本文選題：數(shù)字減影腦血管造影術(shù)(DSA) + 臨床護(hù)理路徑(CNP)��； 參考：《延邊大學(xué)》2015年碩士論文

【摘要】：目的 研究制定數(shù)字減影腦血管造影術(shù)(DSA)臨床護(hù)理路徑,分析其實施的效果及質(zhì)量,為數(shù)字減影腦血管造影術(shù)臨床路徑的制定、實施和推廣提供參考依據(jù)。方法 本研究屬于類試驗性研究。采用便利抽樣的方法,選取吉林省某市三甲醫(yī)院2013年9月～2014年9月期間進(jìn)行數(shù)字減影腦血管造影術(shù)的患者160例,用隨機(jī)數(shù)字表分為實驗組和對照組。實驗組制定臨床護(hù)理路徑實施診療、護(hù)理流程干預(yù),對照組采用目前臨床所用的常規(guī)的診療、護(hù)理流程進(jìn)行對照。研究工具采用簡化版中國醫(yī)院住院患者體驗與滿意監(jiān)測量表(CHPESM量表)和自行設(shè)計的問卷從臨床指標(biāo)、成本指標(biāo)、服務(wù)指標(biāo)、質(zhì)量評價四個方面比較兩組研究對象進(jìn)行數(shù)字減影腦血管造影術(shù)后的各項指標(biāo)。采用SPSS17.0軟件進(jìn)行統(tǒng)計學(xué)分析,檢驗水準(zhǔn)為α =0.05。結(jié)果(1)實驗組和對照組的研究對象在性別、年齡和文化程度等一般人口學(xué)特征方面的差異均無統(tǒng)計學(xué)意義(P0.05),具有可比性。兩組研究對象干預(yù)前barthe1評分、高血壓病史等疾病特征和健康知識掌握、患者滿意度等指標(biāo)的差異均無統(tǒng)計學(xué)意義(P0.05),具有可比性。(2)實驗組患者進(jìn)行數(shù)字減影腦血管造影術(shù)后的健康知識掌握優(yōu)良率高于對照組,并發(fā)癥、不適癥狀發(fā)生例數(shù)低于對照組,差異有顯著的統(tǒng)計學(xué)意義(P0.01)。實驗組患者的平均住院費用、平均住院日、成本-效益比低于對照組,差異有顯著的統(tǒng)計學(xué)意義(P0.01)。實驗組患者的滿意度高于對照組,差異有顯著的統(tǒng)計學(xué)意義(P0.01)。(3)實驗組患者對臨床護(hù)理路徑的實施效果比較認(rèn)可,對臨床護(hù)理路徑的質(zhì)量評價中得分最高的三個條目依次為增加患者的配合程度及健康知識的掌握、促進(jìn)醫(yī)患溝通、增加患者的滿意度�；颊邔εR床護(hù)理路徑是否束縛醫(yī)護(hù)人員的診療或護(hù)理行為、是否束縛患者的就醫(yī)行為持保守態(tài)度。醫(yī)護(hù)及相關(guān)科室人員對臨床護(hù)理路徑的實施效果比較認(rèn)可,對臨床護(hù)理路徑的質(zhì)量評價中得分最高的三個條目依次為增加患者的滿意度、增加患者的配合程度及健康知識的掌握、促進(jìn)醫(yī)患溝通。對于其減少工作量,增加收入方面持較為否定的態(tài)度。醫(yī)護(hù)及相關(guān)科室人員普遍認(rèn)為臨床護(hù)理路徑的信息化程度相對較低,對臨床護(hù)理路徑的實施是否束縛醫(yī)護(hù)人員的診療或護(hù)理行為的評價較為保守。(4)臨床護(hù)理路徑有15例變異,變異符合帕雷托法則(八二法則),屬于合理范圍。結(jié)論 制定并應(yīng)用數(shù)字減影腦血管造影術(shù)臨床護(hù)理路徑有利于醫(yī)患雙方建立安全便捷的工作流程,降低醫(yī)療成本并提高醫(yī)療護(hù)理服務(wù)質(zhì)量�；颊摺⑨t(yī)護(hù)及相關(guān)科室人員對臨床護(hù)理路徑的實施效果比較認(rèn)可,但需進(jìn)一步加大對臨床護(hù)理路徑的宣傳及信息化力度。本研究可為數(shù)字減影腦血管造影術(shù)制定、實施和推廣臨床路徑提供參考依據(jù),亦有利于持續(xù)優(yōu)化臨床路徑的實施。
[Abstract]:Objective to study the clinical nursing path of digital subtraction cerebrovascular angiography (DSAs), analyze the effect and quality of its implementation, and provide a reference for the establishment, implementation and popularization of digital subtraction cerebrovascular angiography. Methods this study is a kind of experimental study. The convenience sampling method was used to select 160 patients who underwent digital subtraction cerebrovascular angiography from September 2013 to September 2014 in a third Class A Hospital of Jilin Province. The patients were divided into experimental group and control group by random digital table. The experimental group made the clinical nursing path to carry out the diagnosis and treatment, the nursing process intervention, the control group adopted the current clinical routine diagnosis and treatment, the nursing process was compared. A simplified version of the Chinese hospital experience and satisfaction monitoring scale (CHPESM) and a self-designed questionnaire were used to analyze the clinical indicators, cost indicators and service indicators. Four aspects of quality evaluation were compared between the two groups of subjects after digital subtraction cerebral angiography. The SPSS17.0 software was used for statistical analysis, and the test level was 0. 05%. Results 1) there was no significant difference in general demographic characteristics such as sex, age and education level between the experimental group and the control group (P 0.05), which was comparable. Before intervention, barthe1 score, hypertension history and other disease characteristics and health knowledge were mastered in the two groups. There was no significant difference in patients' satisfaction degree (P 0.05), but comparable. 2) the rate of mastering excellent and good health knowledge after digital subtraction cerebrovascular angiography in the experimental group was higher than that in the control group, and the incidence of complications and unwell symptoms was lower than that in the control group. The difference was statistically significant (P 0.01). The average hospitalization cost, average length of stay, cost-benefit ratio of the patients in the experimental group were lower than those in the control group, and the difference was statistically significant (P 0.01). The satisfaction degree of the patients in the experimental group was higher than that in the control group, and the difference was statistically significant. The three items with the highest score in the quality evaluation of clinical nursing path were increasing the cooperation degree of patients and mastering health knowledge, promoting doctor-patient communication and increasing patients' satisfaction. Patients have a conservative attitude on whether the clinical nursing path constrains the diagnosis and treatment or nursing behavior of the medical staff and whether the patient's visit behavior is restrained. The implementation effect of clinical nursing path was recognized by medical staff and related departments. The three items with the highest score in the quality evaluation of clinical nursing path were increasing patients' satisfaction. Increase the cooperation of patients and grasp health knowledge to promote communication between doctors and patients. For its reduced workload, increase income to take a more negative attitude. It is generally believed that the degree of informatization of clinical nursing path is relatively low, and the evaluation of whether the implementation of clinical nursing path constrains the diagnosis, treatment or nursing behavior of medical staff is conservative. 4) there are 15 cases of variation of clinical nursing path. The variation accords with the Pareto rule (Eighty-two rule) and belongs to the reasonable range. Conclusion the establishment and application of the clinical nursing path of digital subtraction cerebrovascular angiography is beneficial to the establishment of safe and convenient working process, the reduction of medical cost and the improvement of the quality of medical and nursing service. The effect of clinical nursing path was recognized by patients, medical and medical staff, but the propaganda and informatization of clinical nursing path should be further strengthened. This study can provide reference for making, implementing and popularizing the clinical pathway of digital subtraction cerebral angiography, and it is also helpful to optimize the implementation of clinical pathway.
【學(xué)位授予單位】：延邊大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R473.74

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