The Effect Of Structured Curriculum Combined With 5A On Self-management Of Patients With Type 2 Diabetes In Rural Areas

Objective:The purpose of this research is to the rural district of Lvliang city,Shanxi Province,part of type 2 diabetes as the research object.Through the implementation of structured health education course and 5A nursing mode,enhance the understanding of the basic knowledge of patients with type 2 diabetes,improve the patients' ability of self-management,which is beneficial to reduce the risk of type 2 diabetes(DM)complication rate.The introduction of expert team led by Ji Linong of Peking University Health Science Center designed "structured therapy in patients with type 2 diabetes and education courses" curriculum,and explore with the Lvliang City area in patients with type2 diabetes health education,the use of 5A nursing mode by phone,We-Chat follow-up nursing intervention to improve the implementation of rural follow-up health education in patients with type 2 diabetes after discharge,eventually becoming a kind of new type 2diabetes mellitus in our hospital management mode,to subordinate communities,towns and townships and brothers hospital diabetes slow disease management to provide a kind of practical,feasible and scientific nursing management solution.Methods:1.120 patients with type 2 diabetes who met the inclusion and exclusion criteria in the department of endocrinology of Lvliang people's hospital were selected as the subjects of this study.According to the odd-even of the end of the hospitalization number and the odd-even combination of the hospital bed number,the patients were divided into experimental group 1,experimental group 2 and control group,with 40 cases in each group.2.The control group,40 cases of patients with type 2 diabetes given routine health education guidance,and regular follow-up care after discharge management way,the specific way is health education cards guidance,combines with a bedside teaching and checks regularly,telephone follow-up after discharge,etc.On the basis of routine health education management,80 patients in the experimental group were in accordance with Peking University medicine during the period of hospitalization.Ji Linong led the design team of experts from Germany similar courses "structured therapy in patients with type 2 diabetes and education courses" for training,the main content: disease awareness,diet guidance,oral hypoglycemic drugs,diabetes retinopathy,foot care and related inspection,a total of 4 times,1 time every 3 days.1.5-2hours at each time,the class knowledge effectiveness evaluation before having the next class.Follow-up after discharge: 40 patients of treatment group 1 on the basis of routine follow-up to join 5A nursing mode: asked(Ask)and Suggestions(Advice),assessment(Assess),help(Assist),Arrange follow-up(Arrange);The 40 patients in the experimental group 2 were with regular review,telephone follow-up etc.The time of questionnaire survey for 120 subjects was as follows: the knowledge level of diabetes was investigated 1-2 days before the patient was discharged from hospital.Patients were investigated for diabetes self-management at the time of admission,1 month after discharge and 3 months after discharge.Blood glucose levels and glycosylated hemoglobin were investigated at 3 months after discharge.The tools used in this study are:the Michigan Diabetes test questionnaire(DKT)and the diabetes self-management scale(SDSCA).3.The collected data were processed by SPSS 18.0 software,and the measured data were expressed by mean standard deviation(`x±s).The three groups were compared with single factor ANOVA,SNK-q test for group comparison,independent sample t test for the same group intervention before and after intervention,chi-square test for count data(x2),and the difference was statistically significant(p < 0.05).Results:(1)Three groups there was no statistically significant difference comparing the general data in diabetic patients,patients with diabetes knowledge study,diabetes self-management score difference had no statistical difference(P > 0.05).(2)Patients at discharge,1 month after discharge,and 3 months respectively to investigate.The score of the Diabetes knowledge scale and the diabetes self-management scale to two experimental groups and one control group.Data analysis results show that:the results of diabetes knowledge scale: The results of the investigation 1-2 days before discharge the patients in experimental groups were higher than those of the control group(p<0.05).But there was no significant difference in diabetes knowledge score between experimental group 1 and experimental group 2(p>0.05);The self-management questionnaire survey shows: One month after discharge,the experimental group 1 and the experimental group 2 were significantly higher than the control group(p<0.05).But there was no significant difference between experimental group1 and experimental group 2(p>0.05).Then investigating 3 month after discharge,The experimental group 1 was higher than the experimental group 2,and were higher than the control group patients score,the difference was statistically significant(p<0.05);Through three times,the statistical analysis of diabetes patients' diet,exercise,foot care,blood glucose monitoring and so on,the difference was statistically significant(P<0.05).(3)Discharge of the hospital blood glucose levels and glycosylated hemoglobin in March results compared with on admission,the experimental group 1 is lower than group 2numerical,and scores were lower than the control group patients,statistically significant difference(P < 0.05).Conclusion:Structured health education combined with 5A nursing mode is effective and feasible for improving the self-management level and diabetes knowledge level of patients with type 2 diabetes mellitus in this study area.In the course of follow-up,the use of 5A nursing mode is useful to improve the self-management ability of diabetes patients.This study not only has the reference significance for the health education of patients with diabetes in clinical nursing work,and to provide a basis for improving the quality of follow-up intervention,but because the time is too short,for long-term follow-up tests,this paper does not,therefore,has a certain limitation in the follow-up time,hope that the future researchers in the related research that can increase the test time,verify the type 2 diabetes self-management ability of sustainable.