CAJ | 학술논문

目的：探讨出院前综合评估干预和出院后连续护理对老年慢性病患者健康知识和自理能力的影响。方法将我院收治的老年慢性病患者200例随机分为研究组和对照组，两组各100例，对照组老年患者接受目前常规的治疗、康复和护理，干预组在此基础上实施由专业的健康教育护士、专科医生、康复师、营养师、老年患者家属或其他照顾者、保健医生等构成多学科综合评估干预和出院后为期6个月以健康教育为主的连续护理。6个月后测评两组患者参与健康教育，知识掌握、自理能力等改变情况。结果干预组94人、对照组93人完成研究，干预组患者出院后6月，参与健康教育的数量、知识掌握情况、自理能力明显优于对照组（P＜0．05）。结论实施出院前综合评估干预和出院后连续护理，能有效地提高老年慢性病患者健康教育的参与，改善和维持其日常生活能力。
목적：탐토출원전종합평고간예화출원후련속호리대노년만성병환자건강지식화자리능력적영향。방법장아원수치적노년만성병환자200례수궤분위연구조화대조조，량조각100례，대조조노년환자접수목전상규적치료、강복화호리，간예조재차기출상실시유전업적건강교육호사、전과의생、강복사、영양사、노년환자가속혹기타조고자、보건의생등구성다학과종합평고간예화출원후위기6개월이건강교육위주적련속호리。6개월후측평량조환자삼여건강교육，지식장악、자리능력등개변정황。결과간예조94인、대조조93인완성연구，간예조환자출원후6월，삼여건강교육적수량、지식장악정황、자리능력명현우우대조조（P＜0．05）。결론실시출원전종합평고간예화출원후련속호리，능유효지제고노년만성병환자건강교육적삼여，개선화유지기일상생활능력。
Objective To investigate the influence of health knowledge and ability of self-care for the elderly pa-tients with chronic disease by comprehensive assessment before discharge and continuity of care after discharge . Method Two hundreds elderly patients with chronic diseases in our hospital were randomly divided into study group and control group ,100 patients in each group .The patients in control group received the current conventional treat-ment ,rehabilitation and care . Patients in study group received the intervention of multidisciplinary assessment formed by a professional health nurses and specialists ,rehabilitation ,dietitian ,family members of the elderly pa-tients and other health-careers ,continuous nursing care of health education for 6 months after discharge was conduc-ted .The changes of health education and knowledge and the self-care ability between the two groups were tested six months after discharge .Result 94 patients of the study group and 93 patients of the control group completed the study .The number involved in health education ,knowledge level and self-care ability for patients in study group 6 months after discharge were significantly better than that of the control group (P<0 .05) .Conclusion The implemen-tation of integrated assessment interventions before discharge and continuity of care after discharge can effectively improve the health education involvement for elderly patients with chronic disease and increase their health knowl-edge ,as well as improve and maintain of ability of daily living .