本文選題：品管圈 + 肝硬化�。� 參考：《山東大學(xué)》2014年碩士論文

【摘要】：目的通過(guò)調(diào)查了解肝硬化患者飲食依從性情況,成立“品管圈”活動(dòng)小組,分析依從性差原因并實(shí)施針對(duì)性措施,開(kāi)展活動(dòng)后再次評(píng)估、比較患者飲食依從性、并發(fā)癥發(fā)生及滿意度有無(wú)差異,進(jìn)而探討“品管圈”質(zhì)量管理工具在提高肝硬化患者飲食依從性中的應(yīng)用效果,為其在護(hù)理質(zhì)量持續(xù)改進(jìn)中應(yīng)用提供依據(jù)及支持。 方法采取方便抽樣方法,抽取2013.2-6月山東某三甲醫(yī)院消化內(nèi)科152例肝硬化患者為對(duì)照組,2013.8-12月同科住院的161例肝硬化患者為觀察組,對(duì)照組實(shí)施常規(guī)飲食護(hù)理,觀察組實(shí)施品管圈持續(xù)質(zhì)量改進(jìn)方法：通過(guò)了解對(duì)照組肝硬化患者飲食依從性現(xiàn)狀,成立“品管圈”活動(dòng)小組,從護(hù)理、患者及管理三個(gè)角度研討,采用頭腦風(fēng)暴法對(duì)肝硬化患者飲食依從性現(xiàn)狀進(jìn)行流程及內(nèi)容分析,以魚(yú)骨圖形式呈現(xiàn)依從性差的主要原因,以此作為持續(xù)護(hù)理質(zhì)量改進(jìn)的切入及關(guān)鍵點(diǎn),針對(duì)現(xiàn)有問(wèn)題采取相應(yīng)措施,根據(jù)患者不同特點(diǎn),通過(guò)圈員間互相協(xié)作制定個(gè)性化飲食健康宣教計(jì)劃,以加強(qiáng)飲食管理、強(qiáng)化完善健康教育資料,改進(jìn)飲食管理流程為主要改善方向,逐一解決影響肝硬化患者飲食依從性的不良因素。采用一般資料問(wèn)卷、依從性問(wèn)卷、滿意度問(wèn)卷等對(duì)患者進(jìn)行調(diào)查,比較兩組患者飲食依從性、并發(fā)癥發(fā)生率及滿意度有無(wú)差異并判定活動(dòng)效果。運(yùn)用SPSS17.0軟件進(jìn)行數(shù)據(jù)錄入與分析,具體包括：描述性統(tǒng)計(jì)分析、t檢驗(yàn)、χ2檢驗(yàn)及秩和檢驗(yàn)等。 結(jié)果共313名患者參與本次研究,其中對(duì)照組152例,觀察組161例,兩組患者在性別、年齡、婚姻、學(xué)歷、職業(yè)、收入等一般資料上均無(wú)統(tǒng)計(jì)學(xué)差異性(P0.05)。具體結(jié)果如下： 1.兩組患者中,對(duì)照組患者飲食依從性好63例(41.45%),一般49例(32.24%),差40例(26.31%)；實(shí)施品管圈活動(dòng)采取針對(duì)性措施后,觀察組患者飲食依從性好94例(58.39%),一般48例(29.81%),差19例(11.80%)。兩組患者之間有明顯統(tǒng)計(jì)學(xué)差異(P0.01),品管圈活動(dòng)開(kāi)展后,肝硬化患者飲食依從性有了明顯提高； 2.對(duì)照組患者8例出現(xiàn)并發(fā)癥,分別為消化道出血14例、肝性腦病2例,電解質(zhì)紊亂2例；觀察組患者2例發(fā)生并發(fā)癥,消化道出血及肝性腦病各1例,兩組患者并發(fā)癥發(fā)生率有顯著差異(P0.05)； 3.兩組患者護(hù)理滿意度比較,對(duì)照組患者總滿意度為91.45%,其中滿意139例,一般10例,不滿意3例；觀察組總滿意度為96.89%,其中滿意156例,一般5例,不滿意0例,品管圈活動(dòng)開(kāi)展有效提高了患者的護(hù)理滿意度(P0.05)。 結(jié)論品管圈質(zhì)量管理工具應(yīng)用可以提高肝硬化患者飲食依從性,減少患者并發(fā)癥的發(fā)生,促進(jìn)疾病康復(fù),提高護(hù)理滿意度。圈員的工作熱情、個(gè)人表達(dá)能力、創(chuàng)造性思維、品管圈手法運(yùn)用及團(tuán)隊(duì)精神在其中也有明顯提高,值得進(jìn)一步推廣。
[Abstract]:Objective to investigate the dietary compliance of patients with liver cirrhosis and set up a "product pipe circle" group to analyze the reasons of poor compliance and implement the targeted measures. After carrying out the activities, the diet compliance, complications and satisfaction were compared, and the quality management tool of "quality control circle" was explored to improve the liver. The application effect of dietary compliance in sclerotic patients provides evidence and support for its application in the continuous improvement of nursing quality.
Methods to take a convenient sampling method, 152 cases of liver cirrhosis in a three a hospital of Shandong, Shandong, were selected as the control group, 161 cases of liver cirrhosis in the same department of the same department were observed in 2013.8-12 month. The control group carried out routine diet nursing, and the observation group implemented the continuous quality improvement method of the product tube circle: through understanding the control group of liver cirrhosis patients The status of dietary compliance was established, and the "product management circle" group was set up, from three perspectives of nursing, patients and management. The flow and content analysis of dietary compliance status of patients with liver cirrhosis was analyzed by brainstorming, and the main reasons for poor compliance were presented in the form of fish bone map, which was the key point for improving the quality of continuous nursing. According to the existing problems, according to the different characteristics of the patients, according to the different characteristics of the patients, the individualized diet health education program is formulated through cooperating with each other, in order to strengthen the diet management, improve the health education data, improve the diet management process as the main improvement direction, and solve the adverse factors of dietary compliance of the patients with liver cirrhosis. The general data questionnaire, the compliance questionnaire, the satisfaction questionnaire and so on were investigated. The dietary compliance of the two groups, the incidence of complications and the satisfaction of the patients were compared. The data were recorded and analyzed by SPSS17.0 software, including descriptive statistical analysis, t test, chi square 2 test and rank sum test.
Results a total of 313 patients were involved in this study, of which 152 cases in the control group and 161 in the observation group. There were no statistical differences between the two groups in gender, age, marriage, education, occupation, and income (P0.05). The results were as follows:
1. of the two groups, the diet compliance of the control group was 63 (41.45%), 49 (32.24%) and 40 (26.31%). After the implementation of the targeted measures, the diet compliance of the patients in the observation group was 94 (58.39%), 48 (29.81%) and 19 (11.80%). There was significant difference between the patients (P0.01) and the activities of the tube circle. After the development, the compliance of patients with cirrhosis increased significantly.
2. patients in the control group had complications in 8 cases, including 14 cases of gastrointestinal bleeding, 2 cases of hepatic encephalopathy, 2 cases of electrolyte disturbance, 2 cases in the observation group, 1 cases of gastrointestinal bleeding and hepatic encephalopathy, and there were significant differences in the incidence of complications in two groups (P0.05).
3. the satisfaction of patients in the two groups was compared. The total satisfaction of the control group was 91.45%, of which 139 cases were satisfactory, 10 cases were general and 3 cases were dissatisfied. The total satisfaction of the observation group was 96.89%, of which 156 cases were satisfactory, the general 5 cases were 5, and 0 cases were dissatisfied. The nursing satisfaction of the patients was improved effectively (P0.05).
Conclusion the application of quality management tools can improve the compliance of the patients with liver cirrhosis, reduce the incidence of complications, promote the rehabilitation of the disease, and improve the satisfaction of nursing. The work enthusiasm, individual expression, creative thinking, management and team spirit of the circle members are also obviously improved, which deserve further promotion.

【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類(lèi)號(hào)】：R473.5

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