Zoni Sandra, Verga Marie-Elise, Hauschild Michael, Aquarone-Vaucher Marie-Paule, Gyuriga Teresa, Ramelet Anne-Sylvie, Dwyer Andrew A
University of Lausanne Institute of Higher Education and Research in Healthcare, Lausanne, Switzerland.
University of Lausanne Institute of Higher Education and Research in Healthcare, Lausanne, Switzerland; Haute école de santé Fribourg, Fribourg Switzerland.
J Pediatr Nurs. 2018 Jan-Feb;38:99-105. doi: 10.1016/j.pedn.2017.11.015. Epub 2017 Dec 6.
We aimed to evaluate patient self-management activities, patient perceptions of the therapeutic relationship and satisfaction with nurse-led consultations as part of a structured, pilot program transitioning young adults with type 1 diabetes (T1DM) to adult-oriented community-based practices.
A descriptive, cross-sectional study of patients receiving nurse-led consultations. Patients provided sociodemographic/health information, glycated hemoglobin (HbA1c) measures and completed questionnaires assessing self-management (Revised Self-Care Inventory) and the therapeutic relationship (Caring Nurse-Patient Interaction - short scale). HbA1c values were compared to guideline recommendations.
Twenty patients participated. HbA1c was ≤7.5% in 3/14 (21%) and 5/14 (36%) exhibited poor glycemic control (≥9.5%). The greatest concordance for self-care was in relation to insulin therapy (4.5±0.5) while patients reported the lowest adherence to diet recommendations (2.9±0.8). Overall satisfaction with nurse-led consultations was high (4±0.5 out of 5). Patients considered diabetes knowledge and technical competence as very important and were most pleased with the humanistic aspects of nursing care. Respect for privacy was deemed the most important (and most frequently observed) nursing attitude/behavior during consultations.
Young adults found the nurse-led consultations with therapeutic education to develop T1DM self-care skills are an important complement to medical management during transition.
Patient autonomy and privacy should be respected during this developmental period. Nurses taking a humanistic approach towards accompanying and supporting the patient can enhance the therapeutic relationship during transition and promote continuity of care. Transition nurses can use technical competence and therapeutic education to empower patients for self-management.
作为一项结构化试点项目的一部分，该项目旨在将1型糖尿病（T1DM）青少年过渡到以成人为导向的社区医疗实践，我们旨在评估患者的自我管理活动、患者对治疗关系的认知以及对护士主导咨询的满意度。
对接受护士主导咨询的患者进行描述性横断面研究。患者提供社会人口统计学/健康信息、糖化血红蛋白（HbA1c）测量值，并完成评估自我管理（修订后的自我护理量表）和治疗关系（关怀护士 - 患者互动 - 简短量表）的问卷。将HbA1c值与指南建议进行比较。
20名患者参与。14名患者中3名（21%）的HbA1c≤7.5%，5名（36%）血糖控制不佳（≥9.5%）。自我护理方面一致性最高的是胰岛素治疗（4.5±0.5），而患者报告对饮食建议的依从性最低（2.9±0.8）。对护士主导咨询的总体满意度较高（5分制中为4±0.5）。患者认为糖尿病知识和技术能力非常重要，并且对护理的人文方面最为满意。尊重隐私被认为是咨询期间最重要（也是最常观察到）的护理态度/行为。
青少年发现护士主导的咨询以及通过治疗性教育来培养T1DM自我护理技能是过渡期间医疗管理的重要补充。
在此发育阶段应尊重患者自主权和隐私。护士采取人文关怀的方式陪伴和支持患者，可以增强过渡期间的治疗关系并促进护理的连续性。过渡护士可以利用技术能力和治疗性教育来增强患者自我管理的能力。
