长期留置导尿管使用者的自我管理干预：随机临床试验
Self-management intervention for long-term indwelling urinary catheter users: randomized clinical trial.
作者信息
Wilde Mary H, McMahon James M, McDonald Margaret V, Tang Wan, Wang Wenjuan, Brasch Judith, Fairbanks Eileen, Shah Shivani, Zhang Feng, Chen Ding-Geng Din
机构信息
Mary H. Wilde, PhD, RN, is Associate Professor; and James M. McMahon, PhD, is Associate Professor, University of Rochester School of Nursing, New York. Margaret V. McDonald, MSW, is Associate Director of Research Studies, Center for Home Care Policy and Research, Visiting Nurse Service of New York. Wan Tang, PhD, is Research Associate Professor; and Wenjuan Wang, PhD, is Postdoctoral Fellow, Department of Biostatistics and Computational Biology, University of Rochester, New York. Judith Brasch, RN, MS, is Project Nurse; and Eileen Fairbanks, RN,MS, PNP, is Health Project Coordinator, University of Rochester School of Nursing, New York. Shivani Shah, MPH, is Research Analyst, Center for Home Care Policy and Research, Visiting Nurse Service of New York. Feng Zhang, RN, BS, is MS/PhD Student, University of Rochester School of Nursing, New York. Ding-Geng (Din) Chen, PhD, is Professor, University of Rochester School of Nursing and Department of Biostatistics and Computational Biology, University of Rochester, New York.
出版信息
Nurs Res. 2015 Jan-Feb;64(1):24-34. doi: 10.1097/NNR.0000000000000071.
BACKGROUND
People using long-term indwelling urinary catheters experience multiple recurrent catheter problems. Self-management approaches are needed to avoid catheter-related problems.
OBJECTIVES
The aim was to determine effectiveness of a self-management intervention in prevention of adverse outcomes (catheter-related urinary tract infection, blockage, and accidental dislodgement). Healthcare treatment associated with the adverse outcomes and catheter-related quality of life was also studied.
METHODS
A randomized clinical trial was conducted. The intervention involved learning catheter-related self-monitoring and self-management skills during home visits by a study nurse (twice during the first month and at 4 months-with a phone call at 2 months). The control group received usual care. Data were collected during an initial face-to-face home interview followed by bimonthly phone interviews. A total of 202 adult long-term urinary catheter users participated. Participants were randomized to treatment or control groups following collection of baseline data. Generalized estimating equations were used for the analysis of treatment effect.
RESULTS
In the intervention group, there was a significant decrease in reported blockage in the first 6 months (p = .02), but the effect did not persist. There were no significant effects for catheter-related urinary tract infection or dislodgment. Comparison of baseline rates of adverse outcomes with subsequent periods suggested that both groups improved over 12 months.
DISCUSSION
A simple-to-use catheter problems calendar and the bimonthly interviews might have functioned as a modest self-monitoring intervention for persons in both groups. A simplified intervention using a self-monitoring calendar is suggested-with optimal and consistent fluid intake likely to add value.
背景
长期使用留置导尿管的患者会反复出现多种导尿管相关问题。需要采用自我管理方法来避免与导尿管相关的问题。
目的
旨在确定自我管理干预措施在预防不良后果（导尿管相关尿路感染、堵塞和意外拔管）方面的有效性。还研究了与不良后果相关的医疗保健治疗以及导尿管相关的生活质量。
方法
进行了一项随机临床试验。干预措施包括由研究护士在家庭访视期间教授与导尿管相关的自我监测和自我管理技能（第一个月两次，4个月时一次，2个月时进行一次电话随访）。对照组接受常规护理。在最初的面对面家庭访谈以及随后的每两个月一次的电话访谈中收集数据。共有202名成年长期导尿管使用者参与。在收集基线数据后，将参与者随机分为治疗组或对照组。使用广义估计方程分析治疗效果。
结果
在干预组中，前6个月报告的堵塞情况显著减少（p = 0.02），但这种效果没有持续。对于导尿管相关尿路感染或拔管没有显著影响。将不良后果的基线发生率与后续时间段进行比较表明，两组在12个月内均有所改善。
讨论
一个简单易用的导尿管问题日历和每两个月一次的访谈可能对两组人员起到了适度的自我监测干预作用。建议采用一种使用自我监测日历的简化干预措施，最佳且一致的液体摄入量可能会增加其价值。
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