助产士特定情况下处方权内容的研究

发布时间：2018-01-04 01:07

本文关键词：助产士特定情况下处方权内容的研究　出处：《山西医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:本课题旨在大量文献查询的基础上,参考国外助产士处方权的情况,结合我国的实际情况探讨中国助产士在特定情况下开具的处方内容及处方形式,探讨助产士未来的工作范围,以期为我国未来制定相关法律政策提供科学参考及理论依据。对象:本研究的专家入选条件为:(1)副主任医师、副主任护师及以上职称或相当于副高职称的中级职称及以上职称(2)10年及以上从事本专业工作经验(3)本科及以上学历(4)具有严谨求实的态度,自愿参与。本研究邀请了省内外多所三甲医院的从事助产专业的14名医疗专家和18名护理专家进行两轮的专家咨询。方法:1.文献调研法通过大量的国内外文献查阅和信息搜索,初步制定专家咨询问卷。2.半结构访谈法在查阅大量文献的基础上,对临床工作者进行访谈,吸取意见,通过对访谈结果进行分析,对初步制定的专家问卷进行修订,形成第一轮专家咨询问卷。3.德尔菲法邀请省内外多所三甲医院的从事助产专业的14名医疗专家和18名护理专家,进行两轮关于助产士开具处方的特定情况、具体的处方内容和处方形式、助产士工作范围的专家咨询,并对咨询结果进行计算和统计分析得出最终研究结果。4.统计学方法采用microsoftexcel数据库和spss22.0统计软件对咨询结果进行统计分析,得出指标的均数、变异系数、标准差,计算专家认同率、专家的积极系数、权威系数和协调系数,并运用spss22.0对协调系数进行显著性检验。结果:通过两轮专家咨询,最终确定了助产士可以开具处方的6种特定情况、在这6种特定情况下可以开具的20个药物处方和13个辅助检查处方,其中51.5%的药物和辅助检查处方倾向于独立处方,30.3%的倾向于协议处方,18.2%的两种处方形式都接近,以及确定了助产士的17项工作内容。具体为助产士可以开具处方的六种特定情况分别为:子宫收缩乏力、子宫收缩过强、产后出血、胎膜早破、正常分娩和新生儿窒息。在这六种特定情况下可以开具的处方内容及处方形式为:倾向于独立处方形式的是:子宫收缩乏力情况下的5%葡萄糖+维生素c、胎心监测;子宫收缩过强情况下的胎心监测;产后出血情况下的缩宫素、平衡液、血常规及凝血功能检查;胎膜早破情况下的缩宫素、胎心监测、血常规检查;正常分娩情况下的利多卡因、缩宫素、维生素k1、胎心监测、b超检查、心电图检查;新生儿窒息情况下的动脉血气分析、血糖监测。倾向于协议处方形式的是:子宫收缩乏力情况下的地西泮;子宫收缩过强情况下的硫酸镁、哌替啶;产后出血情况下的米索前列醇;胎膜早破情况下的抗生素、羊膜腔感染监测;正常分娩情况下的哌替啶、胃复安;新生儿窒息情况下的肾上腺素、纳洛酮。两种处方形式接近的是:子宫收缩乏力情况下的缩宫素、麦角新碱、血液生化检查;产后出血情况下的麦角新碱、欣母沛、电解质检查。助产士的17项工作内容分别是:产前孕期知识宣教、产前咨询、产前检查及监测、孕期营养的管理、孕期不适及保胎的管理;正常分娩的接生、导乐分娩、非药物性减痛分娩、会阴侧切及缝合、监测产妇出血情况;观察产妇伤口及会阴情况、观察产妇出血及恶露情况、正常新生儿的照护、指导产妇科学哺育、产褥期保健知识宣教、电话随访、产后42天复查。本研究专家的权威系数为0.915;在关于处方特定情况的咨询中,两轮的协调系数分别为0.207和0.489;在工作范围的咨询中,两轮的协调系数分别为0.057和0.131,本研究协调系数均在0-1之间,显著性检验P值均小于0.05,本研究专家权威程度较高,专家意见协调性好,结果可信。结论:建议给予一定资质的助产士在子宫收缩乏力、子宫收缩过强、产后出血、胎膜早破、正常分娩及新生儿窒息这六种情况下的部分处方权,建议国家对助产士的工作范围有所界定,以提升助产专业的自主性及专业性,壮大助产队伍,更好的服务于母婴健康。参与此项研究的咨询专家权威程度高,专家意见的协调性好,结果可信。
[Abstract]:Objective: the purpose of this study is to search literatures on the reference of foreign midwife prescription right, combined with the actual situation of China to explore the content and form of prescription prescription China midwives in specific cases issued, to investigate the midwife the scope of future work with a view to China's future development of relevant laws and policies provide scientific reference and theoretical basis the object of this study. Expert selection: (1) the deputy chief physician, deputy director of the nurse and above or equivalent to the high title of intermediate and above titles (2) and more than 10 years engaged in the professional work experience (3) Bachelor degree or above (4) has a rigorous and realistic attitude voluntary participation. This study invited experts engaged in midwifery professional 14 medical experts and 18 nursing experts for two more hospitals outside the province. Methods: 1. literature research method through a large number of domestic Foreign literature and information search, preliminary expert consultation questionnaires were made.2. semi-structured interviews based on the literatures, the clinical workers were interviewed, get advice from the interview results, to revise the questionnaire formulated by experts, the formation of the first round of expert consultation questionnaire.3. Delphi invited a number of hospitals inside and outside the province, engaged in professional midwifery of 14 medical experts and 18 nursing experts, two specific prescriptions about midwives, the content of the prescription and prescription of the specific form of expert midwives work scope, and the consultation results are obtained the final research results of.4. statistical methods for statistical analysis of the consultation results using microsoftexcel database and spss22.0 software calculation and statistical analysis, the average number of index variation coefficient, standard deviation calculation, expert recognition rate, The positive coefficient of experts, the authority coefficient and the coordination coefficient, and the use of spss22.0 on the coordination coefficient is statistically significant. Results: through two rounds of expert consultation, and ultimately determine the midwife can 6 special prescriptions, in which 6 specific cases can 20 drug prescribing and 13 auxiliary examination of prescription, which 51.5% of the drugs and prescription prescription auxiliary examination tend to be independent, 30.3% tended to protocol prescription. Two prescription forms are close to 18.2%, and identified 17 work content. The midwife midwife can six special issue at the party were: uterine contraction, uterine contraction is too strong, postpartum hemorrhage, prom, normal delivery and neonatal asphyxia. The content of the prescription and prescription form in these six specific circumstances can be drawn as: the tendency to form independent prescription is: uterine atony. The 5% glucose + vitamin C, fetal heart monitoring; uterine contraction after fetal heart monitoring under the condition of strong; oxytocin, postpartum hemorrhage under the balance of fluid, blood and coagulation function test; premature rupture of membranes under the condition of oxytocin, fetal heart monitoring, blood routine examination; lidocaine under normal delivery, oxytocin, vitamin K1, fetal heart monitoring, B Ultrasound examination, electrocardiogram examination; blood glucose monitoring of arterial blood gas analysis, neonatal asphyxia. The tendency to agreement prescription form is: under the condition of weak uterine contraction diazepam; uterine contraction in the case of excessive Magnesium Sulfate, pethidine; postpartum hemorrhage. Misoprostol; premature rupture of membranes under the condition of antibiotics, amniotic cavity infection monitoring; normal delivery in case of pethidine, metoclopramide; neonatal asphyxia by epinephrine, naloxone. Two kinds of prescription form approach is: uterine atony situation Under the conditions of oxytocin, ergometrine, blood biochemical examination; postpartum hemorrhage of ergonovine, hemabate, electrolyte examination. 17 work contents are: midwives prenatal education during pregnancy, prenatal counseling, prenatal examination and pregnancy monitoring, nutrition management, pregnancy discomfort and miscarriage management; normal delivery the birth of Doula delivery, non drug pain relief delivery, perineal side incision and suture, monitoring maternal bleeding; maternal and perineal wound observation, observation of maternal hemorrhage and lochia, normal neonatal care, maternal guidance of scientific feeding, postpartum health education, telephone follow-up at 42 days after delivery. The coefficient of authority the expert is 0.915; in particular about prescription consultation, coordination coefficient of the two rounds were 0.207 and 0.489; the scope of work in consultation, coordination coefficient of the two rounds were 0.057 and 0.131, the Study on the coordination coefficient between 0-1, P significant test values were less than 0.05, the expert authority degree, expert opinion coordination, the result is credible. Conclusion: weak contraction proposal to give certain qualified midwives in the uterus, uterine contraction is too strong, postpartum hemorrhage, premature rupture of fetal membrane, normal delivery and neonatal asphyxia some prescription rights under the six conditions, the midwife's scope of work suggested that the state has been defined, in order to enhance the autonomy of professional midwifery and professional team, strengthen midwifery, better service to the maternal and child health. Degree of authority experts involved in the study, expert opinion coordination, the result is credible.

【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R473.71

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