Qian Shuman, Ma Ying
Department of Pain, Department of Hand Surgery, Wuhan Fourth Hospital, Wuhan, Hubei, China.
Medicine (Baltimore). 2025 Jan 17;104(3):e40982. doi: 10.1097/MD.0000000000040982.
Digit replantation is often caused by sudden trauma, with 75% of amputated patients being low-income, low-education workers, and adding societal pressure. Orem's self-care model emphasizes self-care and may be an optimal nursing model for digit replantation, but its clinical application and research are limited. This study explores Orem's self-care model's impact on digit replantation. This single-center retrospective observational study included 389 patients who underwent digit replantation in our hospital from June 2019 to November 2023. Based on previous nursing methods, patients were divided into an experimental group (153 cases, Orem's self-care model) and a control group (236 cases, conventional nursing). After propensity score matching, indicators such as replanted finger function, self-efficacy, daily living ability, finger sensory recovery, and complications were compared between the 2 groups. Data were analyzed using t test, analysis of variance, and chi-square test. After matching for gender, age, education level, degree of finger amputation, time to hospital admission, number of amputated fingers, and medical history, the 2 groups showed no significant differences. Function scores at discharge showed no difference, but 2 months post-discharge, the experimental group scored higher (P < .001), with the gap widening at 6 months (P < .001). Sensory recovery showed no difference at discharge; 2 months post-discharge, 8% of the experimental group recovered to S3 level, and 7% to S3+ at 6 months (P < .05). Complication rates showed no significant differences, but the experimental group had a lower rise curve. Daily living ability scores showed no difference at discharge; 2 months post-discharge, the experimental group scored higher (P < .001), with a sustained advantage at 6 months (P < .001). At 6 months, high self-efficacy was 44.3% in the experimental group and 34.3% in the control group; low self-efficacy was 19.5% in the experimental group and 35.3% in the control group (P < .05). Higher education levels correlated with higher self-efficacy (P < .05). After matching, the experimental group outperformed the control group in functional recovery, sensory recovery, daily living ability, and self-efficacy. Orem's self-care model improves physical recovery and promotes psychological recognition in digit replantation patients.
断指再植常由突发外伤引起，75%的断指患者为低收入、低学历劳动者，这也增加了社会压力。奥瑞姆自理模式强调自我护理，可能是断指再植的最佳护理模式，但其临床应用和研究有限。本研究探讨奥瑞姆自理模式对断指再植的影响。这项单中心回顾性观察研究纳入了2019年6月至2023年11月在我院接受断指再植的389例患者。根据以往的护理方法，将患者分为实验组（153例，采用奥瑞姆自理模式）和对照组（236例，采用传统护理）。在进行倾向得分匹配后，比较两组患者再植手指功能、自我效能感、日常生活能力、手指感觉恢复及并发症等指标。采用t检验、方差分析和卡方检验进行数据分析。在匹配性别、年龄、教育程度、断指程度、入院时间、断指数量和病史后，两组无显著差异。出院时功能评分无差异，但出院后2个月，实验组评分更高（P < .001），6个月时差距扩大（P < .001）。感觉恢复在出院时无差异；出院后2个月，实验组8%恢复至S3级，6个月时7%恢复至S3+级（P < .05）。并发症发生率无显著差异，但实验组上升曲线较低。日常生活能力评分在出院时无差异；出院后2个月，实验组评分更高（P < .001），6个月时持续保持优势（P < .001）。6个月时，实验组高自我效能感为44.3%，对照组为34.3%；实验组低自我效能感为19.5%，对照组为35.3%（P < .05）。较高的教育水平与较高的自我效能感相关（P < .05）。匹配后，实验组在功能恢复、感觉恢复、日常生活能力和自我效能感方面优于对照组。奥瑞姆自理模式可促进断指再植患者的身体恢复并提升心理认同感。
