刘瑞凤

【摘要】目的 “看图对话+叙事医学”模式对0级糖尿病足患者知信行健康教育的影响结果。方法 选择80例经Wagner分级评估为0级糖尿病足的2型糖尿病患者，在患者入院第1天随机分别纳入观察组和对照组各40例。对照组实施床边宣教手册和糖尿病课堂健康教育模式，观察组实施“看图对话+叙事医学”小组知信行健康教育模式；干预时间自入院第1天起至出院前1天，跟踪随访1年，比较两组患者知信行健康教育效果及满意度和糖尿病足转归结果。结果 随访结果显示，观察组患者KAP问卷调查知信行评分评分显著优于对照组；观察组糖尿病足恶化进展率明显低于对照组；观察组对健康教育的满意度评价明显优于对照组；差异均有统计学意义（P<0.05）。结论 “看图对话+叙事医学”健康教育模式能显著提高0级糖尿病足患者知信行水平，患者接受程度高，改善了糖尿病足发展进程，减少致残率。

【关键词】看图对话；叙事医学；糖尿病足；知信行；健康教育

【中图分类号】R473.5 【文献标识码】A 【文章编号】ISSN.2095-6681.2017.36..03

【Abstract】Objective "Look at the picture dialog + narrative medicine" mode of 0 grade diabetic foot patients know nobuyuki affect the outcome of health education.Methods Select 80 cases by the Wager grading evaluation of 0 grade diabetic foot patients with type 2 diabetes， in patients admitted to hospital day 1 randomly into observation group and control group （n=40）.Control group to implement the bedside mission manual and the diabetes health education model，observation group implement "the picture dialog+narrative medicine" group know nobuyuki health education mode； Intervention time since day 1 admission to hospital before 1 day，1 year follow-up，compared two groups of patients with known nobuyuki health education effect and satisfaction and diabetic foot outcome results.Results Follow-up，according to the results of observation group patients know nobuyuki KAP questionnaire score score significantly better than control group；The deterioration of diabetic foot progress rate of observation group was obviously lower than the control group；Observation group the satisfaction evaluation of health education was better than control group；The differences were statistically significant （P<0.05）.Conclusion "Look at the picture dialog+narrative medicine" health education mode can significantly improve the level of 0 grade diabetic foot patients know nobuyuki，high degree of patients accepted，improved the development of diabetic foot processes，reduce morbidity.

【Key words】Look at the picture talk；Narrative medicine；Diabetic foot；Know nobuyuki；Health education

隨着糖尿病发病率的逐渐增高，糖尿病足严重致残、致死的危害性越来越受到患者个体、家庭和社会的高度重视。加强早期预防和多学科积极干预，可有效避免或延缓糖尿病足恶化进展[1]。叙事医学是近年来引入我国医疗护理领域的叙事能力实践医学模式，其人文价值在于促使临床护理人员反思其工作并不断改进，达到全面提高医疗护理水平并改善医患和护患关系[2]。我院自2015年1月起全面推进叙事护理模式，并在各专业领域取得可喜的践行效果，本文对我院内分泌科实行的“看图对话+叙事医学”教育模式对糖尿病足患者自我管理护理教育的成果介绍