優(yōu)質護理延伸服務在COPD患者居家護理中的開展及研究
發(fā)布時間：2018-11-28 13:21
【摘要】：目的本研究是針對昆山市第六人民醫(yī)院呼吸內科COPD患者出院后的疾病認知情況和延伸服務需求進行調查和臨床分析,結合奧瑞姆自我護理理論和健康促進模式探索并制定適用本轄區(qū)COPD患者經(jīng)住院治療病情穩(wěn)定出院后延續(xù)護理措施和居家護理干預方式,達到提高穩(wěn)定期COPD患者健康自我護理能力,提高這一人群的生活質量,減少疾病復發(fā),降低再住院率的目的方法本研究分為兩個部分,第一部分在參閱文獻和請專家指導的基礎上設計調查問卷,篩選病例對COPD患者出院后疾病認知情況和社區(qū)延伸服務需求調查,分析總結并制定出相應的優(yōu)質護理延伸服務措施。第二部分結合優(yōu)質護理延伸服務理念,以奧瑞姆自我護理理論為指導,根據(jù)本轄區(qū)COPD出院患者的特點按照護理程序制定適宜居家護理干預方式,并組織開展實施和效果評價。結果①COPD患者疾病認知情況和延伸服務需求調查結果：本轄區(qū)COPD患者以老年人居多,文化程度普遍較低,且住在鄉(xiāng)下農(nóng)村居多,出行和行動均不方便、記憶力減退接受能力差、自理能力下降及子女工作繁忙而對老人無暇顧及等諸多問題而導致此類人群疾病認知低,了解自身病情的治療措施和掌握功能鍛煉方法分別為29.2%、17.5%；延伸服務需求調查前三位：用藥指導占94.2%、營養(yǎng)飲食占79.2%、功能鍛煉指導占72.5%。②優(yōu)質護理延伸服務干預結果：兩組患者出院時和出院后3個月6MWT測試結果對比無明顯差異(P0.05),但6個月的結果對比的差異有統(tǒng)計學意義(P0.05)；兩組患者在出院時和出院后3個月呼吸困難程度(MMRC)結果差異不明顯(P0.05),到出院后6個月的呼吸困難評分要顯著低于對照組(P＜0.05)；兩組患者出院時和出院后3個月中文版呼吸問卷調查(CAT)情況對比無明顯差異(P0.05),但6個月的CAT調查結果對比的差異有統(tǒng)計學意義(P0.05)；兩組COPD患者在出院后6個月內的加重次數(shù)的差異和復發(fā)率的差別均有統(tǒng)計學意義(P0.05)。結論①COPD患者優(yōu)質護理延伸服務措施的關鍵是以通俗易懂的方式普及疾病相關知識,已規(guī)范的流程保持定期隨訪,結合評估需求設計并計劃護理活動,從而幫助、協(xié)助患者滿足自護需要。②COPD患者優(yōu)質護理延伸服務措施短期內對患者生活質量的影響不明顯,只有長期追蹤、定期評估的管理能夠從一定程度上幫助出院患者處理COPD癥狀帶來的影響,提高COPD患者的活動耐力和整體健康狀況,改善生活質量。③優(yōu)質護理延伸服務可以使患者6個月內的復發(fā)率顯著降低,但對患者疾病加重的次數(shù)影響不大,長期的影響還有待進一步研究。④優(yōu)質護理延伸服務在COPD患者中的開展實現(xiàn)了對我院現(xiàn)有的優(yōu)質護理服務模式的改進,促進了臨床護理服務領域的拓展,為今后相關方面的研宄提供一定的參考和借鑒。
[Abstract]:Objective to investigate and analyze the disease cognition and extended service demand of COPD patients in Department of Respiratory Medicine of the sixth people's Hospital of Kunshan City. Combined with Orrem's self-care theory and health promotion model, the authors explored and formulated the continuous nursing measures and home nursing intervention methods for COPD patients in their own jurisdiction after their stable condition after hospitalization and discharge from hospital. To improve the ability of health self-care of COPD patients in stable period, to improve the quality of life, to reduce the recurrence of disease and to reduce the rate of rehospitalization this study is divided into two parts. The first part is to design a questionnaire on the basis of consulting the literature and asking for the guidance of experts, to select the patients with COPD after discharge from hospital and to investigate the disease cognition and community extension service demand, and to analyze and summarize the corresponding measures of quality nursing extension service. The second part combined with the concept of quality nursing extension service, with the guidance of Orrem self-care theory, according to the characteristics of patients discharged from COPD in their own area, according to the nursing procedures to formulate appropriate home nursing intervention, and organize the implementation and evaluation of the effect. Results the results of investigation on disease cognition and extended service demand of patients with 1COPD were as follows: the elderly were the majority of COPD patients in their own area, their education level was generally low, and most of them lived in rural areas, their travel and movement were inconvenient, and their memory loss and receptivity were poor. The decline of self-care ability and the busy work of children lead to the low cognition of disease in this kind of population. The treatment measures to understand their illness and the method of mastering the function exercise are 29.2and 17.5respectively. The first three places in the survey of the demand for extended services were as follows: drug use guidance accounted for 94.2%, nutrition and diet accounted for 79.2%, Functional exercise guidance accounted for 72.5.2 quality nursing extended service intervention results: there was no significant difference in 6MWT test results between the two groups at discharge and 3 months after discharge (P0.05). But there was significant difference in the results of 6 months (P0.05). There was no significant difference in the degree of dyspnea between the two groups at discharge and 3 months after discharge (P0.05), and the score of dyspnea at 6 months after discharge was significantly lower than that in the control group (P < 0. 05). There was no significant difference in (CAT) between the two groups at discharge and 3 months after discharge (P0.05), but there was significant difference in the results of 6-month CAT survey (P0.05). Two groups of COPD patients in 6 months after discharge from the times of aggravation and recurrence rate differences were statistically significant (P0.05). Conclusion the key of 1COPD patients' quality nursing extension service is to popularize disease related knowledge in a simple and understandable way, to keep regular follow up, to design and plan nursing activities in combination with needs assessment, so as to help. To assist patients to meet the needs of self-care. 2COPD patients quality care extension service measures in the short term, the impact on the quality of life of patients is not obvious, only long-term follow-up, The management of periodic evaluation can help discharged patients deal with the effects of COPD symptoms to some extent, and improve the activity endurance and overall health status of COPD patients. To improve the quality of life. 3 the quality of nursing extension service can significantly reduce the recurrence rate of patients within 6 months, but it has little effect on the number of exacerbations of patients' diseases. The long-term effect needs to be further studied. (4) the extension of quality nursing service in COPD patients has improved the existing mode of quality nursing service in our hospital and promoted the expansion of the field of clinical nursing service. To provide some reference and reference for the related research in the future.
【學位授予單位】：南京中醫(yī)藥大學
【學位級別】：碩士
【學位授予年份】：2015
【分類號】：R473.2
本文編號：2362935
[Abstract]:Objective to investigate and analyze the disease cognition and extended service demand of COPD patients in Department of Respiratory Medicine of the sixth people's Hospital of Kunshan City. Combined with Orrem's self-care theory and health promotion model, the authors explored and formulated the continuous nursing measures and home nursing intervention methods for COPD patients in their own jurisdiction after their stable condition after hospitalization and discharge from hospital. To improve the ability of health self-care of COPD patients in stable period, to improve the quality of life, to reduce the recurrence of disease and to reduce the rate of rehospitalization this study is divided into two parts. The first part is to design a questionnaire on the basis of consulting the literature and asking for the guidance of experts, to select the patients with COPD after discharge from hospital and to investigate the disease cognition and community extension service demand, and to analyze and summarize the corresponding measures of quality nursing extension service. The second part combined with the concept of quality nursing extension service, with the guidance of Orrem self-care theory, according to the characteristics of patients discharged from COPD in their own area, according to the nursing procedures to formulate appropriate home nursing intervention, and organize the implementation and evaluation of the effect. Results the results of investigation on disease cognition and extended service demand of patients with 1COPD were as follows: the elderly were the majority of COPD patients in their own area, their education level was generally low, and most of them lived in rural areas, their travel and movement were inconvenient, and their memory loss and receptivity were poor. The decline of self-care ability and the busy work of children lead to the low cognition of disease in this kind of population. The treatment measures to understand their illness and the method of mastering the function exercise are 29.2and 17.5respectively. The first three places in the survey of the demand for extended services were as follows: drug use guidance accounted for 94.2%, nutrition and diet accounted for 79.2%, Functional exercise guidance accounted for 72.5.2 quality nursing extended service intervention results: there was no significant difference in 6MWT test results between the two groups at discharge and 3 months after discharge (P0.05). But there was significant difference in the results of 6 months (P0.05). There was no significant difference in the degree of dyspnea between the two groups at discharge and 3 months after discharge (P0.05), and the score of dyspnea at 6 months after discharge was significantly lower than that in the control group (P < 0. 05). There was no significant difference in (CAT) between the two groups at discharge and 3 months after discharge (P0.05), but there was significant difference in the results of 6-month CAT survey (P0.05). Two groups of COPD patients in 6 months after discharge from the times of aggravation and recurrence rate differences were statistically significant (P0.05). Conclusion the key of 1COPD patients' quality nursing extension service is to popularize disease related knowledge in a simple and understandable way, to keep regular follow up, to design and plan nursing activities in combination with needs assessment, so as to help. To assist patients to meet the needs of self-care. 2COPD patients quality care extension service measures in the short term, the impact on the quality of life of patients is not obvious, only long-term follow-up, The management of periodic evaluation can help discharged patients deal with the effects of COPD symptoms to some extent, and improve the activity endurance and overall health status of COPD patients. To improve the quality of life. 3 the quality of nursing extension service can significantly reduce the recurrence rate of patients within 6 months, but it has little effect on the number of exacerbations of patients' diseases. The long-term effect needs to be further studied. (4) the extension of quality nursing service in COPD patients has improved the existing mode of quality nursing service in our hospital and promoted the expansion of the field of clinical nursing service. To provide some reference and reference for the related research in the future.
【學位授予單位】：南京中醫(yī)藥大學
【學位級別】：碩士
【學位授予年份】：2015
【分類號】：R473.2
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