护士主导的共同决策指导伤口治疗压力损伤:一项随机试验的初步研究。

IF 1.4 Q2 MEDICINE, GENERAL & INTERNAL Tzu Chi Medical Journal Pub Date : 2023-07-01 DOI:10.4103/tcmj.tcmj_256_22
Mei-Yu Hsu, Yu-Sin Chen, Ying-Chun Chen, Yu-Lin Wu
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引用次数: 0

摘要

目的:管理压力性损伤(PI)和溃疡的国际指南建议家庭成员和护理人员应参与制定适当的伤口护理决策。然而,共同决策(SDM)在PI背景下的影响尚不清楚。本研究探讨护士主导的医学SDM治疗PI的疗效。材料与方法:我们在护理证据的基础上构建了PI治疗的患者决策辅助系统(PDA)。随后,我们进行了一项随机对照试验,比较SDM与常规护理(对照组,[CG])治疗PI的疗效。3期、4期或不可分期PI的参与者被纳入并随机分为两组。SDM组(SDMG) 10例患者在治疗前接受SDM干预。所有参与者随访4周。主要结果采用SDM问卷(SDM- q -9)和决策冲突量表(DCS)进行测量。次要结局包括伤口大小和伤口处理费用。结果:测量了为PI设计的PDA的专家效度(医学教授和普通人群),内容效度指数为0.96 ~ 0.97。共有20名参与者入组(10名接受SDM治疗,10名接受常规治疗)。参与者的平均年龄为55.7±8.8岁。两组患者的基线特征(性别、年龄、分期或伤口面积)无显著差异。SDMG组的SDM-Q-9评分(P < 0.001)和DCS评分(P < 0.01)均高于CG组。次要结果显示,与CG相比,SDMG的伤口大小变化更小,伤口管理费用更低;然而,差异没有统计学意义。结论:构建了一种用于PI治疗的PDA,可用于临床护理。中试结果显示,在SDM-PI干预4周后,SDMG患者的相关伤口处理成本较CG低,伤口尺寸减小。今后的临床研究应在本初步研究的基础上进行大规模的随机试验。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

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Nurse-led coaching of shared decision-making for wound treatment of pressure injury: A pilot study of a randomized trial.

Objectives: International guidelines for managing pressure injury (PI) and ulcers recommend that family members and caregivers should be involved in making decisions for appropriate wound care. However, the effect of shared decision-making (SDM) in the context of PI remains unknown. This study investigated the efficacy of nurse-led medical SDM for PI treatment.

Materials and methods: We constructed a patient decision aid (PDA) for PI treatment on the basis of nursing evidence. Subsequently, we conducted a pilot randomized controlled trial to evaluate the efficacy of SDM compared with that of usual care (control group, [CG]) for PI treatment. Participants with stage 3, stage 4, or unstageable PI were included and randomized into two groups. In the SDM group (SDMG), 10 participants received the SDM intervention for PI before treatment. All participants were followed up for 4 weeks. Primary outcomes were measured using the nine-item SDM Questionnaire (SDM-Q-9) and Decisional Conflict Scale (DCS). Secondary outcomes included wound size and cost of wound management.

Results: The expert validity (medical professors and general population) of the PDA designed for PI was measured, and the content validity index was 0.96-0.97. A total of 20 participants were enrolled (10 received SDM and 10 received usual care). The mean age of the participants was 55.7 ± 8.8 years. No significant difference in baseline characteristics (sex, age, staging, or wound area) was observed between the two groups. The SDMG had higher SDM-Q-9 (P < 0.001) and DCS (P < 0.01) scores than did the CG. For the secondary outcomes, the SDMG had a decreased change of wound size and lower wound management costs than did the CG; nevertheless, the differences were not statistically significant.

Conclusion: We constructed a PDA for PI treatment, which can be applied in clinical care. The pilot test results revealed that the participants had a lower cost related wound treatment and decreasing wound size in SDMG than CG after the intervention of SDM-PI for 4 weeks. In the future, clinical studies should conduct large-scale randomized trials based on the results of this pilot study.

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来源期刊
Tzu Chi Medical Journal
Tzu Chi Medical Journal MEDICINE, GENERAL & INTERNAL-
CiteScore
3.40
自引率
0.00%
发文量
44
审稿时长
13 weeks
期刊介绍: The Tzu Chi Medical Journal is the peer-reviewed publication of the Buddhist Compassion Relief Tzu Chi Foundation, and includes original research papers on clinical medicine and basic science, case reports, clinical pathological pages, and review articles.
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