| ObjectiveTo construct a feasible,systematic and standardized nursing intervention system for middle-aged and elderly patients with type 2 diabetes and osteoporosis,and to provide relevant evidence;Apply the constructed nursing intervention system to middle-aged and elderly patients with type 2 diabetic osteoporosis,and discuss its influence on the patient’s body mass index,fasting blood glucose,Hb Alc,bone mineral density,falls and fracture incidence,disease knowledge,and medication compliance and the impact of quality of life,to provide reference for clinical work.Methods1.The preliminary intervention system was drafted by searching literature on the basis of relevant guidelines and case reviews,and the Delphi method was adopted to finalize the system in accordance with expert advice and clinical experience.2.Clinical application of nursing intervention system.Middle-aged and elderly patients with type 2 diabetes and osteoporosis who meet the inclusion criteria hospitalized in the Endocrinology Department of a tertiary hospital in Hengyang were selected as subjects,and they were numbered according to admission order.By using the random number table method,the patients were divided into the control group and the intervention group,with 38 patients in each group.Patients in the control group received routine care for 5 months,and patients in the intervention group were performed an intervention using the constructed nursing intervention system for 5 months.At 3 months and 5months of intervention,the BMI,fasting blood glucose,Hb Alc,bone mineral density,falls and fracture occurrence,diabetes knowledge,osteoporosis knowledge,medication compliance and quality of life were measured.Statistical software SPSS 23.0 was used for data entry and analysis.Statistical description is performed using mean,standard deviation or frequency.Statistical analysis were performed by the two independent samples t-test,repeated measures analysis of variance,chi-square test or rank sum test.Results1.Totally 15 experts were enrolled,and the opinions of all experts tended to be consistent after 2 rounds of consultation.The expert authority coefficient was 0.862,and the importance and feasibility of Kendall’s coordination coefficients were 0.369、0.396 and 0.428、0.415 in the 2 rounds respectively（P<0.001）.The content included 6 sections for first-level indicator,namely nutrition intervention,exercise intervention,disease-related knowledge education,medication guidance,pain nursing intervention,and psychosocial intervention;it also contained 19 second-level indicators,and 59 third-level indicators.2.There were no significant differences in general information,BMI,course of disease,FBG,Hb Alc,femoral neck BMD and lumbar L1-4 BMD between the two groups before intervention（P>0.05）.3.There was no statistically significant difference in the total scores of diabetes knowledge and the knowledge scores of each dimension between the two groups before the intervention（P>0.05）.At the end of 3 months and 5months of intervention,the scores of general knowledge and insulin-related knowledge of diabetes,and total diabetes knowledge of the intervention group were higher than those of the control group（P<0.05）.Repeated measures analysis of variance showed that the total scores of diabetes knowledge and the scores of each dimension of the two groups were significantly different at different times and groups（P<0.05）,and there was a significant interaction effect between time factors and grouping factors（P<0.05）.4.There was no statistically significant difference in the total scores of osteoporosis knowledge and knowledge scores of various dimensions between the two groups before the intervention（P>0.05）.At the end of 3 months,the total scores of osteoporosis knowledge,exercise knowledge dimension and calcium knowledge dimension of the intervention group were significantly higher than those of the control group（P<0.05）;the knowledge of osteoporosis risk factors dimension were higher than the control group,but the difference was not statistically significant（P>0.05）.At the end of 5months,the total scores of osteoporosis knowledge and each dimensions of the intervention group were significantly higher than those of the control group,（P<0.05）.Repeated measures analysis of variance showed that the total scores of osteoporosis knowledge and the scores of various dimensions between the two groups were significantly different at different times and groups（P<0.05）,and there was a significant interaction effect between time factors and grouping factors（P<0.05）.5.There was no significant difference in medication compliance scores between the two groups before the intervention（P>0.05）.At the end of 3months and 5 months,the medication compliance scores of the intervention group were significantly higher than those of the control group（P<0.05）.Repeated measures analysis of variance showed that the medication compliance scores of the two groups were significantly different at different times and groups（P<0.05）,and there was a significant interaction effect between time factors and grouping factors（P<0.05）.6.There was no statistically significant difference in the total scores of quality of life and each dimension between the two groups before the intervention（P>0.05）.At the end of 3 months,the scores of total quality of life and physiological function dimensions in the intervention group were significantly lower than those of the control group（P<0.05）,and the dimensions of mental function,social relationship,and treatment were lower than those of the control group,but the differences was not statistically significant（P>0.05）.At the end of 5 months,the scores of physiological function,psychological function and total scores of quality of life of the intervention group were significantly lower than those of the control group（P<0.05）,and the scores of social relationship and treatment were lower than those of the control group,but the difference was not statistically significant（P>0.05）.Repeated measures analysis of variance showed that there were significant differences between the two groups in the physiological function dimensions scores,mental function dimension scores,and the total scores of quality of life（P<0.05）;the scores of total quality of life and each dimension of the two groups changed with the proceeding of time（P<0.05）,and there was a significant interactive effect on the intervention method and intervention time（P<0.05）.7.At the end of 3 months,there was no significant difference in BMI and FBG in the two groups（P>0.05）.At the end of 5 months,the BMI,FBG,and Hb Alc of the intervention group were significantly lower than those of the control group（P<0.05）,and the femoral neck BMD and lumbar spine L1-4BMD were significantly higher than those of the control group（P<0.05）.8.At the end of 5 months,the incidence of falls and fractures in the intervention group was lower than that in the control group,but the difference was not statistically significant（P>0.05）.Conclusion1.The constructed intervention system is scientific,reliable,practical and pertinent,and is important for guiding clinical nursing work.2.The nursing intervention system can improve disease-related knowledge,medication compliance and of quality of life of the patients with type 2 diabetes and osteoporosis.3.The nursing intervention system can improve the BMI,fasting blood glucose,Hb Alc,femoral neck BMD and lumbar L1-4 BMD of the patients with type 2 diabetes and osteoporosis. |
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