护患非语言沟通中触摸的编码及标准化流程构建的研究

发布时间：2018-07-15 22:24

【摘要】：研究目的本研究旨在通过调查术前老年患者能量情绪状态、编码护理人员和患者的触摸体验以及构建触摸技能干预标准化流程,以明确不同科室术前老年患者的特征性的能量情绪状态,帮助患者提高将负性能量转化为正性能量情绪的能力,改善老年患者术前的负性能量情绪状态,促进疾病康复,指导护理人员找到最佳时机进行科学的触摸技能干预,探索触摸与护患沟通的相关性,建立伙伴式合作型建设性护患关系。研究方法1.本研究采用量性研究方法即问卷调查法对第三军医大学第三附属医院120名老年患者进行手术前能量情绪状态的调查;2.本研究运用质性研究方法即观察法、深度访谈及焦点小组访谈相结合,对第三军医大学3所附属医院的18名护士深度访谈及21名患者及家属焦点小组访谈,形成触摸体验的主题编码;3.本研究采用量性研究与质性研究相结合的方法,以人际交往理论和奥兰多的护理程序理论为理论基础,使用Delphi专家函询法构建基于老年患者情绪状态的能量等级模型、针对不同能量能级情绪状态老年患者的触摸干预对策以及护患沟通中触摸技能对术前老年患者情绪调控的标准化干预流程。研究结果1.本研究通过对眼科、骨科及脑外科的老年患者的手术前的能量等级水平、正性负性情绪水平以及焦虑水平进行基线资料的现状调查,结果显示:手术前一天中午,眼科视觉剥夺老年患者的能量情绪状态以悲伤为主要特征,骨科意外跌倒老年患者以痛苦为主要能量情绪状态的特征,脑外科脑出血清醒期老年患者则以压抑为主要特征。2.本研究根据对术前老年患者的能量情绪状态和护患沟通中护理人员应用触摸这一非语言沟通技能的现状,提炼出护患沟通中护理人员与患者触摸体验的9大主题,如表1所示:3.基于术前老年患者的能量情绪现状和护患沟通中触摸体验的9大主题,进一步形成了基于老年患者情绪状态的能量等级模型,横坐标为老年患者术前情绪类型,从左至右依次为消极的情绪类型(悲伤、痛苦、忧郁)、中性的情绪类型(无精打采、被唤醒、中立)、积极的情绪类型(愉快、放松、兴奋);纵坐标为能量等级,从下至上使患者的能量等级逐级提高;在此基础上形成针对不同能量能级情绪状态老年患者的触摸干预对策,使其从消极的情绪状态转化为中性甚至是积极的情绪状态。4.本研究得出护患沟通中护理人员运用触摸这一非语言技能调控术前老年患者负性能量情绪状态的核心标准化流程——“RPNAS”沟通模式:R——建立关系(Relationship):与患者或家属互相介绍,构建和谐的沟通氛围;P——介绍病程(Process):向患者或家属介绍整个病程(现有诊断、病情发展、疾病预后、治疗计划);N——询问意愿(Needs):询问患者与家属的需求与意愿;A——调整需求(Adjustment):进行双方需求调整,努力达成一致;S——构建安全感(Security):治疗方案调整后再次询问患者及家属的其他需求及意愿,构建双方的安全感。5.通过Delphi专家函询,修订了在护患沟通中针对不同疾病类型不同情绪状态的术前老年患者触摸干预的标准化流程。在临床护理工作中,通过运用触摸干预的标准化流程,可有效调控术前老年患者能量情绪状态,使其负性能量情绪转化为积极能量情绪状态,提高患者依从性,促进疾病康复,建立良好的护患关系。结论本研究通过现状调查术前老年患者的能量情绪状态以及质性研究,明确了基于老年患者情绪状态的能量等级模型,应用人际交往理论和奥兰多护理程序理论为理论基础,构建了针对不同能量能级情绪状态老年患者的触摸干预对策以及护患沟通过程中触摸干预的标准化流程——“RPNAS”沟通模式,制订了针对不同疾病类型、不同情绪类型患者的触摸干预核心技能的标准化流程,研究发现中性的触摸特别是被唤醒的触摸是护患双方关系“破冰”的临界点,倡导在临床实践中护理人员科学运用触摸这一非语言沟通技能,有效调控术前老年患者的能量情绪状态,为促进患者疾病康复,建立和谐的护患关系提供了参考依据,值得进一步推广。
[Abstract]:The purpose of this study is to investigate the energy and emotional state of the elderly patients before the operation, to encode the touch experience of the nurses and patients and to construct the standardized process of the touch skill intervention to identify the characteristic energy and emotional state of the elderly patients in different sections of the Department and to help the patients to improve their negative energy into positive energy emotion. The ability to improve the negative energy and emotional state of the elderly patients, promote the rehabilitation of the disease, guide the nursing staff to find the best time to carry out the scientific touch skill intervention, explore the relevance of the communication between the touch and the nurse and the patient, and establish a cooperative and constructive relationship between the patient and the patient. 1. research methods are the quantitative research method, that is, the questionnaire survey The method was used to investigate the energy and emotional state of 120 elderly patients at the Third Affiliated Hospital of Third Military Medical University. The 2. studies used qualitative research methods, such as observation method, deep interview and focus group interview, to interview 18 nurses in 3 affiliated hospitals of Third Military Medical University, and interview 21 patients and family focus group. In the 3. study, a combination of quantitative research and qualitative research is used in the 3. study. Based on the theory of interpersonal communication and the theory of Orlando's nursing procedure, an energy grade model based on the emotional state of the elderly patients is constructed by using the Delphi expert inquiry method. The approach of touch intervention and the standardized intervention process of touch skills on emotional regulation of pre operative elderly patients during the patient communication. Results 1. this study was conducted through the survey of baseline data on the level of energy level, positive negative emotion level and anxiety level before operation in the ophthalmology, Department of orthopedics and Department of cerebral surgery, The results showed that the energy and emotional state of the elderly patients with visual deprivation in the Department of orthopedics were characterized by sadness as the main characteristic of sadness as the main characteristic of the elderly patients in the Department of orthopedics before the operation. The elderly patients in the sober period of cerebral hemorrhage in the Department of cerebral surgery were characterized by depression as the main characteristic.2. based on the ability of the elderly patients before the operation. The status of emotional state and nurse patient communication in the use of touch this non-verbal communication skills, to extract the 9 major themes of the touch experience of nurses and patients, as shown in Table 1: 3. based on the status of the energy and emotion of the elderly patients before the operation and the 9 themes of touch experience in the nurse patient communication, it is further formed on the basis of the old age. The energy level model of the emotional state of the elderly patients, the horizontal coordinate is the emotional type of the elderly patients before the operation, from left to right in turn as negative emotional types (sad, painful, melancholy), neutral emotional types (lethargy, awakened, neutral), positive emotional types (cheerful, relaxed, excited); the ordinate is the energy level, from the bottom to the patient. The level of energy level is improved step by step; on this basis, a touch intervention strategy for elderly patients with different energy levels is formed, which transforms from negative emotional state to neutral or even positive emotional state.4.. This study suggests that nursing staff use touch this nonverbal skill to regulate the negativity of the elderly patients. The core standardization process of energy state of emotion - "RPNAS" communication mode: R - establishing relationship (Relationship): introducing each other with the patient or family, building a harmonious communication atmosphere; P - introduction of the course of disease (Process): introducing the patient or family to the whole course of the disease (now with diagnosis, disease development, disease prognosis, treatment plan); N - inquiring Needs: inquiring the needs and wishes of the patients and their families; A - adjustment requirements (Adjustment): to adjust the needs of both parties and strive to reach agreement; S - build a sense of security (Security): after the adjustment of the treatment plan, the other needs and wishes of the patients and their families are requestioned, and the security.5. of both parties is constructed by the Delphi expert to inquire and amend In the nurse patient communication, the standardized process of touch intervention for the elderly patients with different emotional states and different types of emotional state. In the clinical nursing work, through the use of the standardized process of touch intervention, the energy and emotion state of the elderly patients can be effectively regulated, and the negative performance emotion can be transformed into positive energy state, and the patients can improve the suffering. In this study, the energy level model based on the emotional state of the elderly patients was defined, and the theory of interpersonal communication and Orlando nursing procedure theory were used as the theoretical basis. The touch intervention strategy of the elderly patients with different energy level emotional state and the standardized process of touch intervention during the patient communication process, the "RPNAS" communication model, developed a standardized flow for the core skills of touch intervention for patients with different types of disease and different emotional types, and the study found that neutral touch was especially awakened. The touch is the critical point of the "ice breaking" of the relationship between the two sides. In the clinical practice, it is advocated that the nursing staff should use the non-verbal communication skills to touch the non language communication skills scientifically and effectively regulate the state of the energy and emotion of the elderly patients, and provide reference for the rehabilitation of the patients and the establishment of a harmonious relationship between the patients and the patients.
【学位授予单位】：第三军医大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R47

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