品管圈活动对肝硬化患者饮食依从性的影响

发布时间：2018-04-22 00:29

本文选题：品管圈 + 肝硬化　；参考：《山东大学》2014年硕士论文

【摘要】：目的通过调查了解肝硬化患者饮食依从性情况,成立“品管圈”活动小组,分析依从性差原因并实施针对性措施,开展活动后再次评估、比较患者饮食依从性、并发症发生及满意度有无差异,进而探讨“品管圈”质量管理工具在提高肝硬化患者饮食依从性中的应用效果,为其在护理质量持续改进中应用提供依据及支持。方法采取方便抽样方法,抽取2013.2-6月山东某三甲医院消化内科152例肝硬化患者为对照组,2013.8-12月同科住院的161例肝硬化患者为观察组,对照组实施常规饮食护理,观察组实施品管圈持续质量改进方法：通过了解对照组肝硬化患者饮食依从性现状,成立“品管圈”活动小组,从护理、患者及管理三个角度研讨,采用头脑风暴法对肝硬化患者饮食依从性现状进行流程及内容分析,以鱼骨图形式呈现依从性差的主要原因,以此作为持续护理质量改进的切入及关键点,针对现有问题采取相应措施,根据患者不同特点,通过圈员间互相协作制定个性化饮食健康宣教计划,以加强饮食管理、强化完善健康教育资料,改进饮食管理流程为主要改善方向,逐一解决影响肝硬化患者饮食依从性的不良因素。采用一般资料问卷、依从性问卷、满意度问卷等对患者进行调查,比较两组患者饮食依从性、并发症发生率及满意度有无差异并判定活动效果。运用SPSS17.0软件进行数据录入与分析,具体包括：描述性统计分析、t检验、χ2检验及秩和检验等。结果共313名患者参与本次研究,其中对照组152例,观察组161例,两组患者在性别、年龄、婚姻、学历、职业、收入等一般资料上均无统计学差异性(P0.05)。具体结果如下： 1.两组患者中,对照组患者饮食依从性好63例(41.45%),一般49例(32.24%),差40例(26.31%)；实施品管圈活动采取针对性措施后,观察组患者饮食依从性好94例(58.39%),一般48例(29.81%),差19例(11.80%)。两组患者之间有明显统计学差异(P0.01),品管圈活动开展后,肝硬化患者饮食依从性有了明显提高； 2.对照组患者8例出现并发症,分别为消化道出血14例、肝性脑病2例,电解质紊乱2例；观察组患者2例发生并发症,消化道出血及肝性脑病各1例,两组患者并发症发生率有显著差异(P0.05)； 3.两组患者护理满意度比较,对照组患者总满意度为91.45%,其中满意139例,一般10例,不满意3例；观察组总满意度为96.89%,其中满意156例,一般5例,不满意0例,品管圈活动开展有效提高了患者的护理满意度(P0.05)。结论品管圈质量管理工具应用可以提高肝硬化患者饮食依从性,减少患者并发症的发生,促进疾病康复,提高护理满意度。圈员的工作热情、个人表达能力、创造性思维、品管圈手法运用及团队精神在其中也有明显提高,值得进一步推广。
[Abstract]:Objective to investigate the dietary compliance of patients with liver cirrhosis and set up a "product pipe circle" group to analyze the reasons of poor compliance and implement the targeted measures. After carrying out the activities, the diet compliance, complications and satisfaction were compared, and the quality management tool of "quality control circle" was explored to improve the liver. The application effect of dietary compliance in sclerotic patients provides evidence and support for its application in the continuous improvement of nursing quality.
Methods to take a convenient sampling method, 152 cases of liver cirrhosis in a three a hospital of Shandong, Shandong, were selected as the control group, 161 cases of liver cirrhosis in the same department of the same department were observed in 2013.8-12 month. The control group carried out routine diet nursing, and the observation group implemented the continuous quality improvement method of the product tube circle: through understanding the control group of liver cirrhosis patients The status of dietary compliance was established, and the "product management circle" group was set up, from three perspectives of nursing, patients and management. The flow and content analysis of dietary compliance status of patients with liver cirrhosis was analyzed by brainstorming, and the main reasons for poor compliance were presented in the form of fish bone map, which was the key point for improving the quality of continuous nursing. According to the existing problems, according to the different characteristics of the patients, according to the different characteristics of the patients, the individualized diet health education program is formulated through cooperating with each other, in order to strengthen the diet management, improve the health education data, improve the diet management process as the main improvement direction, and solve the adverse factors of dietary compliance of the patients with liver cirrhosis. The general data questionnaire, the compliance questionnaire, the satisfaction questionnaire and so on were investigated. The dietary compliance of the two groups, the incidence of complications and the satisfaction of the patients were compared. The data were recorded and analyzed by SPSS17.0 software, including descriptive statistical analysis, t test, chi square 2 test and rank sum test.
Results a total of 313 patients were involved in this study, of which 152 cases in the control group and 161 in the observation group. There were no statistical differences between the two groups in gender, age, marriage, education, occupation, and income (P0.05). The results were as follows:
1. of the two groups, the diet compliance of the control group was 63 (41.45%), 49 (32.24%) and 40 (26.31%). After the implementation of the targeted measures, the diet compliance of the patients in the observation group was 94 (58.39%), 48 (29.81%) and 19 (11.80%). There was significant difference between the patients (P0.01) and the activities of the tube circle. After the development, the compliance of patients with cirrhosis increased significantly.
2. patients in the control group had complications in 8 cases, including 14 cases of gastrointestinal bleeding, 2 cases of hepatic encephalopathy, 2 cases of electrolyte disturbance, 2 cases in the observation group, 1 cases of gastrointestinal bleeding and hepatic encephalopathy, and there were significant differences in the incidence of complications in two groups (P0.05).
3. the satisfaction of patients in the two groups was compared. The total satisfaction of the control group was 91.45%, of which 139 cases were satisfactory, 10 cases were general and 3 cases were dissatisfied. The total satisfaction of the observation group was 96.89%, of which 156 cases were satisfactory, the general 5 cases were 5, and 0 cases were dissatisfied. The nursing satisfaction of the patients was improved effectively (P0.05).
Conclusion the application of quality management tools can improve the compliance of the patients with liver cirrhosis, reduce the incidence of complications, promote the rehabilitation of the disease, and improve the satisfaction of nursing. The work enthusiasm, individual expression, creative thinking, management and team spirit of the circle members are also obviously improved, which deserve further promotion.

【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R473.5

【参考文献】