住院患者规范化压疮护理体系的构建

发布时间：2018-06-11 10:10

本文选题：压疮 + 压力性损伤　；参考：《天津医科大学》2017年硕士论文

【摘要】：目的:1.通过检索和查阅大量国内外有关压疮的文献和指南,了解压疮评估、预防、处理和管理现状,为建立住院患者规范化压疮护理体系提供依据。2.根据国情,构建一套科学、系统、全面的住院患者规范化压疮护理体系,为护理实践者和护理管理者提供压疮评估、预防、处理、管理等各方面的参考依据。方法:1.制定检索式,计算机检索PubMed、Cochrane library、EMbase、BMJ、EBSCO、中国生物医学文献数据库(CBM)、中国知网、万方等数据库,在指南网站National Guideline Clearinghouse(NGC)中检索相关指南,检索时限为2006年至2015年。通过阅读摘要和全文筛选出符合纳入标准的文献,使用澳大利亚JBI循证卫生保健中心2010年版证据分级系统对其评估分级,并从中提取资料,经专家小组讨论和分析,最终形成住院患者规范化压疮护理体系的初稿。2.应用德尔菲法通过两轮专家函询,对一级条目和二级条目的重要性进行评价,对三级条目的重要性和可操作性进行评价,经过分析和讨论对条目进行修改、增加和删除,最终确立住院患者规范化压疮护理体系。结果:1.基于循证得到住院患者规范化压疮护理体系的初稿,包括4个一级条目、19个二级条目和79个三级条目,主要涉及压疮的风险评估、预防、处理和压疮的管理等内容。2.两轮函询的问卷有效回收率分别是93.75%、100%,提出修改意见的专家比率分别为83.33%、16.67%;两轮专家函询的权威系数分别为0.91、0.92;两轮专家意见的重要性协调系数为0.251~0.465(P0.05),可操作性协调系数分别为0.235、0.452(P0.05)。3.第一轮专家函询一级条目重要性得分均值为4.43~4.93,变异系数为0.06~0.16,二级条目重要性得分均值为4.13~4.80,变异系数为0.09~0.17,三级条目的重要性得分均值为3.50~4.83,变异系数为0.09~0.34,可操作性得分均值为3.20~4.83,变异系数为0.08~0.32。4.第二轮函询一级条目重要性得分均值为4.60~5.00,变异系数为0.00~0.15,二级条目重要性得分均值为4.33~4.87,变异系数为0.07~0.16,三级条目的重要性得分均值为4.27~4.97,变异系数为0.04~0.17,可操作性得分均值为4.07~4.97,变异系数为0.04~0.23。5.经过两轮专家函询,对问卷结果进行统计学分析,根据专家小组的讨论后,一级条目仍是4个条目,二级条目修改2项、增加3项,三级条目修改9项、删除1项、增加7项。最终形成包含4个一级条目,23个二级条目和85个三级条目的住院患者规范化压疮护理体系。结论:本研究基于循证、应用德尔菲法最终构建了一套包括4个一级条目,23个二级条目和85个三级条目的住院患者压疮护理体系,涵盖压疮的风险评估、预防、处理和管理等四个方面的内容,为护理实践者提供科学、规范的压疮护理依据,为护理管理者规范压疮管理提供指导。
[Abstract]:Purpose 1. Through searching and consulting a lot of literature and guidebooks about pressure sore at home and abroad, we can understand the present situation of pressure sore evaluation, prevention, treatment and management, and provide the basis for establishing standardized nursing system of pressure sore for inpatients. According to the national conditions, a set of scientific, systematic and comprehensive nursing system for in-patients with pressure sores was set up to provide reference basis for nursing practitioners and nursing administrators to evaluate, prevent, deal with and manage pressure sores. Method 1: 1. A computer search method was developed for online search of PubMeden Cochrane library- EMbase BMJJ Besco, China Biomedical Literature Database (CBMU), China Zhiwang, Wanfang and other databases. The relevant guidelines were searched on the National Guideline Clearinghouse NGC website for the period from 2006 to 2015. The literature that meets the inclusion criteria is screened out by reading the abstracts and the full text. It is assessed and graded using the evidence classification system of the 2010 edition of the JBI Evidence-Based Health Care Centre in Australia, from which information is extracted and discussed and analysed by the expert group. In the end, the first draft. 2. 2 of the standardized nursing system of pressure sore for inpatients was formed. Through two rounds of expert letters, Delphi method is used to evaluate the importance of the first and second level items, to evaluate the importance and operability of the third level entries, and to modify, add and delete the items through analysis and discussion. Finally, a standardized nursing system for patients with pressure sore was established. The result is 1: 1. Based on the evidence, the first draft of the standardized nursing system for the hospitalized patients was obtained, including 4 first-level items, 19 second-order items and 79 third-level items, which mainly involved the risk assessment, prevention, treatment and management of pressure sores. The effective recovery rate of the two rounds of questionnaires was 93.75 / 100, and the expert ratio of the revised opinions was 83.33 and 16.67, respectively; the authoritative coefficient of the two rounds of expert letters was 0.91and 0.92respectively; the coordination coefficient of the importance of the two rounds of expert opinions was 0.251 / 0.465nP0.05and the operational coordination coefficient was 0.2350.452P0.05. In the first round of expert letter, the mean value of the importance of the first item is 4.43 / 4.93, the coefficient of variation is 0.06 / 0.16, the mean value of the second level item is 4.134.80, the coefficient of variation is 0.09 / 0.17, the mean value of the importance of the third level item is 3.504.83 and the coefficient of variation is 0.09 / 0.34. The mean score was 3.20 and 4.83, and the coefficient of variation was 0.08 and 0.32.4respectively. In the second round, the mean value of the importance of the first item was 4.60 / 5.00, the coefficient of variation was 0.000.15, the mean of the importance of the second level was 4.330.87, the coefficient of variation was 0.07 / 0.16, the mean value of the importance of the third level was 4.27 / 4.97, the coefficient of variation was 0.04 / 0.17, and the operational scores were all. The coefficient of variation was 0.04 ~ 0.23.5. After two rounds of expert letters, the results of the questionnaire were statistically analyzed. According to the discussion of the expert group, the first level item is still 4 items, the second level item is modified 2 items, the addition is 3 items, the third level item is revised 9 items, the deletion item is 1 item, increases 7 items. Finally, a standardized nursing system for patients with pressure sore was formed, which included 4 first grade items, 23 second grade items and 85 third grade items. Conclusion: based on the evidence-based method, the author finally constructed a nursing system for patients with bedsore, including 4 grade 1 items, 23 2 items and 85 3 items, covering the risk assessment and prevention of pressure sores. The four aspects of treatment and management provide scientific and standardized nursing basis for nursing practitioners and provide guidance for nursing managers to regulate the management of pressure sore.
【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R472

【参考文献】