学龄期急性白血病患儿腰椎穿刺期间护理需求的调查分析

发布时间：2018-01-09 08:28

本文关键词：学龄期急性白血病患儿腰椎穿刺期间护理需求的调查分析　出处：《苏州大学》2016年硕士论文　论文类型：学位论文

【摘要】：目的本课题以患儿自我报告的需求作为关注点,通过对学龄期白血病患儿腰椎穿刺期间护理需求的调查,旨在了解其护理需求现状,深入分析其护理需求的特点及其影响因素,为该类患儿的临床护理实践制定个体化干预措施提供科学依据。方法本研究以人类基本需要层次理论为理论框架,通过概念界定、文献回顾、参考血液病循证指南、半结构访谈、Delphi专家函询等方法初步构建《学龄期AL患儿腰椎穿刺期间护理需求问卷》,该问卷共31个条目,5个维度,分别是信息需求(条目数为10)、沟通需求(条目数为8)、尊重需求(条目数为5)、舒适需求(条目数为4)、自我实现需求(条目数为4)。选取20名不同年龄、性别、疾病类型的腰椎穿刺期间的急性白血病患儿进行预调查,考察问卷的可行性,分析整理结果并对问卷进行相应调整。调查100例急性白血病患儿来检验问卷的信效度,结果显示可靠,最终保留30个条目,并增设一个开放性问题,形成正式问卷。应用此问卷调查240例学龄期AL患儿腰椎穿刺期间的护理需求情况,最后获得216份有效问卷,采用Epidata3.1软件建立数据库,将数据导入SPSS17.0软件对数据进行统计学分析,根据资料的性质和研究目的选择合适的统计方法,主要包括描述性的统计分析、独立样本t检验、方差分析及多元逐步回归分析,P0.05视为有统计学意义,所有P值均为双侧概率。比较不同人口统计学因素及疾病相关因素对AL患儿腰椎穿刺期间护理需求的影响差异性,分析学龄期AL患儿腰椎穿刺期间护理需求的影响因素。结果1、学龄期急性白血病患儿对腰椎穿刺期间护理工作的总体需求得分是124.37±14.27分。五个维度中,需求程度从高到低依次为:信息需求、沟通需求、尊重需求、舒适需求、自我实现需求。2、按患儿对护理需求各单项均值大小进行排序,前五位的需求是“腰穿时尽量减少我的身体暴露”、“护士安慰我、帮我转移注意力,以减轻我的不舒服和紧张”、“床上大小便时,护士为我提供屏风、拉上床帘等”、“护士教我一些放松方法”、“护士考虑我的感受并尽量满足我的要求”。后五位的护理需求依次为“护士告诉我床上进食、大小便的原因及方法”、“护士提前告诉我腰穿可能引起的不舒服”、“护士提前告诉我腰穿时家长不能陪同的原因”、“护士告诉我腰穿的必要性并解释腰穿过程”、“护士带我熟悉做腰穿的房间”。3、将不同特征的学龄期al患儿进行分类比较,比较在不同性别、年龄、出生地、是否独生子女、已完成的最高年级、有无其他病史、疾病类型、腰椎穿刺次数、照顾者、照顾者文化程度、照顾者婚姻状况以及医疗费用支付方式等方面,患儿对腰椎穿刺期间护理需求各维度的差异性,结果显示:在性别、年龄、出生地、是否独生子女、已完成的最高年级、腰椎穿刺次数、照顾者、照顾者文化程度方面,患儿对腰椎穿刺期间的护理需求存在差异,且差异有统计学意义(p0.05)。4、将不同人口学变量进行多重线性回归分析,影响学龄期al患儿对腰椎穿刺护理总体需求的主要因素是腰椎穿刺次数、患儿性别、年龄及照顾者。信息需求层面的的主要影响因素是腰椎穿刺次数和年龄。沟通需求层面的主要影响因素是性别、腰椎穿刺次数、年龄、出生地和照顾者。尊重需求层面的主要影响因素是性别、是否独生子女、患儿已完成的最高年级和照顾者文化程度。舒适需求层面的主要影响因素是性别、腰椎穿刺次数、年龄、照顾者和照顾者文化程度。自我实现需求层面的主要影响因素是患儿年龄、性别和腰椎穿刺次数。5、患儿在开放性问题中提出了“做腰穿时,操作室的人员应该少一些,不希望被很多人围观”、“腰穿时不想看到针头、针筒及血迹之类的东西”、“需要父母在腰穿室内陪伴”等方面的需求。结论1.腰椎穿刺期间学龄期al患儿护理需求多样化,对信息的需求仍是主要的。在腰椎穿刺护理需求的前五位排序中,有3项需求是尊重方面的需求,说明患儿希望医护人员在关注他们疾病的同时,考虑他们的真实感受,尊重并注意保护其隐私,彼此建立相互尊重的平等关系。医院管理者应鼓励护士扩充人文学、心理学方面的知识,尊重患儿,关注与患儿的沟通,真正做到“以人为本,以患儿为中心”。2.影响学龄期AL患儿对腰椎穿刺护理需求的主要因素是腰椎穿刺次数、患儿性别、年龄及照顾者,提示临床医护人员及管理者应加强对这些方面的关注力度。贯彻落实“精准护理”的服务理念,最终提供以需求为导向的个体化护理。3.临床医护人员在关注患儿外在生理状态的同时,应倾听来自患儿内心的声音,采取各种方法满足腰椎穿刺期间患儿的需求,减轻其生理上的不适,降低其焦虑水平,真正提高其腰椎穿刺依从性,最终提高其生活质量。
[Abstract]:The purpose of this subject to self reporting with demand as the focus, through the investigation of the nursing needs of school-age children with leukemia during lumbar puncture, to understand the status of nursing needs, in-depth analysis of the characteristics and influence factors of the nursing needs, provide scientific basis for clinical nursing practice of the children to develop individualized intervention measures. Methods on the hierarchy of needs theory as the theoretical framework, by definition, literature review, reference blood disease evidence-based guidelines, semi-structured interviews, expert consultation method of preliminary construction of Delphi < school-age children with AL during lumbar puncture and nursing needs questionnaire ", the questionnaire included 31 items and 5 dimensions, respectively is the demand of information (number 10), communication (number 8) needs, respect the needs (number of entries is 5), comfort (number of entries is 4), the self realization needs (number 4) selected 20 different. Age, gender, children with acute leukemia during lumbar puncture and the type of disease of the pre survey questionnaire, feasibility study, analysis results and make corresponding adjustments to the questionnaire investigation of 100 cases of children with acute leukemia. To test the reliability and validity of the questionnaire, the results show reliable and ultimately retained 30 items, and the addition of an open-ended question, the formation of a formal questionnaire. This questionnaire applied nursing needs of 240 school-age children with AL during lumbar puncture, finally obtained 216 valid questionnaires, using Epidata3.1 software to establish the database, import data into SPSS17.0 software for statistical analysis of data, according to the nature of the materials and the selection of appropriate statistical methods, including descriptive analysis statistics, independent sample t test, variance analysis and multiple stepwise regression analysis, P0.05 is regarded as statistically significant, all P values were two-sided probability. Comparison of different demographic factors and disease related factors during AL with lumbar puncture effect of nursing demand differences, analysis of school-age children with AL during lumbar puncture effect of nursing demand factors. The results of 1 school-age children with acute leukemia on lumbar puncture during the nursing work of the overall demand score is 124.37 + 14.27. Five dimensions in the demand degree from high to low are: information needs, communication needs, respect needs and comfort needs, self actualization needs.2, according to the sort of nursing needs individual mean value of children, five of the demand is "puncture my body to minimize exposure", "the nurse comforted me, help me to divert attention, to ease my uncomfortable and nervous", "bed size, the nurse offered me a bed screen, pull curtain", "the nurse taught me some relaxation method", "the nurses consider my feeling And try to meet my requirements. Care needs after five are "eating the nurse told me on the bed, because of the size and the method", "the nurse told me in advance of lumbar puncture may cause discomfort", "the nurse told" parents can not accompany me when the puncture nurse told me, "the necessity of lumbar puncture and explain the puncture process", "nurse took me familiar with lumbar puncture room".3, the al of school-age children with different characteristics of classification, comparison in different gender, age, place of birth, whether only child, has completed the most high grade, there is no other history, type of disease, lumbar the number of puncture, caregivers, caregivers who take care of the cultural degree, marital status and payment of medical expenses, with the differences in each dimension of care needs, lumbar puncture during the results showed that: in gender, age, place of birth, whether alone Children, the highest grade completed, lumbar puncture times, caregiver, caregiver education, nursing needs for patients with lumbar puncture during the difference, and the difference was statistically significant (P0.05.4), the different demographic variables analysis of multiple linear regression, the main factors affecting the demand for nursing care of lumbar puncture in general school-age children with Al is the number of children lumbar puncture, gender, age and caregivers. Main factors affecting the level of demand information is lumbar puncture frequency and age. The main influence factors of communication demand level is sex, lumbar puncture times, age, place of birth and caregivers. Respect the main influencing factors of the level of demand is sex. That is only one child, children completed the highest grade and caregiver education. Main factors affecting the comfort level of demand is the gender, age, number of lumbar puncture, caregivers and photos Gu cultural degree of self realization. Main factors affecting the level of demand is in age, gender and the number of lumbar puncture.5, were made in the open problems in lumbar puncture, operating room personnel should be less, do not want to be a lot of people watching "," do not want to see when the puncture needle and needle things like blood "," parents need lumbar puncture in indoor company "and other needs. During the conclusion of the 1. lumbar puncture in children with Al care needs of school-age diversification, the demand for information is still the main. In the top five ranking in the lumbar puncture nursing needs, there are 3 requirements is respect for the demand that children hope that medical personnel in their disease at the same time, consider their true feelings, respect and protect their privacy, to establish mutual relations of equality mutual respect. Hospital managers should encourage nurses to expand humanities, psychology Knowledge, respect for children, and the children's attention to communication, truly "people-oriented, to children as the main factors affecting the.2. center of school-age children with AL of lumbar puncture nursing needs lumbar puncture is the number of children with gender, age and caregivers, medical staff and management should be strengthened in these aspects concern efforts. Implement the" precise care "service concept, to provide the final demand oriented individualized nursing.3. clinical medical personnel in the children with attention external physiological state at the same time, from the children should listen to the voice of the heart, adopt various methods to meet the demand during the children lumbar puncture, relieve physical discomfort, reduce the level of anxiety, really improve the lumbar puncture compliance, and ultimately improve their quality of life.

【学位授予单位】：苏州大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R473.73

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