呼吸内科出院患者医院社区一体化延续护理模式构建与应用研究

发布时间：2018-01-27 07:31

  本文关键词： 奥马哈系统 呼吸系统 延续护理 自我管理能力 生存质量 护理满意度　出处：《南京中医药大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的构建出适合我国国情的呼吸内科出院患者医院社区一体化延续护理模式。评价该模式的实施效果,验证该模式的实施能满足呼吸内科出院患者的专业化护理需求。研究方法本研究采用奥马哈问题分类系统作为理论框架,编制出"呼吸内科出院患者护理需求评估表";同时,对150例呼吸内科出院患者的护理需求及出院时所存在的健康问题进行调查。基于前期调查结果及国内外文献,构建呼吸内科出院患者医院社区一体化延续护理服务模式,主要包括3个部分:①三级医院:建立呼吸内科出院患者信息档案,评估出院患者的护理需求及问题,制定延续护理计划,培训及指导社区护士;②三级医院和社区卫生服务中心的衔接:建立QQ交流平台,医院护士将呼吸内科患者的电子信息档案及延续护理计划转介给社区卫生服务中心,社区护士及时反馈进展;③社区卫生服务中心:社区护士及时接收呼吸内科出院患者的电子信息档案及延续护理计划,实施延续护理计划。采用便利抽样法选取2016年2月～2017年1月在南京某三级甲等医院的呼吸内科128例住院患者作为研究对象,将呼吸内科的一区和二区随机分为干预组和对照组,每组各64例出院患者,随访时间为6个月,对照组出院患者接受呼吸内科常规护理,而干预组出院患者则在接受呼吸内科常规护理的基础上,接受呼吸内科出院患者医院社区一体化的延续护理,并分别在呼吸内科患者出院前、出院后1个月、出院后3个月和出院后6个月时,采用自我管理能力测定量表(ESCA)、生存质量调查问卷(SF-36)、自行设计的卫生服务利用调查问卷和护理满意度调查问卷,对两组患者进行效果评价,以评估对呼吸内科出院患者实施医院社区一体化延续护理模式的有效性和可行性。研究结果1.专家咨询结果显示,量表各条目CVI值为0.91～1.00,全部条目平均CVI=0.962,内部一致性Cronbach'α系数为0.949,Guttman分半信度为0.919,同时,重测信度为0.988,符合接受标准。2.呼吸内科出院患者护理需求评估的结果显示,80.7%的呼吸内科出院患者希望在出院后继续获得延续护理;79.3%的患者选择电话随访为服务形式;48.0%的患者希望每2周一次获得延续护理,并希望医院护士(占64.7%)和社区护士(52.0%)能为其提供护理服务;超过半数的(占51.3%)患者愿意支付延续护理的费用,在这些患者中,选择按频次收费的患者占83.12%,收费区间为10-150元。对呼吸内科出院患者进行护理问题的评估,结果显示,在患者出院时,主要存在的护理问题为呼吸(占100%)、健康照顾的督导(占80.7%)、认知(占64.0%)、身体活动(占52.7%)和药物滥用(占51.3%)。3.两组呼吸内科出院患者自我管理能力的组间比较显示,干预前,比较两组患者自我管理能力的总分和各维度得分,结果显示差异无统计学意义(P0.05);干预后,比较两组患者自我管理能力的总分,除出院1个月后,差异不具有统计学意义外(P0.05),出院3个月后和6个月后,差异均具有统计学意义(P0.05);干预后,比较两组患者自我管理能力各维度得分,其中自我管理概念维度、自我责任感维度和自我管理技能维度,在出院1个月后、3个月后和6个月后差异均具有统计学意义(P0.05),而健康知识水平维度在出院1个月后、3个月后和6个月后的差异无统计学意义(P0.05)。4.两组呼吸内科出院患者生存质量的组间比较显示,干预前,比较两组患者生存质量的总分和各维度得分,差异均无统计学意义(P0.05);干预后,比较两组患者生存质量的总分,结果显示出院1个月后、3个月后和6个月后,差异均具有统计学意义(P0.05);干预后,比较两组患者生存质量的各维度得分,结果显示,在出院1个月后,总体健康(GH)、生理功能(PF)、生理职能(RP)、躯体疼痛(BP)、社会功能(SF)、情感职能(RE)、心理健康(MH)的得分的差异有统计学意义(P0.05),而在出院3个月后和6个月后,各维度间的差异均具有统计学意义(P0.05)。5.两组呼吸内科出院患者卫生服务利用的组间比较显示,在干预1个月后、3个月后和6个月后,两组患者访问门诊次数、再入院次数的差异均具有统计学意义(P0.05),而访问社区卫生服务机构、访问急诊次数的差异无统计学意义(P0.05)。6.两组呼吸内科出院患者的住院满意度和社区卫生机构护理满意度的组间比较显示,干预前,两组患者的住院护理满意度评分和对社区卫生机构护理满意的评分之间,差异无统计学意义(P0.05);干预1个月后、3个月后、6个月后,干预组患者对住院护理的满意度和对社区护理的满意度均显著高于对照组(P0.05)。研究结论本研究所构建的呼吸内科出院患者医院社区一体化延续护理模式能够较好的适用于呼吸内科出院患者。通过实施呼吸内科出院患者医院社区一体化延续护理服务,能够有效改善呼吸内科出院患者的自我管理能力及生存质量,使患者的自我管理能力及生存质量达到较高水平,同时,延续护理模式能够有效降低患者访问访问门诊的次数及再入院的次数等卫生服务利用情况,使出院患者对住院时的护理满意度和出院后社区护理的满意度均得到有效地提高。
[Abstract]:Objective to construct the respiratory medicine for the situation of our country patients discharged from hospital community integration continued nursing mode. To evaluate the effect of the model, verify the implementation of the model can meet the discharge of respiratory medicine professional care needs of patients. Methods: This study adopts the Omaha question classification system as the theoretical framework, developed the "nursing of respiratory medicine the needs of the patients evaluation form"; at the same time, to investigate 150 cases of respiratory medicine nursing needs of patients and the existing hospital health problems. The results of preliminary investigation and literature at home and abroad based on the construction of respiratory medicine patients discharged from hospital community integration continue nursing service mode, mainly includes 3 parts: the three stage: the establishment of hospital patients with respiratory medicine information archives hospital, nursing assessment requirements and problems of patients, making continuing nursing plan, training and guidance of community nurses; II Between the three hospitals and community health service center: to establish a QQ communication platform, the hospital nurse will breathe electronic information archives of internal patients and extended care plan referrals to community health service centers, community nurses timely feedback progress; the community health service center: community nurses receive respiratory medicine hospital patients and the continuation of electronic information archives the nursing plan, nursing care plan. With the convenient sampling method from February 2016 to January 2017 in the Department of respiratory medicine in Nanjing from three hospitals in 128 patients as the research object, the respiratory medicine of a region and the two region were randomly divided into intervention group and control group, each group had 64 cases of discharged patients, follow-up time was 6 months, the control group patients received respiratory routine nursing care, while the intervention group patients in Department of Respiratory Medicine received routine nursing, respiratory medicine accepted Continue nursing patients in hospital community integration of the hospital, and were discharged in patients with respiratory medicine before and 1 months after discharge, 3 months after discharge and 6 months after discharge, the determination of the ability of self management scale (ESCA), quality of life questionnaire (SF-36), using questionnaire and nursing satisfaction questionnaire the self-designed health service, evaluation of two groups of patients, to evaluate the effectiveness of implementation of respiratory medicine hospital hospital community integration continued nursing mode and feasibility of patients. The results showed that 1. expert consultation results, scale of each entry CVI value from 0.91 to 1, the average CVI=0.962 of all entries, the internal consistency coefficient of Cronbach'0.949, Guttman split half reliability was 0.919, and the test-retest reliability was 0.988, with medical.2. standard nursing needs of patients with respiratory discharge evaluation results showed that 80.7% of the patients in respiratory department Want to continue to receive continuing nursing care after discharge; 79.3% of the patients selected for telephone follow-up service; 48% of the patients hope once every 2 weeks to get extended care, and hope that the hospital nurses (64.7%) and community nurses (52%) to provide care for their services; more than half (51.3%) were willing to pay for the continuation of the nursing cost in these patients, selected according to the frequency of charges accounted for 83.12% of patients, the toll area is 10-150 yuan. The assessment of respiratory medicine patients were nursing problems. The results show that when the patient was discharged, the main problems for respiratory care (100%), health care supervision (80.7%) cognitive, physical activity (64%), (52.7%) and drug abuse (51.3%) shows that the two group respiratory.3. discharge patients' ability of self-management among groups before intervention, compared two groups of patients self management ability of the total score and scores of each dimension, The results showed no statistically significant difference (P0.05); after the intervention, compared two groups of patients self management ability scores, except for 1 months after discharge, the difference was not statistically significance (P0.05), 3 months after discharge and 6 months later, the differences were statistically significant (P0.05); intervention, comparison two groups of patients self management ability scores, the concept of self management dimension, self responsibility dimensions and self management skills dimensions, in 1 months after discharge, the difference after 3 months and 6 months were statistically significant (P0.05), and the level of health knowledge dimension in 1 months after discharge, no statistically significant difference after 3 months and 6 months later (P0.05), two group comparison showed that the quality of life of patients with respiratory.4. discharge between groups before intervention, compared two groups of patients survival quality score and score of each dimension, the differences were not statistically significant (P0.05); after the intervention between the two groups 鎮ｈ，

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