以奥马哈系统为框架的延续护理在永久性结肠造口患者中的应用研究

发布时间：2018-07-10 17:45

本文选题：延续护理 + 奥马哈系统　；参考：《蚌埠医学院》2017年硕士论文

【摘要】：目的:应用奥马哈系统对永久性结肠造口患者实施延续护理,归纳患者出院后延续护理问题及干预措施,为提高造口患者自护意愿、自我护理知识、造口自我护理能力,及降低造口并发症提供科学理论及实践指导。方法:选取2016年1月-9月某市三所三甲医院90名永久性结肠造口患者为研究对象,1月-4月为对照组,5月-9月为实验组,每组各45例。对照组给予常规出院指导和随访;实验组在对照组的基础上实施以奥马哈系统为框架的延续护理。通过查阅文献、专家小组讨论,以奥马哈系统为框架,在整体护理理论、马斯洛人类基本需求层次论、自我效能理论指导下,根据永久性结肠造口患者康复特点、《中国肠造口护理指导意见(2013版)》制定永久性结肠造口患者延续护理评估干预评分记录表,研究者通过评估采集实验组患者出院后的护理问题后,造口治疗师对其实施个性化、系统化的延续护理干预措施,并从认知、行为、状况3个方面对延续护理问题效果进行动态评价。使用自我护理意愿问卷、自我护理知识问卷及造口自我护理能力量表评价两组患者在出院时、出院1个月及出院3个月的自我意愿、自我护理知识及自我护理能力得分情况,分析两组患者在出院当天、出院1个月及出院3个月的造口照顾情况和造口并发症的发生率。结果:(1)实验组永久性结肠造口患者出院当天现存的延续护理问题主要分布在心理社会领域3个(35.05%)和健康相关行为领域5个(34.69%),其次是生理领域5个(23.25%),环境领域2个(7.01%)。其中,个人照顾、角色改变、精神健康、消化-水合、睡眠和休息型态、社交、营养的发生率超过50%。(2)实验组永久性结肠造口患者出院当天潜在的护理问题2个,分别是造口并发症和造口周围皮肤并发症。其中造口周围皮肤并发症44个(100%),造口并发症42个(95.5%)。(3)实验组患者出院当天发生率超过30%的延续护理问题进行效果评价分析发现精神健康、社交、角色改变、个人照顾、睡眠和休息型态、营养和消化-水合延续护理问题上的认知、行为、状况3方面评分在延续护理不同阶段差异均有统计学意义(P0.05)。(4)两组患者并发症发生情况在出院当天、出院一个月比较差异无统计学意义(P0.05),而在出院三个月时,两组患者并发症发生情况比较差异有统计学意义(P0.05)。(5)两组患者造口照顾情况和自我护理知识得分在出院当天、出院三个月时比较差异无统计学意义(P0.05),而在出院一个月时,两组患者比较差异有统计学意义(P0.05)。(6)两组患者自我意愿得分和造口自我护理能力得分在出院当天比较差异无统计学意义(P0.05),而在出院一个月时、出院三个月时,两组患者比较差异有统计学意义(P0.05)。结论:(1)奥马哈系统能够对永久性结肠造口患者延续护理问题提供全面评估。(2)奥马哈系统能够对永久性结肠造口患者延续护理问题提供全面的干预指引。(3)以奥马哈系统为框架的延续护理能够改善永久性结肠造口患者主要护理结局,提高永久性结肠造口自护意愿、自我护理知识、自我护理能力得分,降低造口并发症的发生。
[Abstract]:Objective: to use the Omaha system to carry on continuous nursing for patients with permanent colostomy, to sum up the continuous nursing problems and intervention measures after discharge from the hospital, to provide scientific theory and practical guidance for improving self care will, self nursing knowledge, self nursing ability of stomatostomy, and reducing the complications of stoma. Methods: select the -9 month of January 2016. 90 permanent colostomy patients in three third class hospital of three city were studied. In January, the control group was used as the control group and the experimental group in May was the experimental group, with 45 cases in each group. The control group was given the routine discharge guidance and follow-up. The experimental group implemented the continuation nursing with the framework of the Omaha system on the basis of the control group. The Omaha system is the framework. Under the guidance of the holistic nursing theory, the Maslow human basic requirement hierarchy, the self efficacy theory, according to the characteristics of the patients with permanent colostomy, "Chinese enterostomy nursing guidance (2013 Edition) > to establish a permanent colostomy patient's continuous nursing assessment intervention score record table, the researchers are evaluated through the assessment." After collecting the nursing problems after the discharge of the patients in the experimental group, the stoma therapist applied individualized, systematic and continuous nursing intervention, and made a dynamic evaluation of the effect of continuing nursing problems from 3 aspects of cognition, behavior and condition. The self nursing willingness questionnaire, self nursing knowledge questionnaire and self nursing ability scale of stoma were evaluated two. The patients were discharged from hospital for 1 months and 3 months of discharge, self care, self-care knowledge and self-care ability, and the incidence of stoma care and stoma complications of two groups of patients on the day of discharge, 1 months discharged and 3 months discharged from discharge. Results: (1) permanent colostomy patients in the experimental group were discharged on the day of discharge. The problem of continuing care was mainly distributed in 3 (35.05%) and 5 health related fields (34.69%) in the psychosocial field, followed by 5 physiological fields (23.25%) and 2 (7.01%) in the environmental field. Among them, personal care, role change, mental health, digestion - hydration, sleep and rest patterns, social, and nutrition rates exceeded the 50%. (2) experimental group perpetual There were 2 potential nursing problems on the day of discharge from patients with sexual colostomy, which were complications of stoma and skin complications around stoma, including 44 (100%) complications around the stoma, 42 (95.5%) complications of stoma, and (3) the effect evaluation analysis of the patients in the experimental group that had an incidence of more than 30% on the day of discharge and found mental health, Social, role change, personal care, sleep and rest patterns, nutrition and digestive and hydration continuity nursing problems were statistically significant (P0.05) in different stages of continuous nursing (P0.05). (4) there was no significant difference between the two groups in the day of discharge and one month discharge (P0.05 And at three months after discharge, there was a significant difference in the incidence of complications between the two groups (P0.05). (5) the scores of stoma care and self nursing knowledge in the two groups were not statistically significant (P0.05) on the day of discharge and three months after discharge (P), and the difference between the two groups was statistically significant (P) at one month's discharge. 0.05) (6) there was no significant difference between the scores of self will and self nursing ability of the two groups in the day of discharge (P0.05), and the difference between the two groups was statistically significant (P0.05) at the discharge of the hospital for one month and three months after discharge (1) the Omaha system was able to continue the nursing problem for patients with permanent colostomy. Provide comprehensive assessment. (2) the Omaha system can provide comprehensive intervention guidelines for permanent colostomy patients. (3) continuing care based on the framework of the Omaha system can improve the main nursing outcomes of patients with permanent colostomy, improve permanent colostomy self-care willingness, self-care knowledge, and self-care ability Score, reduce the incidence of stoma complications.
【学位授予单位】：蚌埠医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R473.73

【参考文献】