基于EMS管理模式的延续性护理在学龄前喘息性疾病儿童中的应用观察

doi:10.3969/j.issn.1674-8115.2024.02.009

上海交通大学学报（医学版） ›› 2024, Vol. 44 ›› Issue (2): 228-236.doi: 10.3969/j.issn.1674-8115.2024.02.009

• 论著 · 临床研究 • 上一篇

基于EMS管理模式的延续性护理在学龄前喘息性疾病儿童中的应用观察

姜允丽¹(), 李爱求²(), 肖艳赏¹, 李田田¹, 胡亚晨¹, 张潇潇¹, 吴蓓蓉¹

^1.上海市儿童医院，上海交通大学医学院附属儿童医院呼吸科，上海 200040
^2.上海市儿童医院，上海交通大学医学院附属儿童医院护理部，上海 200040

收稿日期:2023-02-03 接受日期:2023-10-25 出版日期:2024-02-28 发布日期:2024-03-25
通讯作者: 李爱求 E-mail:jiangyl@shchildren.com.cn;liaiqiu817@hotmail.com
作者简介:姜允丽（1987—），女，主管护师，本科；电子信箱：jiangyl@shchildren.com.cn。
基金资助:
上海申康医院发展中心临床科技创新项目(SHDC12016215)

Application of continuous nursing based on EMS management mode in preschool children with wheezing diseases

JIANG Yunli¹(), LI Aiqiu²(), XIAO Yanshang¹, LI Tiantian¹, HU Yachen¹, ZHANG Xiaoxiao¹, WU Beirong¹

^1.Department of Respiratory Medicine, Shanghai Children's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200040, China
^2.Nursing Department, Shanghai Children's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200040, China

Received:2023-02-03 Accepted:2023-10-25 Online:2024-02-28 Published:2024-03-25
Contact: LI Aiqiu E-mail:jiangyl@shchildren.com.cn;liaiqiu817@hotmail.com
Supported by:
Clinical Science and Technology Innovation Project of Shanghai Hospital Development Center(SHDC12016215)

摘要/Abstract

摘要：

目的·探讨基于EMS［环境管理（environment management，E）、用药指导（medicine direction，M）与自我监测（self monitoring，S）］管理模式的延续性护理在学龄前喘息性疾病儿童中的应用效果。方法·选取2019年12月至2020年11月，在上海交通大学医学院附属儿童医院呼吸科收治的67例0~6岁喘息性疾病患儿，按照随机数字表分为观察组33例和对照组34例，其中失访3例，最终每组32例。观察组采用基于EMS管理模式的延续性护理，对照组给予常规护理和出院电话随访。2组患儿出院后1、3、6个月随访评估儿童呼吸和哮喘测试（Test for Respiratory and Asthma Control in Kids，TRACK）结果、喘息复发情况；出院后6个月随访采用支气管哮喘用药依从性评分表（Medication Adherence Report Scale for Asthma，MARS-A）和护理工作满意度调查表评估用药依从性及护理工作满意度。结果·2组患儿人口学特征及临床基线特征差异无统计学意义。重复测量方差分析结果显示，时间、组别、组别×时间的交互作用对TRACK总分的影响均有统计学意义；出院后1、3、6个月，观察组TRACK总分均显著高于对照组（均P=0.000）；2组患儿TRACK总分均随时间推移逐渐上升（P=0.000）。观察组1、3、6个月随访发现喘息复发率分别为25.0%、18.7%、9.4%，均显著低于对照组（分别为50.0%、43.7%、31.3%，均P<0.05）；广义估计方程分析显示组间比较差异有统计学意义（P=0.013），观察组干预效果优于对照组（OR=0.292）。出院后6个月观察组MARS-A得分为（4.519±0.395）分，显著高于对照组［（3.994±0.739）分，P=0.001］。护理工作满意度调查结果显示，观察组显著高于对照组（P=0.000）。患儿MARS-A得分与护理工作满意度呈中度正相关（r=0.389，P=0.001）。结论·基于EMS管理模式的延续性护理可显著提高学龄前喘息性疾病儿童的用药依从性和喘息控制水平，明显降低喘息复发率，以及提高护理工作满意度。

关键词: EMS管理模式, 延续性护理, 学龄前儿童, 喘息性疾病

Abstract:

Objective ·To explore the effect of continuous nursing based on EMS [environment management (E), medicine direction (M) and self monitoring (S)] management mode on the preschool children with asthmatic diseases. Methods ·A total of 67 children aged 0 to 6 years with asthmatic diseases admitted to the Department of Respiratory Medicine, Shanghai Children's Hospital, Shanghai Jiao Tong University School of Medicine from December 2019 to November 2020 were selected and divided into observation group (33 cases) and control group (34 cases) according to the random number table method, with 3 cases lost, and finally 32 cases in each group. The observation group received continuous nursing care based on EMS management mode, while the control group received routine care and discharge follow-up through the telephone. The children in the two groups were followed up at 1, 3, and 6 months after discharge to evaluate the results of Test for Respiratory and Asthma Control in Kids (TRACK) and wheezing recurrence; Medication Adherence Report Scale for Asthma (MARS-A) and Nursing Job Satisfaction Questionnaire were used to evaluate medication adherence and nursing job satisfaction 6 months after discharge. Results ·There was no significant difference in demographic characteristics and clinical baseline characteristics between the two groups. Repeated measures analysis of variance showed that effects of time, groups and the interaction of groups×time on the total score of TRACK were statistically significant. The total scores of TRACK in the observation group were significantly higher than those in the control group at 1, 3, and 6 months after discharge (P=0.000). The total scores of TRACK in the two groups gradually increased with time (P=0.000). The recurrence rates of wheezing in the observation group were 25.0%, 18.7%, and 9.4% at 1, 3, and 6 months after discharge, which were significantly lower than those in the control group (50.0%, 43.7%, and 31.3%, respectively, P<0.05). Generalized estimating equation analysis showed that there was a statistically significant difference between the two groups (P=0.013), and the intervention effect of the observation group was better than that of the control group (OR=0.292). The MARS-A score of the observation group was 4.519±0.395 at 6 months after discharge, which was significantly higher than that of the control group (3.994±0.739, P=0.001). The nursing job satisfaction of the observation group was significantly higher than that of the control group (P=0.000). There was a moderate positive correlation between the MARS-A score and the nursing job satisfaction (r=0.389, P=0.001). Conclusion ·Continuous nursing based on EMS management mode can significantly improve the medication compliance and wheezing control level of the preschool children with asthmatic diseases, significantly reduce the recurrence rate of wheezing, and improve the nursing satisfaction.

Key words: EMS management mode, continuous nursing, preschool child, asthmatic disease

中图分类号:

R725.6

姜允丽, 李爱求, 肖艳赏, 李田田, 胡亚晨, 张潇潇, 吴蓓蓉. 基于EMS管理模式的延续性护理在学龄前喘息性疾病儿童中的应用观察[J]. 上海交通大学学报（医学版）, 2024, 44(2): 228-236.

JIANG Yunli, LI Aiqiu, XIAO Yanshang, LI Tiantian, HU Yachen, ZHANG Xiaoxiao, WU Beirong. Application of continuous nursing based on EMS management mode in preschool children with wheezing diseases[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2024, 44(2): 228-236.

图/表 4

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Item	Observation group (n=32)	Control group (n=32)	Z/t/χ² value	P value
Age/month	12.1 (5.4, 35.5)	14.5 (4.6, 27.9)	-0.752	0.452
Gender/n(%)			1.871	0.171
Male	20 (62.5)	25 (78.1)
Female	12 (37.5)	7 (21.9)
Resident area/n(%)			3.473	0.062
Living in city	25 (78.1)	18 (56.3)
Living in suburbs/village	7 (21.9)	14 (43.7)
Combined with allergic diseases/n(%)			1.362	0.741
No allergic diseases	26 (81.2)	25 (78.1)
Allergic rhinitis	3 (9.4)	4 (12.5)
Allergic conjunctivitis	1 (3.1)	0 (0)
Allergic dermatitis	2 (6.3)	3 (9.4)
Bronchiolitis history/n(%)			0.080	0.777
No	24 (75.0)	23 (71.9)
Yes	8 (25.0)	9 (28.1)
Diagnosed as asthma/n(%)			0.064	0.800
No	19 (59.4)	18 (56.3)
Yes	13 (40.6)	14 (43.7)
Seasonal factor/n(%)			0.674	0.412
No	21 (65.6)	24 (75.0)
Yes	11 (34.4)	8 (25.0)
Passive smoking/n(%)			0.000	1.000
No	6 (18.8)	6 (18.8)
Yes	26 (81.2)	26 (81.2)
Production mode/n(%)			0.251	0.616
Eutocia	16 (50.0)	18 (56.3)
Caesarean	16 (50.0)	14 (43.7)
Premature delivery/n(%)			0.087	0.768
No	8 (25.0)	7 (21.9)
Yes	24 (75.0)	25 (78.1)
Feeding history/n(%)			1.476	0.478
Breast feeding	26 (81.2)	22 (68.7)
Artificial feeding	3 (9.4)	6 (18.8)
Mixed feeding	3 (9.4)	4 (12.5)
Paternal age/n(%)			0.068	0.794
≥35 years old	12 (37.5)	11 (34.4)
<35 years old	20 (62.5)	21 (65.6)
Maternal age/n(%)			0.638	0.424
≥35 years old	12 (37.5)	9 (28.1)
<35 years old	20 (62.5)	23 (71.9)
Paternal education level/n(%)			0.481	0.786
Technical secondary school or below	6 (18.8)	4 (12.5)
Junior college	9 (28.1)	10 (31.2)
Bachelor degree or above	17 (53.1)	18 (56.3)
Maternal education level/n(%)			0.136	0.934
Technical secondary school or below	9 (28.1)	8 (25.0)
Junior college	6 (18.8)	7 (21.9)
Bachelor degree or above	17 (53.1)	17 (53.1)
Paternal history of allergic diseases/n(%)			0.110	0.740
Yes	5 (15.6)	6 (18.8)
No	27 (84.4)	26 (81.2)
Maternal history of allergic diseases/n(%)			0.000	1.000
Yes	28 (87.5)	28 (87.5)
No	4 (12.5)	4 (12.5)

Item	Observation group (n=32)	Control group (n=32)	Z/t/χ² value	P value
Age/month	12.1 (5.4, 35.5)	14.5 (4.6, 27.9)	-0.752	0.452
Gender/n(%)			1.871	0.171
Male	20 (62.5)	25 (78.1)
Female	12 (37.5)	7 (21.9)
Resident area/n(%)			3.473	0.062
Living in city	25 (78.1)	18 (56.3)
Living in suburbs/village	7 (21.9)	14 (43.7)
Combined with allergic diseases/n(%)			1.362	0.741
No allergic diseases	26 (81.2)	25 (78.1)
Allergic rhinitis	3 (9.4)	4 (12.5)
Allergic conjunctivitis	1 (3.1)	0 (0)
Allergic dermatitis	2 (6.3)	3 (9.4)
Bronchiolitis history/n(%)			0.080	0.777
No	24 (75.0)	23 (71.9)
Yes	8 (25.0)	9 (28.1)
Diagnosed as asthma/n(%)			0.064	0.800
No	19 (59.4)	18 (56.3)
Yes	13 (40.6)	14 (43.7)
Seasonal factor/n(%)			0.674	0.412
No	21 (65.6)	24 (75.0)
Yes	11 (34.4)	8 (25.0)
Passive smoking/n(%)			0.000	1.000
No	6 (18.8)	6 (18.8)
Yes	26 (81.2)	26 (81.2)
Production mode/n(%)			0.251	0.616
Eutocia	16 (50.0)	18 (56.3)
Caesarean	16 (50.0)	14 (43.7)
Premature delivery/n(%)			0.087	0.768
No	8 (25.0)	7 (21.9)
Yes	24 (75.0)	25 (78.1)
Feeding history/n(%)			1.476	0.478
Breast feeding	26 (81.2)	22 (68.7)
Artificial feeding	3 (9.4)	6 (18.8)
Mixed feeding	3 (9.4)	4 (12.5)
Paternal age/n(%)			0.068	0.794
≥35 years old	12 (37.5)	11 (34.4)
<35 years old	20 (62.5)	21 (65.6)
Maternal age/n(%)			0.638	0.424
≥35 years old	12 (37.5)	9 (28.1)
<35 years old	20 (62.5)	23 (71.9)
Paternal education level/n(%)			0.481	0.786
Technical secondary school or below	6 (18.8)	4 (12.5)
Junior college	9 (28.1)	10 (31.2)
Bachelor degree or above	17 (53.1)	18 (56.3)
Maternal education level/n(%)			0.136	0.934
Technical secondary school or below	9 (28.1)	8 (25.0)
Junior college	6 (18.8)	7 (21.9)
Bachelor degree or above	17 (53.1)	17 (53.1)
Paternal history of allergic diseases/n(%)			0.110	0.740
Yes	5 (15.6)	6 (18.8)
No	27 (84.4)	26 (81.2)
Maternal history of allergic diseases/n(%)			0.000	1.000
Yes	28 (87.5)	28 (87.5)
No	4 (12.5)	4 (12.5)

Time	TRACK score/point		F value	P value
Time	Observation group (n=32)	Control group (n=32)	F value	P value
Before intervention	40.00±24.82	42.03±26.36	0.101	0.752
Follow-up at 1 month	81.09±11.69^①	63.44±17.89^①	21.842	0.000
Follow-up at 3 months	90.78±5.84^①②	76.72±11.26^①②	39.345	0.000
Follow-up at 6 months	96.56±3.22^①②③	83.91±9.73^①②③	48.763	0.000
F value	50.757	35.677
P value	0.000	0.000

Time	TRACK score/point		F value	P value
Time	Observation group (n=32)	Control group (n=32)	F value	P value
Before intervention	40.00±24.82	42.03±26.36	0.101	0.752
Follow-up at 1 month	81.09±11.69^①	63.44±17.89^①	21.842	0.000
Follow-up at 3 months	90.78±5.84^①②	76.72±11.26^①②	39.345	0.000
Follow-up at 6 months	96.56±3.22^①②③	83.91±9.73^①②③	48.763	0.000
F value	50.757	35.677
P value	0.000	0.000

Item	Observation group (n=32)	Control group (n=32)	χ²/t value	P value
Wheezing recurring during 1 month/n(%)			4.267	0.039
No	24 (75.0)	16 (50.0)
Yes	8 (25.0)	16 (50.0)
Wheezing recurring during 1-3 months/n(%)			4.655	0.031
No	26 (81.3)	18 (56.3)
Yes	6 (18.7)	14 (43.7)
Wheezing recurring during 3-6 months/n(%)			4.730	0.030
No	29 (90.6)	22 (68.7)
Yes	3 (9.4)	10 (31.3)
MARS-A score/point	4.519±0.395	3.994±0.739	-3.546	0.001
Satisfaction with nursing work/%
Total score	96.1±3.1	92.4±4.3	-3.926	0.000
Nursing communication	95.9±4.3	92.6±4.2	-3.108	0.003
Nursing health education	97.1±3.6	93.4±4.7	-3.477	0.001
Nursing care services	94.6±3.9	89.8±6.1	-3.759	0.000
Nursing Environment	97.7±4.0	94.7±4.4	-2.824	0.006

基于EMS管理模式的延续性护理在学龄前喘息性疾病儿童中的应用观察

Application of continuous nursing based on EMS management mode in preschool children with wheezing diseases

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Metrics

Item	B (95%CI)	Standard error	Wald χ²	df	P value	OR
Observation group vs control group	-1.232 (-2.208‒-0.256)	0.498	6.126	1	0.013	0.292
Follow-up at 6 months vs 1 month	-0.920 (-1.473‒-0.366)	0.282	10.604	1	0.001	0.399
Follow-up at 3 months vs 1 month	-0.301 (-0.657‒0.054)	0.181	2.759	1	0.097	0.740

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