Department of Public Health Nursing, Faculty of Public Health, Mahidol University, Thailand.
J Prim Care Community Health. 2023 Jan-Dec;14:21501319231181106. doi: 10.1177/21501319231181106.
The prevalence of uncontrolled type 2 diabetes has been increasing, and the nurse is a primary healthcare provider to patients when health professionals are scarce in the community setting. A feasible intervention delivered by nurses is necessary to fulfill patients' needs to help them achieve glycemic control.
To investigate whether Thai adults with uncontrolled diabetes in community hospitals lack self-care competency and whether a nurse-led supportive education program can enhance their self-care skills, change behavior, and control HbA1C levels.
We employed a multi-community hospital cluster randomized controlled trial design. Participants were randomly selected in the experimental group (2 hospitals) and control group (2 hospitals), with 30 patients from each hospital. One hundred twenty adults with HbA1c 7-10% treated by oral glycemic medication were recruited. Using Orem's Theory as a framework, nurses implemented self-care deficit assessments and supportive-educative nursing programs into their work. Participants in the control group received usual care, and those in the experimental group underwent a nurse assessment and supportive education measures. Data were collected at baseline, with 4-week and 12-week follow-ups. Data analysis were a repeated measures ANOVA with post hoc analysis, and Independent -test.
One hundred three patients completed the trial (51 in the experimental group and 52 in the control group). At 12 weeks, there were statistically significant improvements in HbA1c ( < .001), fasting plasma glucose ( = .03), knowledge ( < .001), diabetes self-care agency ( < .001), diet consumption ( < .001), physical activity ( < .001), and medical adherence ( = .03) in the experimental group significantly greater than those in the control group. Also, the between-group effect sizes were 0.49 or greater.
The self-care deficit assessment and supportive education program were essential to the nursing intervention that effectively improved knowledge, changed behavior, and HbA1c levels among adults with uncontrolled blood glucose.
2 型糖尿病的患病率不断增加，在社区环境中卫生专业人员短缺的情况下，护士是患者的主要医疗保健提供者。需要由护士提供可行的干预措施，以满足患者的需求，帮助他们控制血糖。
调查社区医院中血糖控制不佳的泰国成年人是否缺乏自我护理能力，以及护士主导的支持性教育计划是否可以增强他们的自我护理技能、改变行为并控制 HbA1C 水平。
我们采用多社区医院聚类随机对照试验设计。在实验组（2 家医院）和对照组（2 家医院）中随机选择参与者，每家医院各有 30 名患者。共招募了 120 名接受口服降糖药物治疗、HbA1c 为 7-10%的成年人。护士根据 Orem 的理论对患者进行自我护理缺陷评估，并将支持性教育护理计划纳入日常工作。对照组接受常规护理，实验组则接受护士评估和支持性教育措施。在基线、4 周和 12 周时收集数据。数据分析采用重复测量方差分析和事后分析，以及独立检验。
共有 103 名患者完成了试验（实验组 51 名，对照组 52 名）。在 12 周时，HbA1c（ < .001）、空腹血浆葡萄糖（ = .03）、知识（ < .001）、糖尿病自我护理能力（ < .001）、饮食摄入（ < .001）、体力活动（ < .001）和医疗依从性（ = .03）均有显著改善，实验组显著优于对照组。此外，组间效应大小为 0.49 或更大。
自我护理缺陷评估和支持性教育计划是护理干预的重要组成部分，可有效提高血糖控制不佳的成年人的知识、改变行为和 HbA1c 水平。
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