断指再植术后延续性康复护理方法的研究与应用
发布时间：2019-07-03 12:38
【摘要】：目的制定断指再植患者延续性康复护理指导标准,为断指再植患者的出院指导和手功能康复训练提供科学的规范和流程;建立卫星式断指再植患者出院后复诊联络点,为患者提供就近复诊医院,保证出院后康复训练科学有效;探讨延续性康复护理在断指再植患者中的应用效果,促进断指再植患者手功能康复。方法1.断指再植患者出院指导及分阶段康复训练标准的制定与改进:通过文献筛选和半结构化访谈初步拟定断指再植患者出院指导标准和分阶段康复训练标准的备选方案,邀请15名手外科专家运用德尔菲法经过两轮专家函询最终确定断指再植患者出院指导及分阶段康复训练标准;利用以往在我院手外科进修学习的医生和护士及其所在医疗单位建立全国卫星式断指再植出院患者复诊联络点,便于出院后居住地距离本院较远的患者就近复诊;建立断指再植患者出院随访及复诊数据库。2.临床应用研究:成立延续性康复护理研究小组,将2016年1~6月在我院手外科行断指再植手术的380例患者根据住院号尾数的奇偶分为观察组和对照组,奇数为观察组181例,偶数为对照组199例。在两组患者出院前3天填写出院患者信息调查表,组织出院患者进行出院前指导,建立患者信息数据库,对照组患者出院后自行进行康复训练,定期返院复诊,观察组患者出院后进行延续性康复护理随访干预,电话随访与复诊干预交叉进行,患者出院后2周、2个月、5个月时电话随访,出院后1个月、3个月、6个月时到本院或就近卫星医院复诊联络点进行康复护理干预。对两组患者出院后复诊情况进行比较,并对两组患者出院时、出院后1个月和6个月患者康复依从性、日常生活能力及手功能康复情况进行评定。结果在出院后三次复诊中观察组181例患者有6例出现缺诊情况,复诊率为96.69%,最终获得175例完整数据;对照组199例患者有49例出现缺诊情况,复诊率为75.38%,最终获得150例完整数据;观察组患者复诊率高于对照组(P0.01),差异具有统计学意义。出院时两组患者康复依从性、日常生活能力评分及手功能评分无差异(P0.05),出院后1个月和6个月观察组患者康复依从性、日常生活能力评分和手功能评分优于对照组(P0.05),差异具有统计学意义,且随着出院时间延长,两组患者日常生活能力评分和手功能评分逐渐提高。结论1.延续性康复护理出院指导标准和分阶段康复训练标准为康复指导者和患者提供了科学规范的操作流程,为出院后断指再植患者康复训练提供了保证。2.卫星式断指再植患者复诊联络点为出院患者提供就近复诊医院,对康复训练进行及时的评估与指导,提高了患者康复依从性和科学性,减轻患者经济负担。3.延续性康复护理为出院后断指再植患者提供规范的康复训练标准,提高患者训练依从性,促进手功能尽快恢复,使患者早日回归社会,值得临床推广应用。
[Abstract]:Objective to establish the guidance standard of continuous rehabilitation nursing for patients with replantation of severed finger, to provide scientific norms and procedures for discharge guidance and rehabilitation training of hand function for patients with replantation of severed finger, and to establish a focal point for rediagnosis after discharge of satellite replantation of severed finger, so as to provide patients with a nearby revisit hospital and ensure that rehabilitation training after discharge can be scientific and effective. To explore the application effect of continuous rehabilitation nursing in patients with replantation of severed fingers and to promote the rehabilitation of hand function in patients with replantation of severed fingers. Method 1. The formulation and improvement of discharge guidance and phased rehabilitation training criteria for patients with severed finger replantation: through literature screening and semi-structured interview, the criteria for discharge guidance and phased rehabilitation training for patients with severed finger replantation were preliminarily worked out, and 15 hand surgical experts were invited to determine the discharge guidance and phased rehabilitation training criteria for patients with replantation of severed fingers through two rounds of expert correspondence. Using the doctors and nurses who studied in hand surgery in our hospital in the past and their medical units, a national focal point for the rediagnosis of patients discharged from satellite replantation of severed fingers was established, which was convenient for the patients whose residence was far from our hospital to revisit the hospital after discharge, and to establish a database of follow-up and rediagnosis of patients with replicating severed fingers. 2. Clinical application study: a continuous rehabilitation nursing research group was set up. 380 patients undergoing replantation of severed fingers in our hospital from January to June 2016 were divided into observation group and control group according to the parity of the number of hospitalization numbers. 181 patients in the observation group and 199 patients in the control group were divided into observation group (181 cases) and even number 199 cases (control group). Three days before discharge, the patients in the two groups filled out the information questionnaire, organized the discharged patients to guide them before discharge, and established the patient information database. The patients in the control group were given rehabilitation training after discharge and returned to the hospital regularly for follow-up. The patients in the observation group were followed up by continuous rehabilitation nursing after discharge, and telephone follow-up and follow-up were carried out at 2 weeks, 2 months and 5 months after discharge. One month, three months and six months after discharge, they went to our hospital or the revisit contact point of the nearest satellite hospital to carry out rehabilitation nursing intervention. The revisit of the two groups after discharge was compared, and the rehabilitation compliance, daily living ability and hand function rehabilitation of the two groups were evaluated at 1 month and 6 months after discharge. Results among 181 patients in the observation group, 6 patients had missed diagnosis, the rediagnosis rate was 96.69%, and 175 complete data were finally obtained, while 49 patients in the control group had absence, the rediagnosis rate was 75.38%, and 150 patients in the observation group had complete data. The rediagnosis rate in the observation group was higher than that in the control group (P 0.01), and the difference was statistically significant. There was no significant difference in rehabilitation compliance, ability of daily living score and hand function score between the two groups at discharge (P 0.05). 1 month and 6 months after discharge, the rehabilitation compliance, daily living ability score and hand function score of the observation group were better than those of the control group (P 0.05). The difference was statistically significant. With the prolongation of discharge time, the daily living ability score and hand function score of the two groups increased gradually. Conclusion 1. The continuous rehabilitation nursing discharge guidance standard and the phased rehabilitation training standard provide the scientific and standardized operation flow for the rehabilitation instructor and the patient, and provide the guarantee for the rehabilitation training of the severed finger replicating patients after discharge. 2. Satellite replantation of severed finger can provide the nearest revisit hospital for discharged patients, evaluate and guide the rehabilitation training in time, improve the compliance and science of patients' rehabilitation, and reduce the economic burden of patients. 3. Continuous rehabilitation nursing provides a standard of rehabilitation training for patients with replantation of severed fingers after discharge, improves the compliance of patients' training, promotes the recovery of hand function as soon as possible, and makes patients return to society as soon as possible, which is worth popularizing and applying in clinic.
【学位授予单位】：青岛大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R473.6
本文编号：2509389
[Abstract]:Objective to establish the guidance standard of continuous rehabilitation nursing for patients with replantation of severed finger, to provide scientific norms and procedures for discharge guidance and rehabilitation training of hand function for patients with replantation of severed finger, and to establish a focal point for rediagnosis after discharge of satellite replantation of severed finger, so as to provide patients with a nearby revisit hospital and ensure that rehabilitation training after discharge can be scientific and effective. To explore the application effect of continuous rehabilitation nursing in patients with replantation of severed fingers and to promote the rehabilitation of hand function in patients with replantation of severed fingers. Method 1. The formulation and improvement of discharge guidance and phased rehabilitation training criteria for patients with severed finger replantation: through literature screening and semi-structured interview, the criteria for discharge guidance and phased rehabilitation training for patients with severed finger replantation were preliminarily worked out, and 15 hand surgical experts were invited to determine the discharge guidance and phased rehabilitation training criteria for patients with replantation of severed fingers through two rounds of expert correspondence. Using the doctors and nurses who studied in hand surgery in our hospital in the past and their medical units, a national focal point for the rediagnosis of patients discharged from satellite replantation of severed fingers was established, which was convenient for the patients whose residence was far from our hospital to revisit the hospital after discharge, and to establish a database of follow-up and rediagnosis of patients with replicating severed fingers. 2. Clinical application study: a continuous rehabilitation nursing research group was set up. 380 patients undergoing replantation of severed fingers in our hospital from January to June 2016 were divided into observation group and control group according to the parity of the number of hospitalization numbers. 181 patients in the observation group and 199 patients in the control group were divided into observation group (181 cases) and even number 199 cases (control group). Three days before discharge, the patients in the two groups filled out the information questionnaire, organized the discharged patients to guide them before discharge, and established the patient information database. The patients in the control group were given rehabilitation training after discharge and returned to the hospital regularly for follow-up. The patients in the observation group were followed up by continuous rehabilitation nursing after discharge, and telephone follow-up and follow-up were carried out at 2 weeks, 2 months and 5 months after discharge. One month, three months and six months after discharge, they went to our hospital or the revisit contact point of the nearest satellite hospital to carry out rehabilitation nursing intervention. The revisit of the two groups after discharge was compared, and the rehabilitation compliance, daily living ability and hand function rehabilitation of the two groups were evaluated at 1 month and 6 months after discharge. Results among 181 patients in the observation group, 6 patients had missed diagnosis, the rediagnosis rate was 96.69%, and 175 complete data were finally obtained, while 49 patients in the control group had absence, the rediagnosis rate was 75.38%, and 150 patients in the observation group had complete data. The rediagnosis rate in the observation group was higher than that in the control group (P 0.01), and the difference was statistically significant. There was no significant difference in rehabilitation compliance, ability of daily living score and hand function score between the two groups at discharge (P 0.05). 1 month and 6 months after discharge, the rehabilitation compliance, daily living ability score and hand function score of the observation group were better than those of the control group (P 0.05). The difference was statistically significant. With the prolongation of discharge time, the daily living ability score and hand function score of the two groups increased gradually. Conclusion 1. The continuous rehabilitation nursing discharge guidance standard and the phased rehabilitation training standard provide the scientific and standardized operation flow for the rehabilitation instructor and the patient, and provide the guarantee for the rehabilitation training of the severed finger replicating patients after discharge. 2. Satellite replantation of severed finger can provide the nearest revisit hospital for discharged patients, evaluate and guide the rehabilitation training in time, improve the compliance and science of patients' rehabilitation, and reduce the economic burden of patients. 3. Continuous rehabilitation nursing provides a standard of rehabilitation training for patients with replantation of severed fingers after discharge, improves the compliance of patients' training, promotes the recovery of hand function as soon as possible, and makes patients return to society as soon as possible, which is worth popularizing and applying in clinic.
【学位授予单位】：青岛大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R473.6
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