Hemşirenin evde destek programının, oral antikoagülan (varfarin) tedavisi alan hastaların öz-yönetimine etkisi
Küçük Resim Yok
Tarih
2015
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Ege Üniversitesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Giriş: Varfarin yaygın olarak kullanılan oral antikoagülanlardandır ve tromboemboliyi önlemeye yardımcıdır. Randomize kontrollü araştırmalarda, evde hemşire izleminin hastaların öz-yönetim stratejilerini (ilaç yönetimi, beslenme, kendi kendine test yapabilme ve kendi kendine izlem) kullanarak tedavi memnuniyetini artırdığı, klinik izleme göre maliyet-etkili olduğu ve rutin hastane bakımına göre daha etkili sonuçlar sağladığı saptanmıştır. Araştırmada amaç, hemşirenin evde destek programının, oral antikoagulan (varfarin) tedavisi alan hastaların öz-yönetimine etkisini incelemektir. Gereç ve Yöntem: Randomize kontrollü deneysel izlem araştırması, gönüllü 36 hasta ile 2012-2014 yılları arasında ev ziyareti yapılarak (12 ay izlem) yürütüldü. Deney (18 kişi) ve kontrol (18 kişi) grupları yaş, hastalığın türü ve hastalık süresine göre randomize edildi. HAS-BLED kanama riski skoru, Duke Antikoagülan memnuniyet ölçeği (DAMÖ) öz-yönetim davranışları formu ile veriler toplandı. Deney grubunda, 6 saat süren iki eğitim oturumu ile hastalar eğitildi. Hastaların kanama riski skoru, yan etkiler, öz-yönetim davranışları ve antikoagülan memnuniyeti değerlendirildi. Veriler sıklık, regresyon, Wilcoxon işaretli sıralar testi, bağımlı ve bağımsız örneklerde T testi, Mann-Whitney U testi, Friedman testi ve ki-kare analizleri ile değerlendirildi. Bulgular: Araştırmaya katılanların yaş ortalaması 62.27±12.36 (31-79 yaş), %47.2'si kadın, %86.1'i evli idi. Deney grubunun, HAS-BLED kanama riski ortalaması araştırma öncesi dönemde yüksek risk göstermekte iken (3.33±.49). araştırma sonrasında, HAS-BLED ortalaması deney grubunda anlamlı düzeyde azaldı (2.0±.77). Deney grubunda (4.06±.64), genel sağlık algısı araştırma sonunda kontrol grubuna (2.39±.85) göre daha iyi düzeyde algılandı. Araştırma öncesi döneme göre, DAMÖ ortalaması deney grubunda 66.3±22.4 ve kontrol grubunda 94±25.7 idi. Bu sonuçlar 12 aylık izlem sürecinde, deney grubunda memnuniyetin arttığını göstermektedir (p<.05). Doğrusal regresyon sonucuna göre, HAS-BLED kanama riski ortalamasının hastanın memnuniyetini etkileyen bir değişken olduğu belirlendi (p<.05). Hastaların öz-yönetim davranışları (ilaç yönetimi, beslenme yönetimi, kendi kendine INR testi yapma ve komplikasyonların izlemi) deney grubunda kontrol grubuna göre anlamlı artış gösterdi (p<.05). INR değerlerinin tedavi edici aralıkta (2.5-3.5) kalma sayısı deney grubunda (174/432), kontrol grubuna göre (82/432) yüksek düzeyde anlamlı idi (p<.05). Deney grubunda kontrol grubuna göre, tromboembolik olayların daha az görüldüğü saptandı. Deney grubu (4 hasta), kontrol grubuyla (7 hasta) karşılaştırıldığında, daha az minör hemorajik olay görüldü. Fakat kontrol grubunda, bir hastada inme ve 3 hastada ise majör hemorajik olay yaşandı. Sonuç: Bu çalışma, oral antikoagülan tedavi alan hastalar için, hemşirenin evde bakım yöntemi ile öz-yönetim davranışlarını geliştirmede, hasta memnuniyetini artırdığı ve komplikasyonları önlediğine ilişkin kanıtlar sağlamıştır. Araştırmada, hastanın bakıma katılımının sağlanarak öz-yönetim davranışlarının geliştirilmesinin, rutin hastane bakımına göre daha yararlı sonuçlar sağlaması nedeniyle bu modelin sağlık kuruluşlarında ve evde bakım hizmetlerinde kullanılabileceği önerildi. Anahtar sözcükler: Öz-yönetim; Varfarin; ilaç tedavisi yönetimi; diyet yönetimi; kişisel izlem; kendi kendine test yapabilme; hemşirelik bakımı
Background: Warfarin is the most widely prescribed oral anticoagulant that helps many patients to protect thromboembolism. In randomized controlled trials it has been shown that nurse home-support has increased the satisfaction of the patients by using patient self-management strategies (medication management, nutrition management, self-testing, self-monitoring), and has been more cost-effective and superior to both standard hospital care monitoring. The aim of the study is to determine the effect of nurse home-support programme on self-management of the patients receiving oral anticoagulation (Warfarin) therapy. Methods: The study as a randomized controlled group trial were implemented by selected eligible 36 volunteer patients for 12 months home visiting in 2012-2014. The patients were randomized to either intervention (18 patients) or control group (18 patients) according to the age, type of illness and duration of illnesses. Data were collected using with HAS-BLEED bleeding risk score, Duke Anticoagulation Satisfaction Scale (DASS) and self-management behaviours form. The intervention group trained comprising three training sessions of 6 hours duration. We examined the bleeding risk scores, potential and preventable warfarin-related complications, patient self-management behaviors, and patients' satisfaction. Data were evaluated by frequencies, regression, Wilcoxon signed-rank test, paired samples t-test, independent samples t-test, Mann-Whitney U test, Friedman's test and Chi-square analysis. Results: Mean age of the patients' was 62,27±12.36 (31-79 years), 47.2% of the participants were female, 86.1% were married. Intervention group patients' HAS-BLED bleeding scores showed higher risk bleeding (3.33±.49) in the pre-study period but at the end of the research HAS-BLED scores were decreased in this intervention group (2.0±.77). Intervention group has perceived general health status higher (4.06±.64) than the control group (2.39±.85) in the post-test.. The mean score of the Duke Anticoagulation Satisfaction Scale was 66.3±22.4 in the intervention group and 94±25.7 in the control group at he end of the study, which represents a statistically significant improvement in the intervention group patient satisfaction at 12-month follow-up (p<.05). Linear regression analysis explained HAS-BLED bleeding score was effective variable to affect patient satisfaction (p<.05). Patients self-management behaviors (medication management, dietary management, self-testing of INR levels, self-monitoring of the complications) improved of the intervention group significantly than control group (p<.05). The number of INR values within the target range (2.5-3.5) was significantly higher in the intervention group (174/432) than the control group (82/432). Intervention group showed significant reductions in both thromboembolic events than control group. Intervention group resulted in fewer minor hemoragic events (4 patient), compared with control group (7 patient), but one patient had stroke and 3 of them experienced major hemorrhagic events in the control group. Conclusion: This study demonstrated evidence that the method of nursing home care has effective on developing self-management behaviors, improving the patient satisfaction and preventing to complications for the oral anticoagulation therapy patients. In this study, since that improving the self-management behaviors of the patients by getting their participation has significant outcomes comparing to the standard care methods, it was recommended that this model could be easily adopted and implemented by home care services and health organizations. Key Words: Self-management; Warfarin; medication therapy management; dietary management; self-monitoring; self-testing; nursing care
Background: Warfarin is the most widely prescribed oral anticoagulant that helps many patients to protect thromboembolism. In randomized controlled trials it has been shown that nurse home-support has increased the satisfaction of the patients by using patient self-management strategies (medication management, nutrition management, self-testing, self-monitoring), and has been more cost-effective and superior to both standard hospital care monitoring. The aim of the study is to determine the effect of nurse home-support programme on self-management of the patients receiving oral anticoagulation (Warfarin) therapy. Methods: The study as a randomized controlled group trial were implemented by selected eligible 36 volunteer patients for 12 months home visiting in 2012-2014. The patients were randomized to either intervention (18 patients) or control group (18 patients) according to the age, type of illness and duration of illnesses. Data were collected using with HAS-BLEED bleeding risk score, Duke Anticoagulation Satisfaction Scale (DASS) and self-management behaviours form. The intervention group trained comprising three training sessions of 6 hours duration. We examined the bleeding risk scores, potential and preventable warfarin-related complications, patient self-management behaviors, and patients' satisfaction. Data were evaluated by frequencies, regression, Wilcoxon signed-rank test, paired samples t-test, independent samples t-test, Mann-Whitney U test, Friedman's test and Chi-square analysis. Results: Mean age of the patients' was 62,27±12.36 (31-79 years), 47.2% of the participants were female, 86.1% were married. Intervention group patients' HAS-BLED bleeding scores showed higher risk bleeding (3.33±.49) in the pre-study period but at the end of the research HAS-BLED scores were decreased in this intervention group (2.0±.77). Intervention group has perceived general health status higher (4.06±.64) than the control group (2.39±.85) in the post-test.. The mean score of the Duke Anticoagulation Satisfaction Scale was 66.3±22.4 in the intervention group and 94±25.7 in the control group at he end of the study, which represents a statistically significant improvement in the intervention group patient satisfaction at 12-month follow-up (p<.05). Linear regression analysis explained HAS-BLED bleeding score was effective variable to affect patient satisfaction (p<.05). Patients self-management behaviors (medication management, dietary management, self-testing of INR levels, self-monitoring of the complications) improved of the intervention group significantly than control group (p<.05). The number of INR values within the target range (2.5-3.5) was significantly higher in the intervention group (174/432) than the control group (82/432). Intervention group showed significant reductions in both thromboembolic events than control group. Intervention group resulted in fewer minor hemoragic events (4 patient), compared with control group (7 patient), but one patient had stroke and 3 of them experienced major hemorrhagic events in the control group. Conclusion: This study demonstrated evidence that the method of nursing home care has effective on developing self-management behaviors, improving the patient satisfaction and preventing to complications for the oral anticoagulation therapy patients. In this study, since that improving the self-management behaviors of the patients by getting their participation has significant outcomes comparing to the standard care methods, it was recommended that this model could be easily adopted and implemented by home care services and health organizations. Key Words: Self-management; Warfarin; medication therapy management; dietary management; self-monitoring; self-testing; nursing care
Açıklama
Anahtar Kelimeler
Halk Sağlığı, Public Health, Hemşirelik, Nursing, Kardiyoloji, Cardiology
