延续性护理模式对重症病毒性脑炎后遗症儿童生存质量影响的研究

发布时间：2018-03-05 21:15

本文选题：病毒性脑炎　切入点：后遗症　出处：《贵州医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:基于家长在重症病毒性脑炎后遗症儿童延续性护理需求的调查基础上,建立了重症病毒性脑炎后遗症儿童的延续性护理模式,并验证该模式的有效性。方法:类实验研究,非同期对照。2015年7月—10月通过自行设计的问卷,采用方便抽样的方法,抽取贵州医科大学附属医院、贵州省人民医院、贵州省儿童医院即将出院的重症病毒性脑炎后遗症患儿家长126例,探讨其延续性护理的需求。2015年10月—12月采取德尔菲法对贵州省6所医院和1所护理院校22名专家开展两轮函询,根据函询结果,最终确立重症病毒性脑炎后遗症儿童的延续性护理模式。将2015年7月—12月于贵州医科大学附属医院就诊的重症病毒性脑炎后遗症患儿及家长44例设为对照组,并实施常规出院护理。将2016年1月—6月于贵州医科大学附属医院就诊的重症病毒性脑炎后遗症患儿及家长设为实验组,并开展延续性护理模式。实验组在出院时、离院1个月、离院3个月分别用儿童生存质量普适性核心量表进行患儿的生存质量本身的评估对比,对照组在出院时、离院1个月、离院3个月分别用儿童生存质量普适性核心量表进行患儿的生存质量本身的评估对比,再将两组患儿不同时期生存质量评分进行效果评价对比,并且实验组分别于出院时、离院3个月进行SVE后遗症儿童家长照护知识问卷评分。采用独立样本t检验、?2检验和Mann-Whitney U秩和检验、配对样本t检验、重复测量方差分析进行数据分析,使用SPSS 22.0软件进行统计分析。结果:(1)通过对126例即将出院的患儿家长进行调查,94%家长希望获得出院延续性护理,在21项延续性护理内容需求中,结果显示家长对延续性护理内容需求有:100.00%家长对精神心理咨询有强烈需求、约96.04%家长对运动功能障碍等并发症指导有需求,此外,患儿家长还对社会支持、日常活动、知识指导、照顾能力方面存在一定需求。家长对延续性护理需求方式占前3位的分别是电话短信占88.12%、门诊复诊占83.17%、网络交流占76.24%,其中家庭访视需求最低。(2)通过两轮函询后,专家积极系数为100%,权威系数(Cr)为0.87,各级指标的协调系数(W)依次为0.324、0.516,且所有的统计检验水准α=0.05。最后确定的延续性护理模式包含4个一级指标和25个二级指标,一级指标条目的评分均数±标准差为3.93±0.86~4.87±0.35;变异系数(CV)为0.07~0.20;满分比为46.67%~86.67%,选择率为73.33%~100.00%。二级指标条目的评分均数±标准差为4.21±0.87~4.94±0.27;变异系数(CV)为0.07~0.22;满分比为40.00%~93.33%,选择率为73.33%~100.00%。(3)实施延续性护理模式方案,两组患儿及家庭基线资料在出院时差异无统计学意义(P0.05),5~7岁和8~12岁实验组与对照组患儿出院时生存质量各维度评分差异无统计学意义(P0.05);5~7岁和8~12岁两组患儿出院时、离院1个月、离院3个月患儿生存质量各维度评分逐渐增加,差异有统计学意义(P0.05),且实验组增长幅度高于对照组(P0.05)。实验组患儿出院时、离院3个月后家庭照护知识得分差异有统计学意义(P0.05)。结论:(1)延续性护理需求的调查是建立延续性护理模式的基础。(2)延续性护理模式的形成的方案具有创新性、针对性,可以为儿科护理提供依据和参考。(3)生存质量的评价反映了重症病毒性脑炎后遗症患儿通过延续性护理模式的实施效果,并且增强了家长对疾病知识的掌握程度,在临床工作中值得推广。
[Abstract]:Objective: Based on the survey of parents based continuous care needs in patients with severe viral encephalitis sequela in children, a continuing nursing mode of severe sequelae of viral encephalitis in children, and verify the validity of the model. Methods: experimental study,.2015 in July October by the self-designed questionnaire of non control over the same period, with convenient sampling method, Guizhou People's Hospital Affiliated Hospital of Guizhou Medical University, extraction, 126 cases of severe viral encephalitis sequelae in children with parents of children's Hospital of Guizhou province to the hospital, to explore the continuity of care needs.2015 in October December by Delphy Fa carried out two rounds consultation in 6 hospitals in Guizhou Province and 1 nursing colleges in 22 experts, according to the letter the final establishment of continuity of care in children with severe viral encephalitis sequela. July 2015 - December in the Affiliated Hospital of Guizhou Medical University Treatment of severe sequelae of viral encephalitis of children and parents in 44 cases as control group, and routine nursing. In January 2016 to June in Guizhou Medical University Affiliated Hospital with severe sequelae of viral encephalitis of children and parents for the experimental group, and carry out continuous nursing mode. In the experimental group when discharged from hospital, 1 a month away from the hospital, 3 months respectively suitable core scale comparative assessment of quality of life for children itself with ordinary children's living quality, the control group at the time of discharge from the hospital, 1 months, 3 months respectively from the hospital of core scale comparative assessment of quality of life of children with itself with ordinary quality the survival of children, the quality of life in different periods in two groups were evaluated and compared the effect, and the experimental group were discharged from the hospital, 3 months for parents of children with sequelae of SVE care knowledge questionnaire score. Using independent sample t test Experiment 2? Mann-Whitney test and U rank sum test, paired samples t test, analysis of variance of repeated measurement data analysis, using SPSS 22 software for statistical analysis. Results: (1) according to a survey of parents of children with 126 cases to be discharged, 94% parents hope to obtain discharge continuity of care, in 21 continuity nursing needs, results showed that the parents of the continuing nursing care content needs: 100% parents have a strong demand for psychological counseling, about 96.04% parents have needs, to guide the movement dysfunction and other complications in addition, parents of social support, daily activities, knowledge guidance, there needs care ability. The parents of the continuation of demand nursing mode of the top 3 were telephone messages accounted for 88.12%, accounted for 83.17% of outpatient visits, network exchange accounted for 76.24%, the family visit demand the lowest. (2) through two rounds of expert consultation, expert product A coefficient of 100%, authority coefficient (Cr) was 0.87, the coordination coefficient of each index (W) were 0.324,0.516, including continuity of care and statistical test level a =0.05. all the final 4 indexes and 25 two level indicators, level indicators to score standard deviation 3.93 + 0.86~4.87 + 0.35; the coefficient of variation (CV) for 0.07~0.20; out than to 46.67%~86.67%, select the rate of 73.33%~100.00%. two level index to score standard deviation was 4.21 + 0.87~4.94 + 0.27; the coefficient of variation (CV) for 0.07~0.22; out of more than 40% ~93.33%, the selectivity of 73.33%~100.00%. (3) implementation continuous nursing mode, two groups of children and families in the baseline data of discharge and no significant difference (P0.05), 5~7 and 8~12 years old experimental group and the control group were all dimensions of quality of life score no significant difference (P0.05); 5~7 and 8~12 At the age of two groups of patients discharged from hospital, 1 months, 3 months away from the hospital in all dimensions of quality of life score gradually increased, the difference was statistically significant (P0.05), and the growth rate of experimental group was higher than the control group (P0.05). In the experimental group when discharged from the hospital after 3 months of family care knowledge scores there was statistical significance (P0.05). Conclusion: (1) survey of extended care needs is the basis of continuous nursing mode. (2) continuous nursing mode scheme for the formation of innovative, targeted, can provide the basis and reference for pediatric nursing. (3) the quality of life evaluation reflects children the sequelae of severe viral encephalitis by the effect of continuous nursing mode, and enhance the parents' mastery of the knowledge of disease, worthy of promotion in clinical work.

【学位授予单位】：贵州医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R473.72

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