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将时机理论应用于2型糖尿病的护理个案管理:一项临床回顾性研究。

Applying timing theory to nursing case management of type 2 diabetes mellitus: A clinical retrospective study.

作者信息

Tang Yaling, Liu Li, Xu Weiwei, Luo Yunqiu, Sun Hang

机构信息

Department of Endocrinology and Metabolism, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China.

出版信息

Medicine (Baltimore). 2025 Aug 29;104(35):e43832. doi: 10.1097/MD.0000000000043832.

Abstract

This study investigates the impact of a timing theory-based case management model on inpatient management efficiency, self-management capacity, and complication rates in patients with type 2 diabetes mellitus (T2DM). We retrospectively analyzed 120 inpatients with T2DM admitted between December 2023 and March 2024. Patients were divided into 2 groups based on the type of nursing care they received: an observation group (n = 60), which received a timing theory-based case management model, and a control group (n = 60), which received routine nursing care. The timing theory-based model structured nursing interventions into 5 progressive stages - diagnosis, stabilization, preparation, implementation, and adaptation - designed to align with patients' physical and psychological needs throughout the disease course. Primary outcomes included length of hospital stay, HbA1c target achievement rate, diabetes self-management questionnaire scores, psychological status (depression-anxiety-stress scale), and incidence of complications. Compared with the control group, the observation group had a shorter average hospital stay (8.56 ± 3.45 vs 10.34 ± 3.84 days, P < .001) and a 16.67% higher rate of achieving HbA1c goals (66.67% vs 50.00%, P = .041). Total diabetes self-management questionnaire scores (40.70 ± 3.50 vs 33.00 ± 3.80) and subscale scores - such as medication adherence and dietary control - were significantly better in the observation group (all P < .001). Post-intervention, scores for depression (10.46 ± 3.84 vs 15.51 ± 3.93) and anxiety (9.78 ± 3.73 vs 13.37 ± 3.96) were notably lower (both P < .001). The overall complication rate decreased by 26.66% (16.67% vs 43.33%, P = .007), while complete treatment adherence improved by 13.3% (50.0% vs 36.7%, P = .013). A timing theory-based case management model can significantly shorten hospital stays, enhance self-management and psychological well-being, and reduce the risk of complications in T2DM patients. These findings provide practical evidence for comprehensive diabetes care and offer new perspectives for long-term T2DM management.

摘要

本研究探讨基于时机理论的个案管理模式对2型糖尿病(T2DM)患者住院管理效率、自我管理能力及并发症发生率的影响。我们回顾性分析了2023年12月至2024年3月期间收治的120例T2DM住院患者。根据所接受的护理类型将患者分为两组:观察组(n = 60),接受基于时机理论的个案管理模式;对照组(n = 60),接受常规护理。基于时机理论的模式将护理干预分为5个递进阶段——诊断、稳定、准备、实施和适应——旨在在疾病全过程中与患者的生理和心理需求相匹配。主要结局指标包括住院时间、糖化血红蛋白(HbA1c)目标达成率、糖尿病自我管理问卷得分、心理状态(抑郁-焦虑-压力量表)及并发症发生率。与对照组相比,观察组平均住院时间更短(8.56 ± 3.45天 vs 10.34 ± 3.84天,P <.001),HbA1c目标达成率高出16.67%(66.67% vs 50.00%,P =.041)。观察组糖尿病自我管理问卷总分(40.70 ± 3.50 vs 33.00 ± 3.80)及各子量表得分——如用药依从性和饮食控制——均显著更好(均P <.001)。干预后,抑郁得分(10.46 ± 3.84 vs 15.51 ± 3.93)和焦虑得分(9.78 ± 3.73 vs 13.37 ± 3.96)显著降低(均P <.001)。总体并发症发生率降低了26.66%(16.67% vs 43.33%,P =.007),而完全治疗依从性提高了13.3%(50.0% vs 36.7%,P =.013)。基于时机理论的个案管理模式可显著缩短T2DM患者的住院时间,增强自我管理能力和心理健康水平,并降低并发症风险。这些研究结果为糖尿病综合护理提供了实践依据,并为T2DM的长期管理提供了新的视角。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/29ab/12401264/398b0e3e6b57/medi-104-e43832-g001.jpg

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