数字减影脑血管造影术（DSA）临床护理路径的制定与应用

发布时间：2018-04-20 23:00

本文选题：数字减影脑血管造影术(DSA) + 临床护理路径(CNP)　；参考：《延边大学》2015年硕士论文

【摘要】：目的研究制定数字减影脑血管造影术(DSA)临床护理路径,分析其实施的效果及质量,为数字减影脑血管造影术临床路径的制定、实施和推广提供参考依据。方法本研究属于类试验性研究。采用便利抽样的方法,选取吉林省某市三甲医院2013年9月～2014年9月期间进行数字减影脑血管造影术的患者160例,用随机数字表分为实验组和对照组。实验组制定临床护理路径实施诊疗、护理流程干预,对照组采用目前临床所用的常规的诊疗、护理流程进行对照。研究工具采用简化版中国医院住院患者体验与满意监测量表(CHPESM量表)和自行设计的问卷从临床指标、成本指标、服务指标、质量评价四个方面比较两组研究对象进行数字减影脑血管造影术后的各项指标。采用SPSS17.0软件进行统计学分析,检验水准为α =0.05。结果(1)实验组和对照组的研究对象在性别、年龄和文化程度等一般人口学特征方面的差异均无统计学意义(P0.05),具有可比性。两组研究对象干预前barthe1评分、高血压病史等疾病特征和健康知识掌握、患者满意度等指标的差异均无统计学意义(P0.05),具有可比性。(2)实验组患者进行数字减影脑血管造影术后的健康知识掌握优良率高于对照组,并发症、不适症状发生例数低于对照组,差异有显著的统计学意义(P0.01)。实验组患者的平均住院费用、平均住院日、成本-效益比低于对照组,差异有显著的统计学意义(P0.01)。实验组患者的满意度高于对照组,差异有显著的统计学意义(P0.01)。(3)实验组患者对临床护理路径的实施效果比较认可,对临床护理路径的质量评价中得分最高的三个条目依次为增加患者的配合程度及健康知识的掌握、促进医患沟通、增加患者的满意度。患者对临床护理路径是否束缚医护人员的诊疗或护理行为、是否束缚患者的就医行为持保守态度。医护及相关科室人员对临床护理路径的实施效果比较认可,对临床护理路径的质量评价中得分最高的三个条目依次为增加患者的满意度、增加患者的配合程度及健康知识的掌握、促进医患沟通。对于其减少工作量,增加收入方面持较为否定的态度。医护及相关科室人员普遍认为临床护理路径的信息化程度相对较低,对临床护理路径的实施是否束缚医护人员的诊疗或护理行为的评价较为保守。(4)临床护理路径有15例变异,变异符合帕雷托法则(八二法则),属于合理范围。结论制定并应用数字减影脑血管造影术临床护理路径有利于医患双方建立安全便捷的工作流程,降低医疗成本并提高医疗护理服务质量。患者、医护及相关科室人员对临床护理路径的实施效果比较认可,但需进一步加大对临床护理路径的宣传及信息化力度。本研究可为数字减影脑血管造影术制定、实施和推广临床路径提供参考依据,亦有利于持续优化临床路径的实施。
[Abstract]:Objective to study the clinical nursing path of digital subtraction cerebrovascular angiography (DSAs), analyze the effect and quality of its implementation, and provide a reference for the establishment, implementation and popularization of digital subtraction cerebrovascular angiography. Methods this study is a kind of experimental study. The convenience sampling method was used to select 160 patients who underwent digital subtraction cerebrovascular angiography from September 2013 to September 2014 in a third Class A Hospital of Jilin Province. The patients were divided into experimental group and control group by random digital table. The experimental group made the clinical nursing path to carry out the diagnosis and treatment, the nursing process intervention, the control group adopted the current clinical routine diagnosis and treatment, the nursing process was compared. A simplified version of the Chinese hospital experience and satisfaction monitoring scale (CHPESM) and a self-designed questionnaire were used to analyze the clinical indicators, cost indicators and service indicators. Four aspects of quality evaluation were compared between the two groups of subjects after digital subtraction cerebral angiography. The SPSS17.0 software was used for statistical analysis, and the test level was 0. 05%. Results 1) there was no significant difference in general demographic characteristics such as sex, age and education level between the experimental group and the control group (P 0.05), which was comparable. Before intervention, barthe1 score, hypertension history and other disease characteristics and health knowledge were mastered in the two groups. There was no significant difference in patients' satisfaction degree (P 0.05), but comparable. 2) the rate of mastering excellent and good health knowledge after digital subtraction cerebrovascular angiography in the experimental group was higher than that in the control group, and the incidence of complications and unwell symptoms was lower than that in the control group. The difference was statistically significant (P 0.01). The average hospitalization cost, average length of stay, cost-benefit ratio of the patients in the experimental group were lower than those in the control group, and the difference was statistically significant (P 0.01). The satisfaction degree of the patients in the experimental group was higher than that in the control group, and the difference was statistically significant. The three items with the highest score in the quality evaluation of clinical nursing path were increasing the cooperation degree of patients and mastering health knowledge, promoting doctor-patient communication and increasing patients' satisfaction. Patients have a conservative attitude on whether the clinical nursing path constrains the diagnosis and treatment or nursing behavior of the medical staff and whether the patient's visit behavior is restrained. The implementation effect of clinical nursing path was recognized by medical staff and related departments. The three items with the highest score in the quality evaluation of clinical nursing path were increasing patients' satisfaction. Increase the cooperation of patients and grasp health knowledge to promote communication between doctors and patients. For its reduced workload, increase income to take a more negative attitude. It is generally believed that the degree of informatization of clinical nursing path is relatively low, and the evaluation of whether the implementation of clinical nursing path constrains the diagnosis, treatment or nursing behavior of medical staff is conservative. 4) there are 15 cases of variation of clinical nursing path. The variation accords with the Pareto rule (Eighty-two rule) and belongs to the reasonable range. Conclusion the establishment and application of the clinical nursing path of digital subtraction cerebrovascular angiography is beneficial to the establishment of safe and convenient working process, the reduction of medical cost and the improvement of the quality of medical and nursing service. The effect of clinical nursing path was recognized by patients, medical and medical staff, but the propaganda and informatization of clinical nursing path should be further strengthened. This study can provide reference for making, implementing and popularizing the clinical pathway of digital subtraction cerebral angiography, and it is also helpful to optimize the implementation of clinical pathway.
【学位授予单位】：延边大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R473.74

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