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ENGLISH ABSTRACT
肾病综合征患儿以自我管理能力为导向的焦点解决模式的应用与效果
邓群颖
杨文静
作者及单位信息
·
DOI： 10.3760/cma.j.cn211501-20220727-02377
Application and effect of self-management ability-oriented focus solution model in children with nephrotic syndrome
Deng Qunying
Yang Wenjing
Authors Info & Affiliations
Deng Qunying
Department of Nephrology, Children′s Hospital of Nanjing Medical University, Nanjing 210008, China
Yang Wenjing
Department of Nephrology, Children′s Hospital of Nanjing Medical University, Nanjing 210008, China
·
DOI： 10.3760/cma.j.cn211501-20220727-02377
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摘要

目的探讨肾病综合征患儿以自我管理为导向的焦点解决模式的应用效果，并观察其对肾病综合征患儿自我管理及应对方式的优化价值。

方法本研究为类实验研究。采用便利抽样法选取2018年3月至2020年4月就诊于南京医科大学附属儿童医院的96例肾病综合征患儿为研究对象，将2018年3月至2019年2月收住的48例患儿设为对照组，采用常规心理疏导；将2019年3月至2020年4月收住的48例患儿设为观察组，采用以自我管理能力为导向的焦点解决模式。比较2组干预2个月时患儿自我管理及应对方式变化的差异。

结果观察组患儿干预后治疗管理、心理管理、饮食管理、社会活动4个自我管理行为因子评分分别为（32.79 ± 2.94）、（19.43 ± 1.76）、（22.34 ± 1.64）、（39.79 ± 2.97）分，均较同期对照组的（27.42 ± 3.25）、（16.79 ± 1.52）、（18.46 ± 1.58）、（35.28 ± 2.64）分升高，差异均有统计学意义（t值为7.86 ~ 11.80，均P<0.05）；观察组患儿干预后慢性病儿童应对方式量表中的逃避、接受、负性情绪反应分量表评分及总分分别为（12.41 ± 2.15）、（20.41 ± 1.85）、（25.89 ± 1.68）、（99.37 ± 8.94）分，均较同期对照组的（11.22 ± 3.04）、（19.30 ± 2.09）、（24.80 ± 2.10）、（95.12 ± 9.02）分升高，差异均有统计学意义（t值为2.21 ~ 2.81，均P<0.05）。

结论以自我管理为导向的焦点解决模式用于肾病综合征患儿，能够促进自我管理行为改善，并推动患儿逃避、接受、负性情绪反应方面的应对方式改进，对肾病综合征患儿的护理具有借鉴与补充价值。

肾病综合征;自我管理;焦点解决模式;应对方式
ABSTRACT

ObjectiveTo explore the application effect of self-management ability-oriented focus solution model in children with nephrotic syndrome, and to observe the optimal value of self-management and coping style for children with nephrotic syndrome.

MethodsThis was a class trial study. A total of 96 children with nephrotic syndrome in Children′s Hospital of Nanjing Medical Universityfrom March 2018 to April 2020 were selected as the research object by convenient sampling method, 48 cases of children from March 2018 to February 2019 for the control group, using conventional psychological counseling, 48 cases of children from March 2019 to April 2020 for the observation group, with self management ability oriented focus solution mode. The self-management and response changes after 2 months of intervention were compared between the two groups.

ResultsThe scores of treatment management, psychological management, diet management and social activity inself-management behavior after intervention were (32.79 ± 2.94), (19.43 ± 1.76), (22.34 ± 1.64), (39.79 ± 2.97) points in the observation group, and (27.42 ± 3.25), (16.79 ± 1.52), (18.46 ± 1.58), (35.28 ± 2.64) points in the control group, the differences were statistically significant (t values were 7.86-11.80, all P<0.05). The scores of escape, acceptance, negative emotional response, and total score after intervention were (12.41 ± 2.15), (20.41 ± 1.85), (25.89 ± 1.68), (99.37 ± 8.94) points in the observation group, and (11.22 ± 3.04), (19.30 ± 2.09), (24.80 ± 2.10), (95.12 ± 9.02) points in the control group, the differences were statistically significant (t values were 2.21-2.81, all P<0.05).

ConclusionsThe self-management-oriented focus solution model for children with nephrotic syndrome can promote the improvement of self-management behavior, and promote the improvement of coping methods in terms of avoidance, acceptance and negative emotional response, which has reference and complementary value for the care of children with nephrotic syndrome.

Nephrotic syndrome;Self-management;Solution-focused approach;Coping style
Yang Wenjing, Email: mocdef.3ab612891.gnijnewgnay
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引用本文

邓群颖,杨文静. 肾病综合征患儿以自我管理能力为导向的焦点解决模式的应用与效果[J]. 中国实用护理杂志,2023,39(14)：1084-1090.

DOI:10.3760/cma.j.cn211501-20220727-02377

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肾病综合征在泌尿系统疾病中占比为21%以上，存在蛋白尿、低蛋白血症、高脂血症等多种临床表现[ 1 ]。由于肾病综合征具有病程长、高发病率及容易反复发作的疾病特点，需要长期应用激素类药物，同时在保护心理驱使下，家长常会过度保护与溺爱患儿，患儿多处于低自尊、低自我概念状态，影响疾病治疗依从性，导致自我管理能力下降[ 2 ]。自我管理是对自身疾病进行护理与监测的行为，能够有效增进自身健康状况，预防疾病相关并发症风险，降低疾病所引发的社会功能、情感及人际关系等方面影响的一种持久健康行为[ 3 ]。肾病综合征患儿的自我管理能力下降，与患儿自身的应对方式密切相关。既往的护理多注重疾病临床表现，缺乏对患儿的自我管理及应对方式的关注。焦点解决模式是以树立此刻该做什么，以解决问题过程来避免纠缠于问题本身的一种充分尊重个体需求、相信个体潜能的临床干预模式，鼓励患儿正向思考问题，既往主要用于心理疏导方面[ 4 ]。有研究显示，焦点解决模式用于儿童行为问题产生优化作用[ 5 ]。鉴于此，本研究以焦点解决作为理论框架，设计了针对肾病综合征患儿自我管理能力为导向的焦点解决模式，现报道如下。
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备注信息
A
杨文静，Email：mocdef.3ab612891.gnijnewgnay
B

邓群颖：数据整理、论文撰写；杨文静：统计分析、研究指导

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