Damrosch S
Center for Nursing and Health Services Research, University of Maryland School of Nursing, Baltimore.
Nurs Clin North Am. 1991 Dec;26(4):833-43.
There is evidence of nurse dissatisfaction with the outcomes of patient education; some patients are seen as insufficiently motivated to change their health-related behavior. Research findings from the field of health psychology are relevant to the issue of increasing patient motivation to change. In terms of motivating health behavior change, the research findings indicate the importance of the client's belief in the severity of threat to health and personal vulnerability, as well as in the feasibility and effectiveness of a particular health measure. The HBM has generated much research confirming the importance of these beliefs. Research evidence also indicates the importance of the self-efficacy mechanism as a predictor of such outcomes as cessation of smoking and returning to a physically active life after a heart attack. There are unsettled questions about the role of fear in motivating behavior change, but experts agree that high levels of induced fear may result in denying or ignoring the threat. If fear is used, it must be coupled with recommendations for efficacious behavior change. The findings of attitude-change research have yielded practical information on increasing the persuasiveness of information appeals using such techniques as saving the most important point for the beginning and end of the message. Techniques such as self-monitoring and systematic desensitization are also available to help motivate change. The problem of maintaining behavior change is challenging, and further research is needed on how best to prevent relapse or to aid clients in restoring change once relapse occurs. The experts advise tailoring the interventions to aid maintenance of behavior change to the particular stage of change. For example, bolstering motivation to change is important in the initial stage. As important providers of health care education, nurses need to be fully informed of the research findings relevant to effective interventions designed to motivate health-related behavior change.
有证据表明护士对患者教育的结果不满意；一些患者被认为缺乏改变健康相关行为的动力。健康心理学领域的研究结果与提高患者改变动力的问题相关。在激励健康行为改变方面，研究结果表明患者相信健康威胁的严重性和个人易感性，以及特定健康措施的可行性和有效性非常重要。健康信念模式引发了大量研究，证实了这些信念的重要性。研究证据还表明自我效能机制作为诸如戒烟和心脏病发作后恢复积极生活等结果的预测指标的重要性。关于恐惧在激励行为改变中的作用存在未解决的问题，但专家们一致认为，高度诱发的恐惧可能导致否认或忽视威胁。如果使用恐惧，必须同时给出有效行为改变的建议。态度改变研究的结果已经产生了关于使用诸如将最重要的观点放在信息开头和结尾等技术来提高信息吸引力说服力的实用信息。自我监测和系统脱敏等技术也可用于帮助激发改变。维持行为改变的问题具有挑战性，需要进一步研究如何最好地预防复发或在复发发生后帮助患者恢复改变。专家建议根据行为改变的特定阶段调整干预措施以帮助维持行为改变。例如，在初始阶段增强改变的动力很重要。作为健康教育的重要提供者，护士需要充分了解与旨在激励健康相关行为改变的有效干预措施相关的研究结果。
