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社区居住的体弱个体的自我管理能力与生活质量:荷兰社区护士的作用

Self-management abilities and quality of life among frail community-dwelling individuals: the role of community nurses in the Netherlands.

作者信息

Cramm Jane Murray, Nieboer Anna Petra

机构信息

Institute of Health Policy & Management (iBMG), Erasmus University, Rotterdam, The Netherlands.

出版信息

Health Soc Care Community. 2017 Mar;25(2):394-401. doi: 10.1111/hsc.12318. Epub 2016 Jan 5.

Abstract

The objective of the study was to determine whether community nurses in the Netherlands improve self-management abilities and quality of life of frail community-dwelling people. This longitudinal study was performed in the context of a larger evaluation study of the 'Zichtbare Schakels'(Visible Link) programme, conducted to determine the quality of care provided by community nurses to community-dwelling frail people in Rotterdam, the Netherlands. For the current study, clients seen by community workers in Rotterdam between July 2013 and November 2014 participated. Data were gathered via personal interviews by the community nurses as part of care delivery at the start (T0; n = 220) and end of care delivery (T1; n = 111 - the remaining 109 clients were still receiving care) to evaluate and improve quality of care. We measured client's quality of life (using the EQ5D), self-management abilities (using the Self-Management Ability Scale) and background characteristics. Results showed that clients seen by the community nurses especially experience problems when it comes to usual activities and pain/discomfort. Furthermore, quality of life was much worse among clients of the community nurses (0.51) than among frail older (aged ≥70 years) people in Rotterdam (0.61), Dutch patients with chronic illnesses [CVD (0.83), COPD (0.79) or diabetes (0.83)] and older (aged ≥65 years) people who had recently been hospitalised (0.80). Significant improvements were seen in client's self-management and quality of life over time. Self-management abilities at T0 and changes in self-management abilities (T1 - T0) clearly predicted quality of life at T1. Investing in community health nurses may be beneficial for the improvement of self-management abilities and quality of life among very frail people in the community.

摘要

该研究的目的是确定荷兰的社区护士是否能提高体弱的社区居民的自我管理能力和生活质量。这项纵向研究是在对“Zichtbare Schakels”(可见联系)项目进行的一项更大规模评估研究的背景下进行的,该评估研究旨在确定荷兰鹿特丹的社区护士为社区体弱居民提供的护理质量。对于当前的研究,2013年7月至2014年11月期间在鹿特丹接受社区工作者服务的客户参与了研究。数据是由社区护士在护理开始时(T0;n = 220)和护理结束时(T1;n = 111 - 其余109名客户仍在接受护理)通过个人访谈收集的,以评估和提高护理质量。我们测量了客户的生活质量(使用EQ5D)、自我管理能力(使用自我管理能力量表)和背景特征。结果表明,社区护士服务的客户在日常活动和疼痛/不适方面尤其存在问题。此外,社区护士服务的客户的生活质量(0.51)比鹿特丹体弱的老年人(≥70岁)(0.61)、患有慢性病的荷兰患者[心血管疾病(0.83)、慢性阻塞性肺疾病(0.79)或糖尿病(0.83)]以及最近住院的老年人(≥65岁)(0.80)要差得多。随着时间的推移,客户的自我管理和生活质量有显著改善。T0时的自我管理能力以及自我管理能力的变化(T1 - T0)清楚地预测了T1时的生活质量。投资于社区健康护士可能有利于提高社区中非常体弱人群的自我管理能力和生活质量。

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