treatment in China，2018[J]. Chinese Circulation Journal，2019，34（2）：105-119.
[2] MAAIJWEE N A，RUTTEN-JACOBS L C，SCHAAPSMEERDERS P，et al. Ischaemic stroke in young adults：risk factors and long-term consequences[J]. Nat Rev Neurol，2014，10（6）：315–325.
[3] EKKER M S，BOOT E M，SINGHAL A B，et al. Epidemiology，aetiology，and management of ischaemic stroke in young adults[J]. Lancet Neurol，2018，17（9）：790-801.
[4] FEIGIN V L，ROTH G A，NAGHAVI M，et al. Global burden of stroke and risk factors in 188 countries，during 1990-2013：a systematic analysis for the global burden of disease study 2013[J]. Lancet Neurol，2016，15（9）：913-924.
[5] EDWARDS J D，KAPOOR A，LINKEWICH E，et al. Return to work after young stroke：a systematic review[J]. Int J Stroke，2018，13（3）：243-256.
[6] QUINN K，MURRAY C D，MALONE C. The experience of couples when one partner has a stroke at a young age：an interpretative phenomenological analysis[J]. Disabil Rehabil，2014，36（20）：1670-1678.
[7] LEAHY D M，DESMOND D，COUGHLAN T，et al. Stroke in young women：an interpretative phenomenological analysis[J]. J Health Psychol，2016，21（5）：669-678.
[8] SCHWARZER R. Health action process approach（HAPA）as a theoretical framework to understand behavior change[J]. Actual Psicol，2016，30（121）：119–130.
[9] JOVEINI H，ROHBAN A，ARDEBILI H E. The effects of an education program on hookah smoking cessation in university students：an application of the health action process approach（HAPA）[J]. Journal of Substance Use，2019，25：62-69.
[10] 柏乐，颜琬华. HAPA模式在哮喘患者自我健康管理中的应用[J]. 中西医结合护理（中英文），2019，5（1）：193-196.
BAI L，YAN W H. Application of HAPA model in self-health management of asthma patients[J]. Nursing of Integrated Traditional Chinese and Western Medicine，2019，5（1）：193-196.
[11] 杜敏霞，卢颖，任利华，等. HAPA理论在肥胖型多囊卵巢综合征患者饮食控制行为干预中应用的效果评价[J]. 中国实用护理杂志，2014，30（17）：38-40.
DU M X，LU Y，REN L H，et al. Application of the health action process approach on the behavior of diet control in patients with obesity type polycystic ovarian syndrome[J]. Chinese Journal of Practical Nursing，2014，30（17）：38-40.
[12] 中华医学会神经病学分会，中华医学会神经病学分会脑血管病学组. 中国急性缺血性脑卒中诊治指南2018[J]. 中华神经科杂志，2018，51（9）：666-682.
Chinese Society of Neurology，Chinese Stroke Society. Chinese guidelines for diagnosis and treatment of acute ischemic stroke 2018[J]. Chin J Neurol，2018，51（9）：666-682.
[13] 中华医学会神经病学分会，中华医学会神经病学分会脑血管病学组. 中国脑出血诊治指南（2019）[J]. 中华神经科杂志，2019，52（12）：994-1005.
Chinese Society of Neurology，Chinese Stroke Society. Chinese guidelines for diagnosis and treatment of acute intracerebral hemorrhage 2019[J]. Chin J Neurol，2019，52（12）：994-1005.
[14] 王艳桥. 中风自我管理项目的构建与应用研究[D]. 四川：成都中医药大学，2012.
WANG Y Q. Construction and application of self-management intervention project for patients after stroke[D]. Chengdu：Chengdu University of Traditional Chinese Medicine，2012.
[15] 王玉龙. 康复功能评定学[M]. 2版. 北京：人民卫生出版社，2013：154-162.
WANG Y L. Rehabilitation evaluation and assessment[M]. 2nd ed. Beijing：People’s Medical Publishing House，2013：154-162.
[16] ZUNG W W. A rating instrument for anxiety disorders[J]. Psychosomatics，1971，12（6）：371-379.
[17] ZUNG W W. A self-rating depression scale[J]. Arch Gen Psychiatry，1965，12：63-70.
[18] 《中国脑卒中防治报告》编写组.《中国脑卒中防治报告2020》概要[J]. 中国脑血管病杂志，2022，19（2）：136-144.
Report on Stroke Prevention and Treatment in China Writing Group. Brief report on stroke prevention and treatment in China，2020[J]. Chin J Cerebrovasc Dis，2022，19（2）：136-144.
[19] 梅菁，孙慧敏，陈贵儒. 渐进性肌肉放松疗法对中青年缺血性脑卒中患者益处发现的影响[J]. 护理学杂志，2020，35（15）：18-20.
MEI J，SUN H M，CHEN G R. Effect of progressive muscle relaxation therapy on perceived benefit finding in young and middle-aged patients with ischemic stroke[J]. Journal of Nursing Science，2020，35（15）：18-20.
[20] 何易，梅菁，黄桂玲，等. 脑心健康管理提升中青年缺血性脑卒中患者自我管理行为及服药依从性[J]. 神经损伤与功能重建，2022，17（11）：636-639.
HE Y，MEI J，HUANG G L，et al. Brain and heart health management imploves self-management behavior and medication compliance of young and middle-aged patients with ischemic stroke[J]. Neural Injury and Functional Reconstruction，2022，17（11）：636-639.
[21] 赵一莎，周郁秋，吕雨梅. 脑卒中健康管理模式的研究进展[J]. 中国全科医学，2016，19（22）：2724-2728.
ZHAO Y S，ZHOU Y Q，LYU Y M. Research process of health management model of stroke[J]. Chinese General Practice，2016，19（22）：2724-2728.
[22] 赵素伟，曹中慧. 作业疗法可提高脑卒中患者的自我效能及肢体功能[J]. 基因组学与应用生物学，2019，38（2）：933-939.
ZHAO S W，CAO Z H. Improvement of self-efficacy and limb function of stroke patients by occupational therapy[J]. Genomics and Applied Biology，2019，38（2）：933-939.
[23] 苏凤淼，秦菲菲，焦路璐，等. 基于HAPA健康行为的社区管理对老年慢性阻塞性肺气肿患者健康行为、自我效能感及心理弹性的影响[J]. 国际精神病学杂志，2022，49（2）：339-342.
SU F M，QIN F F，JIAO L L，et al. Effects of community management based on HAPA health behavior on self-efficacy，behavior and men-tal resilience in elderly patients with chronic obstructive emphysema[J]. Journal of International Psychiatry，2022，49（2）：339-342.
[24] 周杰. 基于健康行动过程取向模型的菜单式护理干预在脑卒中后痉挛性偏瘫患者护理中的应用价值[J]. 河南医学研究，2021，30（13）：2484-2486.
ZHOU J. Application value of menu nursing intervention based on health action process approach model in nursing care of spastic hemiplegia patients after stroke[J]. Henan Medical Research，2021，30（13）：2484-2486.
[25] 杨孟丽. 微信健康教育对中青年脑卒中患者自我管理能力和生存质量的影响[J]. 河南医学高等专科学校学报，2022，34（2）：213-216.
YANG M L. Effects of Wechat health education on self-management ability and quality of life of young and middle-aged stroke patients[J]. Journal of Henan Medical College，2022，34（2）：213-216.
[26] 周欣欣，黄雅莲，方艳春，等. 健康教练技术对首发脑卒中患者知识水平及自我管理行为的效果评价[J]. 中华护理教育，2022，19（1）：81-85.
ZHOU X X，HUANG Y L，FANG Y C，et al. Effects of the heath coaching on knowledge level and self-management of patients with first stroke[J]. Chin J Nurs Educ，2022，19（1）：81-85.
[27] 李柳. 基于HAPA理论的健康教育模式在2型糖尿病病人中的应用分析[J]. 全科护理，2021，19（21）：2954-2958.
LI L. Application analysis of health education model based on HAPA theory in patients with diabetes mellitus type 2[J]. Chinese General Practice Nursing，2021，19（21）：2954-2958.
[28] 范吾凤，逯文巧. 健康行动过程取向理论在改善冠心病伴抑郁患者情绪及生活质量中的应用[J]. 心脑血管病防治，2021，21（6）：620-622.
FAN W F，LU W Q. Application of health action process approach theory in improving mood and quality of life of patients with coronary heart disease and depression[J]. Prevention and Treatment of Cardio-Cerebral-Vascular Disease，2021，21（6）：620-622.
[29] 陈金花，马雅英，吴肖飞，等. 基于互联网的脑卒中患者康复护理模式的实践[J]. 中国护理管理，2022，22（3）：327-333.
CHEN J H，MA Y Y，WU X F，et al. The practice of internet-based management rehabilitation nursing mode in stroke patients[J]. Chinese Nursing Management，2022，22（3）：327-333.
[30] 张柳，张剑梅，许志萍，等. 健康行动过程取向理论在急性心梗患者术后康复中的应用[J]. 西南国防医药，2019，29（11）：1113-1116.
ZHANG L，ZHANG J M，XU Z P，et al. Application of health action process approach theory in postoperative rehabilitation of patients with acute myocardial infarction[J]. Medical Journal of National Defending Forces in Southwest China，2019，29（11）：1113-1116.