术中低体温护理干预行为的现况分析与指导成效评价

发布时间：2018-01-01 06:18

本文关键词：术中低体温护理干预行为的现况分析与指导成效评价　出处：《新疆医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:术中低体温可引起多种并发症,如:术后寒战、切口感染率增加及呼吸、心血管系统与凝血功能异常、麻醉苏醒延迟等,给患者带来不同程度的危害。有学者认为:护士在术中低体温的预防工作中起到重要作用。本研究采用知信行模式,运用6个调查量表:手术室护理人员对术中低体温护理干预的认知现状、自我效能感、安全文化态度、职业倦怠、管理现状与行为现状量表,以掌握新疆三级甲等医院手术室护理人员对术中低体温护理干预行为现状及其相关影响因素,并分析各因素间的相关关系。在基线调查的基础上,采用多种干预手段:远程网络专题知识讲座、播放影像资料、小组式讨论、PBL+情境模拟演练的培训方法,对干预对象进行实验研究。力求从中探索出科学、可行的培训模式与途径,向基层医院推广术中低体温护理知识与技能,以提升新疆手术室护理人员的安全服务理念及护理能力,落实并深化手术室优质护理服务,充分保障手术患者安全。方法:本研究分为两个部分。前期为描述性研究,根据新疆24所三级甲等医院的现状,考虑新疆地域特点,采用分层整群抽样的方法,将东疆、南疆、北疆及乌鲁木齐地区的不同辖区、相同等级的17所医院的手术室护理人员607名作为研究对象,通过发放调查问卷,调研并分析手术室护理人员对术中患者低体温护理干预的知信行等情况;后期为干预研究,为期2个月。研究者自参与现况调查的17所新疆三级甲等医院中,随机选取10所医院的手术室护理人员作为干预对象,采用数字表法将其随机分为观察组和对照组,每组含5所医院手术室,观察组护理人员59名,对照组61名;随机抽取分别由两组研究对象护理、且符合纳入标准的手术患者作为研究对象:观察组手术患者122名,对照组手术患者124名。两组护理人员与手术患者的一般资料、相关低体温各量表评分等均无统计学差异。研究者采用远程网络专题知识讲座、播放影像资料、小组式讨论、PBL+情境模拟演练的培训方式,对观察组进行强化干预,对照组则实施与观察组同步远程网络授课。将相关术中低体温知信行各量表的评分、术中低体温发生率及术中患者生命体征作为评价指标,比较两组护理人员与手术患者干预前后的评价指标与指标差值差异有无统计学意义。结果:基线调查结果显示:(1)不同人口学特征者对术中低体温护理干预的认知现状、自我效能感、安全文化态度、职业倦怠、管理现状与行为现状评分差异有统计学意义(P0.05);(2)以行为现状为因变量,其它5个因素为自变量,其中认知现状、安全文化态度、管理现状纳入方程且呈正相关,职业倦怠与行为现状呈负相关。(3)Pearson相关性分析结果表明:6个因素中,除职业倦怠仅与行为现状呈负相关关系外(P0.05),其余各因素间均呈正相关性;干预研究结果显示:(1)观察组与对照组护理人员的认知现状、管理现状、安全文化态度与行为现状评分差异有统计学意义(P0.05),自我效能感与职业倦怠评分差异无统计学意义(P0.05);(2)观察组与对照组术中患者低体温发生率差异有统计学意义(P0.01);(3)观察组与对照组术中患者麻醉后鼻咽温与肛温差异无统计学意义(P0.05),结束时鼻咽温与肛温差异有统计学意义(P0.05)。(4)观察组麻醉后与结束时鼻咽温与肛温差异无统计学意义(P0.05);对照组麻醉后与结束时鼻咽温与肛温差异有统计学意义(P0.05),且结束时鼻咽温与肛温低于麻醉后。(5)观察组鼻咽温变化趋势较对照组平稳,对照组鼻咽温自切皮30min骤然下降,维持在35.5℃~36.0℃之间,约于4小时后下降至35.5℃以下;对照组肛温变化趋势较观察组明显,自切皮60min持续下降至35.5℃以下。结论:护理人员实施术中低体温护理干预行为现状与认知现状、自我效能感、安全文化态度、职业倦怠及管理现状有关。为在新疆范围内推广术中低体温的护理知识与技术,以提升护理干预的执行率与质量,确保手术患者安全,研究者考虑到新疆的地域特点、经济与卫生事业发展现状及宗教信仰等因素,运用远程继续教育、播放影像资料、小组式讨论的方式,对护理人员术中低体温护理干预认知与信念情况进行干预,采用PBL+情境模拟演练的方法对护理行为进行指导,使护理人员对术中低体温的认知与信念得以提升,管理与行为现状有所改善,术中低体温的发生率明显下降,但护理人员的自我效能感与职业倦怠的干预效果不显著,需要管理者重点关注并积极引导。
[Abstract]:Objective: intraoperative hypothermia can cause a variety of complications, such as postoperative shivering, incision infection rate increased and respiratory, cardiovascular system and abnormal coagulation function, delay of recovery, bring harm to the patients. Some scholars think that the nurses in hypothermia prevention plays an important role in the research work. The KAP model, using 6 questionnaires: the cognitive status of nursing staff in operation room of intraoperative hypothermia nursing intervention, self efficacy, safety culture attitude, occupation burnout, status and behavior management scale, to grasp the operation room nurses from three hospitals in Xinjiang the status quo of intraoperative hypothermia nursing intervention the behavior and related effects, and analysis the relationship between the various factors. On the basis of the baseline investigation, using a variety of interventions: remote network special lectures, playing image data, group discussion, P The training method of BL+ simulation exercises, carried out the experimental study on the intervention object. In order to explore the training mode and scientific, feasible way to promote the operation of grass-roots hospital, hypothermia nursing knowledge and skills, to enhance the Xinjiang operation room nursing personnel security service concept and nursing ability, implement and deepen the operation room of high quality nursing service, fully to ensure the safety of surgical patients. Methods: This study is divided into two parts. The descriptive study, according to the current situation of Xinjiang 24 three hospitals, considering the geographical characteristics of Xinjiang, using the method of stratified cluster sampling in different districts, the eastern, northern and Urumqi area, the operation room nurses in 17 hospitals the same grade 607 as the research object, through the questionnaire, investigation and analysis of nursing staff in operation room patients hypothermia nursing intervention KAP etc. Condition; study in the intervention for 2 months. Researchers from the participation status investigation of the 17 Xinjiang three hospitals, 10 hospitals were randomly selected from the operation room nursing staff as intervention objects, using randomly divided into observation group and control group, each group containing 5 operation room hospital observation group of 59 nurses and 61 patients in the control group; randomly selected respectively from two groups of subjects and nursing, patients met the inclusion criteria as the object of study: the observation group of 122 patients, the control group of 124 patients. The general information of the two groups of nursing staff and patients, the related low temperature scale there was no significant difference. The researchers used the remote network special lectures, play videos, group discussion, PBL+ simulation exercise training, to strengthen the intervention in the observation group, the control group and the observation group synchronization implementation The remote network teaching. The intraoperative hypothermia KAP scale score, intraoperative hypothermia incidence rate and intraoperative vital signs of patients as the evaluation index, evaluation index and index difference between two groups were compared before and after nursing and intervention for patients with surgery had no statistical significance. Results: the baseline survey results show that: (1) the cognitive status of different demographic characteristics of intraoperative hypothermia nursing intervention, self efficacy, safety culture attitude, occupation burnout, significant status and behavior management score difference (P0.05); (2) in line for the status as the dependent variable, the other 5 factors as independent variables, cognitive status of the safety culture attitude, management status and included in the equation are positively correlated, negatively related to current situation of occupation burnout and behavior. (3) the Pearson correlation analysis showed that 6 factors, in addition to occupation burnout only negatively correlates with the behavior of Outside (P0.05), the other factors were positive correlation; intervention results show: (1) cognitive status, the observation group and the control group of nursing staff in the management of the status quo, there was statistical significance the present situation of the safety culture attitude and behavior difference score (P0.05), self-efficacy and job burnout score difference was statistically significant (P0.05); (2) the observation group and the control group of patients with low temperature occurrence rate were significant (P0.01); (3) the observation group compared with the nasopharyngeal temperature and rectal temperature after anesthesia group had no statistical significance (P0.05), at the end of nasopharyngeal temperature and rectal temperature difference was statistically significant (P0.05). (4) observation group after anesthesia and at the end of nasopharyngeal temperature and rectal temperature difference was not statistically significant (P0.05); the control group after anesthesia and at the end of nasopharyngeal temperature and rectal temperature difference was statistically significant (P0.05), and at the end of nasopharyngeal and rectal temperature lower than the temperature after anesthesia. The observation group (5) nasopharyngeal temperature The change trend of stable than the control group, the control group from the nasopharyngeal temperature skin incision 30min plummeted, maintained at 35.5 DEG ~36.0 DEG, about 4 hours after the fall to 35.5 degrees below the control group; the change trend of rectal temperature significantly compared with the observation group, after skin incision 60min continued to decline to 35.5 DEG. Conclusion: the implementation of nursing the status quo of intraoperative hypothermia nursing intervention and cognitive behavior status, self-efficacy, attitude about safety culture, and management of occupation burnout status. Nursing knowledge and technique of intraoperative hypothermia in Xinjiang range, in order to perform rate and quality improvement of nursing intervention, to ensure the safety of patients, the researchers considered the geographical features of Xinjiang the status quo, and religious factors such as economic and health development, the use of distance continuing education, play videos, group discussion, the nursing staff of hypothermia nursing intervention and cognitive beliefs Intervention methods PBL+ situation simulation exercises to guide the nursing behavior, the nurses' perceptions and beliefs on hypothermia can be improved, and present management behavior has improved, hypothermia incidence rate decreased significantly, but the nurses' self-efficacy intervention and occupation burnout is not significant, need managers focus on and actively guide.

【学位授予单位】：新疆医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R472.3

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