本文關(guān)鍵詞：助產(chǎn)士特定情況下處方權(quán)內(nèi)容的研究　出處：《山西醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

  更多相關(guān)文章： 助產(chǎn)士 特定情況 處方權(quán) 工作范圍 處方形式

【摘要】：目的:本課題旨在大量文獻(xiàn)查詢的基礎(chǔ)上,參考國外助產(chǎn)士處方權(quán)的情況,結(jié)合我國的實(shí)際情況探討中國助產(chǎn)士在特定情況下開具的處方內(nèi)容及處方形式,探討助產(chǎn)士未來的工作范圍,以期為我國未來制定相關(guān)法律政策提供科學(xué)參考及理論依據(jù)。對(duì)象:本研究的專家入選條件為:(1)副主任醫(yī)師、副主任護(hù)師及以上職稱或相當(dāng)于副高職稱的中級(jí)職稱及以上職稱(2)10年及以上從事本專業(yè)工作經(jīng)驗(yàn)(3)本科及以上學(xué)歷(4)具有嚴(yán)謹(jǐn)求實(shí)的態(tài)度,自愿參與。本研究邀請(qǐng)了省內(nèi)外多所三甲醫(yī)院的從事助產(chǎn)專業(yè)的14名醫(yī)療專家和18名護(hù)理專家進(jìn)行兩輪的專家咨詢。方法:1.文獻(xiàn)調(diào)研法通過大量的國內(nèi)外文獻(xiàn)查閱和信息搜索,初步制定專家咨詢問卷。2.半結(jié)構(gòu)訪談法在查閱大量文獻(xiàn)的基礎(chǔ)上,對(duì)臨床工作者進(jìn)行訪談,吸取意見,通過對(duì)訪談結(jié)果進(jìn)行分析,對(duì)初步制定的專家問卷進(jìn)行修訂,形成第一輪專家咨詢問卷。3.德爾菲法邀請(qǐng)省內(nèi)外多所三甲醫(yī)院的從事助產(chǎn)專業(yè)的14名醫(yī)療專家和18名護(hù)理專家,進(jìn)行兩輪關(guān)于助產(chǎn)士開具處方的特定情況、具體的處方內(nèi)容和處方形式、助產(chǎn)士工作范圍的專家咨詢,并對(duì)咨詢結(jié)果進(jìn)行計(jì)算和統(tǒng)計(jì)分析得出最終研究結(jié)果。4.統(tǒng)計(jì)學(xué)方法采用microsoftexcel數(shù)據(jù)庫和spss22.0統(tǒng)計(jì)軟件對(duì)咨詢結(jié)果進(jìn)行統(tǒng)計(jì)分析,得出指標(biāo)的均數(shù)、變異系數(shù)、標(biāo)準(zhǔn)差,計(jì)算專家認(rèn)同率、專家的積極系數(shù)、權(quán)威系數(shù)和協(xié)調(diào)系數(shù),并運(yùn)用spss22.0對(duì)協(xié)調(diào)系數(shù)進(jìn)行顯著性檢驗(yàn)。結(jié)果:通過兩輪專家咨詢,最終確定了助產(chǎn)士可以開具處方的6種特定情況、在這6種特定情況下可以開具的20個(gè)藥物處方和13個(gè)輔助檢查處方,其中51.5%的藥物和輔助檢查處方傾向于獨(dú)立處方,30.3%的傾向于協(xié)議處方,18.2%的兩種處方形式都接近,以及確定了助產(chǎn)士的17項(xiàng)工作內(nèi)容。具體為助產(chǎn)士可以開具處方的六種特定情況分別為:子宮收縮乏力、子宮收縮過強(qiáng)、產(chǎn)后出血、胎膜早破、正常分娩和新生兒窒息。在這六種特定情況下可以開具的處方內(nèi)容及處方形式為:傾向于獨(dú)立處方形式的是:子宮收縮乏力情況下的5%葡萄糖+維生素c、胎心監(jiān)測(cè);子宮收縮過強(qiáng)情況下的胎心監(jiān)測(cè);產(chǎn)后出血情況下的縮宮素、平衡液、血常規(guī)及凝血功能檢查;胎膜早破情況下的縮宮素、胎心監(jiān)測(cè)、血常規(guī)檢查;正常分娩情況下的利多卡因、縮宮素、維生素k1、胎心監(jiān)測(cè)、b超檢查、心電圖檢查;新生兒窒息情況下的動(dòng)脈血?dú)夥治�、血糖監(jiān)測(cè)。傾向于協(xié)議處方形式的是:子宮收縮乏力情況下的地西泮;子宮收縮過強(qiáng)情況下的硫酸鎂、哌替啶;產(chǎn)后出血情況下的米索前列醇;胎膜早破情況下的抗生素、羊膜腔感染監(jiān)測(cè);正常分娩情況下的哌替啶、胃復(fù)安;新生兒窒息情況下的腎上腺素、納洛酮。兩種處方形式接近的是:子宮收縮乏力情況下的縮宮素、麥角新堿、血液生化檢查;產(chǎn)后出血情況下的麥角新堿、欣母沛、電解質(zhì)檢查。助產(chǎn)士的17項(xiàng)工作內(nèi)容分別是:產(chǎn)前孕期知識(shí)宣教、產(chǎn)前咨詢、產(chǎn)前檢查及監(jiān)測(cè)、孕期營養(yǎng)的管理、孕期不適及保胎的管理;正常分娩的接生、導(dǎo)樂分娩、非藥物性減痛分娩、會(huì)陰側(cè)切及縫合、監(jiān)測(cè)產(chǎn)婦出血情況;觀察產(chǎn)婦傷口及會(huì)陰情況、觀察產(chǎn)婦出血及惡露情況、正常新生兒的照護(hù)、指導(dǎo)產(chǎn)婦科學(xué)哺育、產(chǎn)褥期保健知識(shí)宣教、電話隨訪、產(chǎn)后42天復(fù)查。本研究專家的權(quán)威系數(shù)為0.915;在關(guān)于處方特定情況的咨詢中,兩輪的協(xié)調(diào)系數(shù)分別為0.207和0.489;在工作范圍的咨詢中,兩輪的協(xié)調(diào)系數(shù)分別為0.057和0.131,本研究協(xié)調(diào)系數(shù)均在0-1之間,顯著性檢驗(yàn)P值均小于0.05,本研究專家權(quán)威程度較高,專家意見協(xié)調(diào)性好,結(jié)果可信。結(jié)論:建議給予一定資質(zhì)的助產(chǎn)士在子宮收縮乏力、子宮收縮過強(qiáng)、產(chǎn)后出血、胎膜早破、正常分娩及新生兒窒息這六種情況下的部分處方權(quán),建議國家對(duì)助產(chǎn)士的工作范圍有所界定,以提升助產(chǎn)專業(yè)的自主性及專業(yè)性,壯大助產(chǎn)隊(duì)伍,更好的服務(wù)于母嬰健康。參與此項(xiàng)研究的咨詢專家權(quán)威程度高,專家意見的協(xié)調(diào)性好,結(jié)果可信。
[Abstract]:Objective: the purpose of this study is to search literatures on the reference of foreign midwife prescription right, combined with the actual situation of China to explore the content and form of prescription prescription China midwives in specific cases issued, to investigate the midwife the scope of future work with a view to China's future development of relevant laws and policies provide scientific reference and theoretical basis the object of this study. Expert selection: (1) the deputy chief physician, deputy director of the nurse and above or equivalent to the high title of intermediate and above titles (2) and more than 10 years engaged in the professional work experience (3) Bachelor degree or above (4) has a rigorous and realistic attitude voluntary participation. This study invited experts engaged in midwifery professional 14 medical experts and 18 nursing experts for two more hospitals outside the province. Methods: 1. literature research method through a large number of domestic Foreign literature and information search, preliminary expert consultation questionnaires were made.2. semi-structured interviews based on the literatures, the clinical workers were interviewed, get advice from the interview results, to revise the questionnaire formulated by experts, the formation of the first round of expert consultation questionnaire.3. Delphi invited a number of hospitals inside and outside the province, engaged in professional midwifery of 14 medical experts and 18 nursing experts, two specific prescriptions about midwives, the content of the prescription and prescription of the specific form of expert midwives work scope, and the consultation results are obtained the final research results of.4. statistical methods for statistical analysis of the consultation results using microsoftexcel database and spss22.0 software calculation and statistical analysis, the average number of index variation coefficient, standard deviation calculation, expert recognition rate, The positive coefficient of experts, the authority coefficient and the coordination coefficient, and the use of spss22.0 on the coordination coefficient is statistically significant. Results: through two rounds of expert consultation, and ultimately determine the midwife can 6 special prescriptions, in which 6 specific cases can 20 drug prescribing and 13 auxiliary examination of prescription, which 51.5% of the drugs and prescription prescription auxiliary examination tend to be independent, 30.3% tended to protocol prescription. Two prescription forms are close to 18.2%, and identified 17 work content. The midwife midwife can six special issue at the party were: uterine contraction, uterine contraction is too strong, postpartum hemorrhage, prom, normal delivery and neonatal asphyxia. The content of the prescription and prescription form in these six specific circumstances can be drawn as: the tendency to form independent prescription is: uterine atony. The 5% glucose + vitamin C, fetal heart monitoring; uterine contraction after fetal heart monitoring under the condition of strong; oxytocin, postpartum hemorrhage under the balance of fluid, blood and coagulation function test; premature rupture of membranes under the condition of oxytocin, fetal heart monitoring, blood routine examination; lidocaine under normal delivery, oxytocin, vitamin K1, fetal heart monitoring, B Ultrasound examination, electrocardiogram examination; blood glucose monitoring of arterial blood gas analysis, neonatal asphyxia. The tendency to agreement prescription form is: under the condition of weak uterine contraction diazepam; uterine contraction in the case of excessive Magnesium Sulfate, pethidine; postpartum hemorrhage. Misoprostol; premature rupture of membranes under the condition of antibiotics, amniotic cavity infection monitoring; normal delivery in case of pethidine, metoclopramide; neonatal asphyxia by epinephrine, naloxone. Two kinds of prescription form approach is: uterine atony situation Under the conditions of oxytocin, ergometrine, blood biochemical examination; postpartum hemorrhage of ergonovine, hemabate, electrolyte examination. 17 work contents are: midwives prenatal education during pregnancy, prenatal counseling, prenatal examination and pregnancy monitoring, nutrition management, pregnancy discomfort and miscarriage management; normal delivery the birth of Doula delivery, non drug pain relief delivery, perineal side incision and suture, monitoring maternal bleeding; maternal and perineal wound observation, observation of maternal hemorrhage and lochia, normal neonatal care, maternal guidance of scientific feeding, postpartum health education, telephone follow-up at 42 days after delivery. The coefficient of authority the expert is 0.915; in particular about prescription consultation, coordination coefficient of the two rounds were 0.207 and 0.489; the scope of work in consultation, coordination coefficient of the two rounds were 0.057 and 0.131, the Study on the coordination coefficient between 0-1, P significant test values were less than 0.05, the expert authority degree, expert opinion coordination, the result is credible. Conclusion: weak contraction proposal to give certain qualified midwives in the uterus, uterine contraction is too strong, postpartum hemorrhage, premature rupture of fetal membrane, normal delivery and neonatal asphyxia some prescription rights under the six conditions, the midwife's scope of work suggested that the state has been defined, in order to enhance the autonomy of professional midwifery and professional team, strengthen midwifery, better service to the maternal and child health. Degree of authority experts involved in the study, expert opinion coordination, the result is credible.

【學(xué)位授予單位】：山西醫(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)】：R473.71

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 尹雪燕;溫肇霞;陸連芳;于鵬;張凡;袁玉艷;;傷口/造口�？谱o(hù)士核心能力評(píng)價(jià)指標(biāo)體系的構(gòu)建研究[J];中國護(hù)理管理;2016年10期

2 陳彥麗;李紅雨;;英國助產(chǎn)士的教育和助產(chǎn)模式對(duì)我國產(chǎn)科護(hù)理發(fā)展的啟示[J];護(hù)理管理雜志;2016年07期

3 時(shí)春艷;丁秀萍;張夢(mèng)瑩;楊慧霞;;羊水栓塞的早期識(shí)別和團(tuán)隊(duì)流程化搶救[J];中華婦產(chǎn)科雜志;2016年05期

4 程莉敏;;淺談新時(shí)期護(hù)理教育的現(xiàn)狀研究[J];科技視界;2016年10期

5 吳麗萍;趙紅;姜梅;鄧寒羽;付玉惠;李玉玲;梁濤;陳京立;;我國助產(chǎn)士培養(yǎng)的現(xiàn)狀分析[J];中華護(hù)理教育;2016年03期

6 韋余東;張人杰;張新衛(wèi);王臻;劉碧瑤;李娜;張雙鳳;;應(yīng)用德爾菲法構(gòu)建疾控機(jī)構(gòu)應(yīng)急能力評(píng)價(jià)指標(biāo)體系[J];浙江預(yù)防醫(yī)學(xué);2016年01期

7 楊莘;典慧娟;;病房護(hù)理崗位人崗匹配評(píng)價(jià)指標(biāo)體系的研究[J];中華護(hù)理雜志;2016年01期

8 費(fèi)秀珍;王虎峰;呂訥男;;我國助產(chǎn)士專業(yè)體系現(xiàn)狀分析[J];中國衛(wèi)生標(biāo)準(zhǔn)管理;2015年24期

9 王彥;許虹;;國內(nèi)外助產(chǎn)專業(yè)教育及注冊(cè)現(xiàn)狀[J];中國婦幼保健;2015年11期

10 費(fèi)秀珍;田寶朋;王虎峰;呂訥男;趙玫;;我國助產(chǎn)士崗位任務(wù)及任職資格的探討[J];中華醫(yī)院管理雜志;2015年03期

相關(guān)碩士學(xué)位論文 前3條

1 楊葉青;腫瘤�？谱o(hù)士特定情況下處方內(nèi)容的研究[D];山西醫(yī)科大學(xué);2012年

2 李幸;我國護(hù)士處方權(quán)實(shí)施的促進(jìn)因素的研究[D];山西醫(yī)科大學(xué);2011年

3 韓慧慧;臨床護(hù)士特定情況下藥物處方權(quán)內(nèi)容的確定[D];山西醫(yī)科大學(xué);2011年

，

本文編號(hào)：1376364