本文關(guān)鍵詞：術(shù)中低體溫護(hù)理干預(yù)行為的現(xiàn)況分析與指導(dǎo)成效評(píng)價(jià)　出處：《新疆醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

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【摘要】：目的:術(shù)中低體溫可引起多種并發(fā)癥,如:術(shù)后寒戰(zhàn)、切口感染率增加及呼吸、心血管系統(tǒng)與凝血功能異常、麻醉蘇醒延遲等,給患者帶來不同程度的危害。有學(xué)者認(rèn)為:護(hù)士在術(shù)中低體溫的預(yù)防工作中起到重要作用。本研究采用知信行模式,運(yùn)用6個(gè)調(diào)查量表:手術(shù)室護(hù)理人員對術(shù)中低體溫護(hù)理干預(yù)的認(rèn)知現(xiàn)狀、自我效能感、安全文化態(tài)度、職業(yè)倦怠、管理現(xiàn)狀與行為現(xiàn)狀量表,以掌握新疆三級(jí)甲等醫(yī)院手術(shù)室護(hù)理人員對術(shù)中低體溫護(hù)理干預(yù)行為現(xiàn)狀及其相關(guān)影響因素,并分析各因素間的相關(guān)關(guān)系。在基線調(diào)查的基礎(chǔ)上,采用多種干預(yù)手段:遠(yuǎn)程網(wǎng)絡(luò)專題知識(shí)講座、播放影像資料、小組式討論、PBL+情境模擬演練的培訓(xùn)方法,對干預(yù)對象進(jìn)行實(shí)驗(yàn)研究。力求從中探索出科學(xué)、可行的培訓(xùn)模式與途徑,向基層醫(yī)院推廣術(shù)中低體溫護(hù)理知識(shí)與技能,以提升新疆手術(shù)室護(hù)理人員的安全服務(wù)理念及護(hù)理能力,落實(shí)并深化手術(shù)室優(yōu)質(zhì)護(hù)理服務(wù),充分保障手術(shù)患者安全。方法:本研究分為兩個(gè)部分。前期為描述性研究,根據(jù)新疆24所三級(jí)甲等醫(yī)院的現(xiàn)狀,考慮新疆地域特點(diǎn),采用分層整群抽樣的方法,將東疆、南疆、北疆及烏魯木齊地區(qū)的不同轄區(qū)、相同等級(jí)的17所醫(yī)院的手術(shù)室護(hù)理人員607名作為研究對象,通過發(fā)放調(diào)查問卷,調(diào)研并分析手術(shù)室護(hù)理人員對術(shù)中患者低體溫護(hù)理干預(yù)的知信行等情況;后期為干預(yù)研究,為期2個(gè)月。研究者自參與現(xiàn)況調(diào)查的17所新疆三級(jí)甲等醫(yī)院中,隨機(jī)選取10所醫(yī)院的手術(shù)室護(hù)理人員作為干預(yù)對象,采用數(shù)字表法將其隨機(jī)分為觀察組和對照組,每組含5所醫(yī)院手術(shù)室,觀察組護(hù)理人員59名,對照組61名;隨機(jī)抽取分別由兩組研究對象護(hù)理、且符合納入標(biāo)準(zhǔn)的手術(shù)患者作為研究對象:觀察組手術(shù)患者122名,對照組手術(shù)患者124名。兩組護(hù)理人員與手術(shù)患者的一般資料、相關(guān)低體溫各量表評(píng)分等均無統(tǒng)計(jì)學(xué)差異。研究者采用遠(yuǎn)程網(wǎng)絡(luò)專題知識(shí)講座、播放影像資料、小組式討論、PBL+情境模擬演練的培訓(xùn)方式,對觀察組進(jìn)行強(qiáng)化干預(yù),對照組則實(shí)施與觀察組同步遠(yuǎn)程網(wǎng)絡(luò)授課。將相關(guān)術(shù)中低體溫知信行各量表的評(píng)分、術(shù)中低體溫發(fā)生率及術(shù)中患者生命體征作為評(píng)價(jià)指標(biāo),比較兩組護(hù)理人員與手術(shù)患者干預(yù)前后的評(píng)價(jià)指標(biāo)與指標(biāo)差值差異有無統(tǒng)計(jì)學(xué)意義。結(jié)果:基線調(diào)查結(jié)果顯示:(1)不同人口學(xué)特征者對術(shù)中低體溫護(hù)理干預(yù)的認(rèn)知現(xiàn)狀、自我效能感、安全文化態(tài)度、職業(yè)倦怠、管理現(xiàn)狀與行為現(xiàn)狀評(píng)分差異有統(tǒng)計(jì)學(xué)意義(P0.05);(2)以行為現(xiàn)狀為因變量,其它5個(gè)因素為自變量,其中認(rèn)知現(xiàn)狀、安全文化態(tài)度、管理現(xiàn)狀納入方程且呈正相關(guān),職業(yè)倦怠與行為現(xiàn)狀呈負(fù)相關(guān)。(3)Pearson相關(guān)性分析結(jié)果表明:6個(gè)因素中,除職業(yè)倦怠僅與行為現(xiàn)狀呈負(fù)相關(guān)關(guān)系外(P0.05),其余各因素間均呈正相關(guān)性;干預(yù)研究結(jié)果顯示:(1)觀察組與對照組護(hù)理人員的認(rèn)知現(xiàn)狀、管理現(xiàn)狀、安全文化態(tài)度與行為現(xiàn)狀評(píng)分差異有統(tǒng)計(jì)學(xué)意義(P0.05),自我效能感與職業(yè)倦怠評(píng)分差異無統(tǒng)計(jì)學(xué)意義(P0.05);(2)觀察組與對照組術(shù)中患者低體溫發(fā)生率差異有統(tǒng)計(jì)學(xué)意義(P0.01);(3)觀察組與對照組術(shù)中患者麻醉后鼻咽溫與肛溫差異無統(tǒng)計(jì)學(xué)意義(P0.05),結(jié)束時(shí)鼻咽溫與肛溫差異有統(tǒng)計(jì)學(xué)意義(P0.05)。(4)觀察組麻醉后與結(jié)束時(shí)鼻咽溫與肛溫差異無統(tǒng)計(jì)學(xué)意義(P0.05);對照組麻醉后與結(jié)束時(shí)鼻咽溫與肛溫差異有統(tǒng)計(jì)學(xué)意義(P0.05),且結(jié)束時(shí)鼻咽溫與肛溫低于麻醉后。(5)觀察組鼻咽溫變化趨勢較對照組平穩(wěn),對照組鼻咽溫自切皮30min驟然下降,維持在35.5℃~36.0℃之間,約于4小時(shí)后下降至35.5℃以下;對照組肛溫變化趨勢較觀察組明顯,自切皮60min持續(xù)下降至35.5℃以下。結(jié)論:護(hù)理人員實(shí)施術(shù)中低體溫護(hù)理干預(yù)行為現(xiàn)狀與認(rèn)知現(xiàn)狀、自我效能感、安全文化態(tài)度、職業(yè)倦怠及管理現(xiàn)狀有關(guān)。為在新疆范圍內(nèi)推廣術(shù)中低體溫的護(hù)理知識(shí)與技術(shù),以提升護(hù)理干預(yù)的執(zhí)行率與質(zhì)量,確保手術(shù)患者安全,研究者考慮到新疆的地域特點(diǎn)、經(jīng)濟(jì)與衛(wèi)生事業(yè)發(fā)展現(xiàn)狀及宗教信仰等因素,運(yùn)用遠(yuǎn)程繼續(xù)教育、播放影像資料、小組式討論的方式,對護(hù)理人員術(shù)中低體溫護(hù)理干預(yù)認(rèn)知與信念情況進(jìn)行干預(yù),采用PBL+情境模擬演練的方法對護(hù)理行為進(jìn)行指導(dǎo),使護(hù)理人員對術(shù)中低體溫的認(rèn)知與信念得以提升,管理與行為現(xiàn)狀有所改善,術(shù)中低體溫的發(fā)生率明顯下降,但護(hù)理人員的自我效能感與職業(yè)倦怠的干預(yù)效果不顯著,需要管理者重點(diǎn)關(guān)注并積極引導(dǎo)。
[Abstract]:Objective: intraoperative hypothermia can cause a variety of complications, such as postoperative shivering, incision infection rate increased and respiratory, cardiovascular system and abnormal coagulation function, delay of recovery, bring harm to the patients. Some scholars think that the nurses in hypothermia prevention plays an important role in the research work. The KAP model, using 6 questionnaires: the cognitive status of nursing staff in operation room of intraoperative hypothermia nursing intervention, self efficacy, safety culture attitude, occupation burnout, status and behavior management scale, to grasp the operation room nurses from three hospitals in Xinjiang the status quo of intraoperative hypothermia nursing intervention the behavior and related effects, and analysis the relationship between the various factors. On the basis of the baseline investigation, using a variety of interventions: remote network special lectures, playing image data, group discussion, P The training method of BL+ simulation exercises, carried out the experimental study on the intervention object. In order to explore the training mode and scientific, feasible way to promote the operation of grass-roots hospital, hypothermia nursing knowledge and skills, to enhance the Xinjiang operation room nursing personnel security service concept and nursing ability, implement and deepen the operation room of high quality nursing service, fully to ensure the safety of surgical patients. Methods: This study is divided into two parts. The descriptive study, according to the current situation of Xinjiang 24 three hospitals, considering the geographical characteristics of Xinjiang, using the method of stratified cluster sampling in different districts, the eastern, northern and Urumqi area, the operation room nurses in 17 hospitals the same grade 607 as the research object, through the questionnaire, investigation and analysis of nursing staff in operation room patients hypothermia nursing intervention KAP etc. Condition; study in the intervention for 2 months. Researchers from the participation status investigation of the 17 Xinjiang three hospitals, 10 hospitals were randomly selected from the operation room nursing staff as intervention objects, using randomly divided into observation group and control group, each group containing 5 operation room hospital observation group of 59 nurses and 61 patients in the control group; randomly selected respectively from two groups of subjects and nursing, patients met the inclusion criteria as the object of study: the observation group of 122 patients, the control group of 124 patients. The general information of the two groups of nursing staff and patients, the related low temperature scale there was no significant difference. The researchers used the remote network special lectures, play videos, group discussion, PBL+ simulation exercise training, to strengthen the intervention in the observation group, the control group and the observation group synchronization implementation The remote network teaching. The intraoperative hypothermia KAP scale score, intraoperative hypothermia incidence rate and intraoperative vital signs of patients as the evaluation index, evaluation index and index difference between two groups were compared before and after nursing and intervention for patients with surgery had no statistical significance. Results: the baseline survey results show that: (1) the cognitive status of different demographic characteristics of intraoperative hypothermia nursing intervention, self efficacy, safety culture attitude, occupation burnout, significant status and behavior management score difference (P0.05); (2) in line for the status as the dependent variable, the other 5 factors as independent variables, cognitive status of the safety culture attitude, management status and included in the equation are positively correlated, negatively related to current situation of occupation burnout and behavior. (3) the Pearson correlation analysis showed that 6 factors, in addition to occupation burnout only negatively correlates with the behavior of Outside (P0.05), the other factors were positive correlation; intervention results show: (1) cognitive status, the observation group and the control group of nursing staff in the management of the status quo, there was statistical significance the present situation of the safety culture attitude and behavior difference score (P0.05), self-efficacy and job burnout score difference was statistically significant (P0.05); (2) the observation group and the control group of patients with low temperature occurrence rate were significant (P0.01); (3) the observation group compared with the nasopharyngeal temperature and rectal temperature after anesthesia group had no statistical significance (P0.05), at the end of nasopharyngeal temperature and rectal temperature difference was statistically significant (P0.05). (4) observation group after anesthesia and at the end of nasopharyngeal temperature and rectal temperature difference was not statistically significant (P0.05); the control group after anesthesia and at the end of nasopharyngeal temperature and rectal temperature difference was statistically significant (P0.05), and at the end of nasopharyngeal and rectal temperature lower than the temperature after anesthesia. The observation group (5) nasopharyngeal temperature The change trend of stable than the control group, the control group from the nasopharyngeal temperature skin incision 30min plummeted, maintained at 35.5 DEG ~36.0 DEG, about 4 hours after the fall to 35.5 degrees below the control group; the change trend of rectal temperature significantly compared with the observation group, after skin incision 60min continued to decline to 35.5 DEG. Conclusion: the implementation of nursing the status quo of intraoperative hypothermia nursing intervention and cognitive behavior status, self-efficacy, attitude about safety culture, and management of occupation burnout status. Nursing knowledge and technique of intraoperative hypothermia in Xinjiang range, in order to perform rate and quality improvement of nursing intervention, to ensure the safety of patients, the researchers considered the geographical features of Xinjiang the status quo, and religious factors such as economic and health development, the use of distance continuing education, play videos, group discussion, the nursing staff of hypothermia nursing intervention and cognitive beliefs Intervention methods PBL+ situation simulation exercises to guide the nursing behavior, the nurses' perceptions and beliefs on hypothermia can be improved, and present management behavior has improved, hypothermia incidence rate decreased significantly, but the nurses' self-efficacy intervention and occupation burnout is not significant, need managers focus on and actively guide.

【學(xué)位授予單位】：新疆醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R472.3

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 張志剛;侯宇穎;張s，

本文編號(hào)：1363291