發(fā)布時間：2018-01-27 07:31

  本文關(guān)鍵詞： 奧馬哈系統(tǒng) 呼吸系統(tǒng) 延續(xù)護理 自我管理能力 生存質(zhì)量 護理滿意度　出處：《南京中醫(yī)藥大學》2017年碩士論文　論文類型：學位論文

【摘要】：目的構(gòu)建出適合我國國情的呼吸內(nèi)科出院患者醫(yī)院社區(qū)一體化延續(xù)護理模式。評價該模式的實施效果,驗證該模式的實施能滿足呼吸內(nèi)科出院患者的專業(yè)化護理需求。研究方法本研究采用奧馬哈問題分類系統(tǒng)作為理論框架,編制出"呼吸內(nèi)科出院患者護理需求評估表";同時,對150例呼吸內(nèi)科出院患者的護理需求及出院時所存在的健康問題進行調(diào)查�；�于前期調(diào)查結(jié)果及國內(nèi)外文獻,構(gòu)建呼吸內(nèi)科出院患者醫(yī)院社區(qū)一體化延續(xù)護理服務(wù)模式,主要包括3個部分:①三級醫(yī)院:建立呼吸內(nèi)科出院患者信息檔案,評估出院患者的護理需求及問題,制定延續(xù)護理計劃,培訓及指導社區(qū)護士;②三級醫(yī)院和社區(qū)衛(wèi)生服務(wù)中心的銜接:建立QQ交流平臺,醫(yī)院護士將呼吸內(nèi)科患者的電子信息檔案及延續(xù)護理計劃轉(zhuǎn)介給社區(qū)衛(wèi)生服務(wù)中心,社區(qū)護士及時反饋進展;③社區(qū)衛(wèi)生服務(wù)中心:社區(qū)護士及時接收呼吸內(nèi)科出院患者的電子信息檔案及延續(xù)護理計劃,實施延續(xù)護理計劃。采用便利抽樣法選取2016年2月～2017年1月在南京某三級甲等醫(yī)院的呼吸內(nèi)科128例住院患者作為研究對象,將呼吸內(nèi)科的一區(qū)和二區(qū)隨機分為干預組和對照組,每組各64例出院患者,隨訪時間為6個月,對照組出院患者接受呼吸內(nèi)科常規(guī)護理,而干預組出院患者則在接受呼吸內(nèi)科常規(guī)護理的基礎(chǔ)上,接受呼吸內(nèi)科出院患者醫(yī)院社區(qū)一體化的延續(xù)護理,并分別在呼吸內(nèi)科患者出院前、出院后1個月、出院后3個月和出院后6個月時,采用自我管理能力測定量表(ESCA)、生存質(zhì)量調(diào)查問卷(SF-36)、自行設(shè)計的衛(wèi)生服務(wù)利用調(diào)查問卷和護理滿意度調(diào)查問卷,對兩組患者進行效果評價,以評估對呼吸內(nèi)科出院患者實施醫(yī)院社區(qū)一體化延續(xù)護理模式的有效性和可行性。研究結(jié)果1.專家咨詢結(jié)果顯示,量表各條目CVI值為0.91～1.00,全部條目平均CVI=0.962,內(nèi)部一致性Cronbach'α系數(shù)為0.949,Guttman分半信度為0.919,同時,重測信度為0.988,符合接受標準。2.呼吸內(nèi)科出院患者護理需求評估的結(jié)果顯示,80.7%的呼吸內(nèi)科出院患者希望在出院后繼續(xù)獲得延續(xù)護理;79.3%的患者選擇電話隨訪為服務(wù)形式;48.0%的患者希望每2周一次獲得延續(xù)護理,并希望醫(yī)院護士(占64.7%)和社區(qū)護士(52.0%)能為其提供護理服務(wù);超過半數(shù)的(占51.3%)患者愿意支付延續(xù)護理的費用,在這些患者中,選擇按頻次收費的患者占83.12%,收費區(qū)間為10-150元。對呼吸內(nèi)科出院患者進行護理問題的評估,結(jié)果顯示,在患者出院時,主要存在的護理問題為呼吸(占100%)、健康照顧的督導(占80.7%)、認知(占64.0%)、身體活動(占52.7%)和藥物濫用(占51.3%)。3.兩組呼吸內(nèi)科出院患者自我管理能力的組間比較顯示,干預前,比較兩組患者自我管理能力的總分和各維度得分,結(jié)果顯示差異無統(tǒng)計學意義(P0.05);干預后,比較兩組患者自我管理能力的總分,除出院1個月后,差異不具有統(tǒng)計學意義外(P0.05),出院3個月后和6個月后,差異均具有統(tǒng)計學意義(P0.05);干預后,比較兩組患者自我管理能力各維度得分,其中自我管理概念維度、自我責任感維度和自我管理技能維度,在出院1個月后、3個月后和6個月后差異均具有統(tǒng)計學意義(P0.05),而健康知識水平維度在出院1個月后、3個月后和6個月后的差異無統(tǒng)計學意義(P0.05)。4.兩組呼吸內(nèi)科出院患者生存質(zhì)量的組間比較顯示,干預前,比較兩組患者生存質(zhì)量的總分和各維度得分,差異均無統(tǒng)計學意義(P0.05);干預后,比較兩組患者生存質(zhì)量的總分,結(jié)果顯示出院1個月后、3個月后和6個月后,差異均具有統(tǒng)計學意義(P0.05);干預后,比較兩組患者生存質(zhì)量的各維度得分,結(jié)果顯示,在出院1個月后,總體健康(GH)、生理功能(PF)、生理職能(RP)、軀體疼痛(BP)、社會功能(SF)、情感職能(RE)、心理健康(MH)的得分的差異有統(tǒng)計學意義(P0.05),而在出院3個月后和6個月后,各維度間的差異均具有統(tǒng)計學意義(P0.05)。5.兩組呼吸內(nèi)科出院患者衛(wèi)生服務(wù)利用的組間比較顯示,在干預1個月后、3個月后和6個月后,兩組患者訪問門診次數(shù)、再入院次數(shù)的差異均具有統(tǒng)計學意義(P0.05),而訪問社區(qū)衛(wèi)生服務(wù)機構(gòu)、訪問急診次數(shù)的差異無統(tǒng)計學意義(P0.05)。6.兩組呼吸內(nèi)科出院患者的住院滿意度和社區(qū)衛(wèi)生機構(gòu)護理滿意度的組間比較顯示,干預前,兩組患者的住院護理滿意度評分和對社區(qū)衛(wèi)生機構(gòu)護理滿意的評分之間,差異無統(tǒng)計學意義(P0.05);干預1個月后、3個月后、6個月后,干預組患者對住院護理的滿意度和對社區(qū)護理的滿意度均顯著高于對照組(P0.05)。研究結(jié)論本研究所構(gòu)建的呼吸內(nèi)科出院患者醫(yī)院社區(qū)一體化延續(xù)護理模式能夠較好的適用于呼吸內(nèi)科出院患者。通過實施呼吸內(nèi)科出院患者醫(yī)院社區(qū)一體化延續(xù)護理服務(wù),能夠有效改善呼吸內(nèi)科出院患者的自我管理能力及生存質(zhì)量,使患者的自我管理能力及生存質(zhì)量達到較高水平,同時,延續(xù)護理模式能夠有效降低患者訪問訪問門診的次數(shù)及再入院的次數(shù)等衛(wèi)生服務(wù)利用情況,使出院患者對住院時的護理滿意度和出院后社區(qū)護理的滿意度均得到有效地提高。
[Abstract]:Objective to construct the respiratory medicine for the situation of our country patients discharged from hospital community integration continued nursing mode. To evaluate the effect of the model, verify the implementation of the model can meet the discharge of respiratory medicine professional care needs of patients. Methods: This study adopts the Omaha question classification system as the theoretical framework, developed the "nursing of respiratory medicine the needs of the patients evaluation form"; at the same time, to investigate 150 cases of respiratory medicine nursing needs of patients and the existing hospital health problems. The results of preliminary investigation and literature at home and abroad based on the construction of respiratory medicine patients discharged from hospital community integration continue nursing service mode, mainly includes 3 parts: the three stage: the establishment of hospital patients with respiratory medicine information archives hospital, nursing assessment requirements and problems of patients, making continuing nursing plan, training and guidance of community nurses; II Between the three hospitals and community health service center: to establish a QQ communication platform, the hospital nurse will breathe electronic information archives of internal patients and extended care plan referrals to community health service centers, community nurses timely feedback progress; the community health service center: community nurses receive respiratory medicine hospital patients and the continuation of electronic information archives the nursing plan, nursing care plan. With the convenient sampling method from February 2016 to January 2017 in the Department of respiratory medicine in Nanjing from three hospitals in 128 patients as the research object, the respiratory medicine of a region and the two region were randomly divided into intervention group and control group, each group had 64 cases of discharged patients, follow-up time was 6 months, the control group patients received respiratory routine nursing care, while the intervention group patients in Department of Respiratory Medicine received routine nursing, respiratory medicine accepted Continue nursing patients in hospital community integration of the hospital, and were discharged in patients with respiratory medicine before and 1 months after discharge, 3 months after discharge and 6 months after discharge, the determination of the ability of self management scale (ESCA), quality of life questionnaire (SF-36), using questionnaire and nursing satisfaction questionnaire the self-designed health service, evaluation of two groups of patients, to evaluate the effectiveness of implementation of respiratory medicine hospital hospital community integration continued nursing mode and feasibility of patients. The results showed that 1. expert consultation results, scale of each entry CVI value from 0.91 to 1, the average CVI=0.962 of all entries, the internal consistency coefficient of Cronbach'0.949, Guttman split half reliability was 0.919, and the test-retest reliability was 0.988, with medical.2. standard nursing needs of patients with respiratory discharge evaluation results showed that 80.7% of the patients in respiratory department Want to continue to receive continuing nursing care after discharge; 79.3% of the patients selected for telephone follow-up service; 48% of the patients hope once every 2 weeks to get extended care, and hope that the hospital nurses (64.7%) and community nurses (52%) to provide care for their services; more than half (51.3%) were willing to pay for the continuation of the nursing cost in these patients, selected according to the frequency of charges accounted for 83.12% of patients, the toll area is 10-150 yuan. The assessment of respiratory medicine patients were nursing problems. The results show that when the patient was discharged, the main problems for respiratory care (100%), health care supervision (80.7%) cognitive, physical activity (64%), (52.7%) and drug abuse (51.3%) shows that the two group respiratory.3. discharge patients' ability of self-management among groups before intervention, compared two groups of patients self management ability of the total score and scores of each dimension, The results showed no statistically significant difference (P0.05); after the intervention, compared two groups of patients self management ability scores, except for 1 months after discharge, the difference was not statistically significance (P0.05), 3 months after discharge and 6 months later, the differences were statistically significant (P0.05); intervention, comparison two groups of patients self management ability scores, the concept of self management dimension, self responsibility dimensions and self management skills dimensions, in 1 months after discharge, the difference after 3 months and 6 months were statistically significant (P0.05), and the level of health knowledge dimension in 1 months after discharge, no statistically significant difference after 3 months and 6 months later (P0.05), two group comparison showed that the quality of life of patients with respiratory.4. discharge between groups before intervention, compared two groups of patients survival quality score and score of each dimension, the differences were not statistically significant (P0.05); after the intervention between the two groups 鎮(zhèn)ｈ，

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