Yeh Hsiu-Ying, Ma Wei-Fen, Huang Jing-Long, Hsueh Kai-Chung, Chiang Li-Chi
School of Nursing, Min-Hwei College of Health Care Management, Tainan, Taiwan, ROC.
School of Nursing, China Medical University & Nursing Department, China Medical University Hospital, Taichung, Taiwan, ROC.
Int J Nurs Stud. 2016 Aug;60:133-44. doi: 10.1016/j.ijnurstu.2016.04.013. Epub 2016 Apr 28.
Empowerment can be an effective strategy for changing an individual's health behaviours. However, how to empower whole families to manage their children's asthma is a challenge that requires innovative nursing intervention based on family-centred care.
To evaluate the effectiveness of a family empowerment program on family function and pulmonary function of children with asthma compared to those receiving traditional self-management only.
A randomized control trial.
Sixty-five families were recruited from one asthma clinic in a medical centre in Taiwan. After random assignment, 34 families in the experimental group received the family empowerment program consisting of four counselling dialogues with the child and its family. We empowered the family caregiver's ability to manage their child's asthma problems through finding the problems in the family, discovery and discussion about the way to solve problems, and enabling the family's cooperation and asthma management. The other 31 families received the traditional care in asthma clinics. The Parental Stress Index and Family Environment Scale of family caregivers, and pulmonary function, and asthma signs of children with asthma were collected at pre-test, 3-month post-test, and one-year follow-up. We utilized the linear mixed model in SPSS (18.0) to analyze the effects between groups, across time, and the interaction between group and time.
The family empowerment program decreased parental stress (F=13.993, p<.0001) and increased family function (cohesion, expression, conflict solving, and independence) (F=19.848, p<.0001). Children in the experimental group had better pulmonary expiratory flow (PEF) (F=26.483, p<.0001) and forced expiratory volume in first second (FEV1) (F=7.381, p=.001) than children in the comparison group; however, no significant change in forced expiratory volume in first second (FEV1)/forced vital capacity (FVC) was found between the two groups. Sleep problems did not show significant changes but cough, wheezing, and dyspnoea were significantly reduced by family caregiver's observations.
We empowered families by listening, dialogues, reflection, and taking action based on Freire's empowerment theory. Nurses could initiate the families' life changes and assist children to solve the problems by themselves, which could yield positive health outcomes.
赋权可以成为改变个体健康行为的有效策略。然而，如何使整个家庭有能力管理其子女的哮喘是一项挑战，需要基于家庭中心护理的创新护理干预措施。
与仅接受传统自我管理的家庭相比，评估家庭赋权计划对哮喘儿童家庭功能和肺功能的有效性。
一项随机对照试验。
从台湾一家医疗中心的哮喘诊所招募了65个家庭。随机分组后，实验组的34个家庭接受了家庭赋权计划，该计划包括与儿童及其家庭进行的四次咨询对话。我们通过找出家庭中的问题、发现并讨论解决问题的方法以及促使家庭合作和管理哮喘，增强了家庭照顾者管理其子女哮喘问题的能力。其他31个家庭在哮喘诊所接受传统护理。在测试前、测试后3个月和一年随访时收集家庭照顾者的父母压力指数和家庭环境量表，以及哮喘儿童的肺功能和哮喘症状。我们使用SPSS（18.0）中的线性混合模型来分析组间、跨时间的影响以及组与时间之间的相互作用。
家庭赋权计划减轻了父母的压力（F=13.993，p<0.0001），并增强了家庭功能（凝聚力、表达、解决冲突和独立性）（F=19.848，p<0.0001）。实验组儿童的肺呼气流量（PEF）（F=26.483，p<0.0001）和第一秒用力呼气量（FEV1）（F=7.381，p=0.001）比对照组儿童更好；然而，两组之间第一秒用力呼气量（FEV1）/用力肺活量（FVC）没有显著变化。睡眠问题没有显著变化，但家庭照顾者观察到咳嗽、喘息和呼吸困难显著减轻。
我们基于弗莱雷的赋权理论，通过倾听、对话、反思和采取行动，增强了家庭的能力。护士可以启动家庭的生活改变，并帮助儿童自己解决问题，这可以产生积极的健康结果。
