本文關(guān)鍵詞：上海市老年醫(yī)療護理機構(gòu)腦卒中護理質(zhì)量評價指標體系構(gòu)建　出處：《第二軍醫(yī)大學》2017年碩士論文　論文類型：學位論文

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【摘要】：研究目的:針對上海市老年醫(yī)療護理機構(gòu)腦卒中患者護理現(xiàn)況,構(gòu)建《上海市老年醫(yī)療護理機構(gòu)腦卒中護理質(zhì)量評價指標體系》,并對該質(zhì)量評價指標體系進行臨床驗證研究,以期為提高上海市老年醫(yī)療護理機構(gòu)腦卒中護理質(zhì)量,改善卒中患者結(jié)局,實現(xiàn)醫(yī)療護理資源的高效利用提供依據(jù)。研究方法:在對上海市現(xiàn)有老年護理(醫(yī))院、社區(qū)衛(wèi)生服務中心以及設置老年醫(yī)療護理床位的綜合醫(yī)院三類老年醫(yī)療護理機構(gòu)的腦卒中護理現(xiàn)況調(diào)研的基礎(chǔ)上,以單病種臨床護理路徑為指導,通過循證護理研究,初步構(gòu)建上海市老年醫(yī)療護理機構(gòu)腦卒中護理質(zhì)量評價指標體系;再通過兩輪德爾菲專家咨詢法,確立上海市老年醫(yī)療護理機構(gòu)腦卒中護理質(zhì)量評價指標體系。以上海市老年護理管理質(zhì)量控制中心督查范疇內(nèi)的某老年護理院為試點,對該質(zhì)量評價指標體系進行實證研究,以驗證其臨床有效性和可行性。研究結(jié)果:1、現(xiàn)況調(diào)研表明:目前,在上海市老年醫(yī)療護理機構(gòu)中,老年腦卒中患者呈現(xiàn)高齡化趨勢,80歲以上患者占2015年老年醫(yī)療護理機構(gòu)收治腦卒中患者總數(shù)的55.39%;其中女性患者超過男性,占55.40%;腦卒中患者住院天數(shù)在10~637天之間;各機構(gòu)對腦卒中患者日常生活活動能力評估、神經(jīng)系統(tǒng)功能評估等護理評估的執(zhí)行情況差異較大。2、根據(jù)循證方法,通過系統(tǒng)檢索以及指南質(zhì)量評價,最終納入20篇文獻,包括10篇系統(tǒng)評價、6篇證據(jù)匯總和4篇指南,總結(jié)出腦卒中護理相關(guān)的高級別證據(jù)52條。在此基礎(chǔ)上,課題組結(jié)合前期現(xiàn)況調(diào)研,參考郭燕紅等主編的《腦卒中�？谱o理》,討論形成上海市老年醫(yī)療護理機構(gòu)腦卒中護理質(zhì)量評價指標體系初稿。3、通過2輪德爾菲法專家咨詢,最終構(gòu)建了《上海市老年醫(yī)療護理機構(gòu)腦卒中護理質(zhì)量評價指標體系》,包括指標名稱、指標考核內(nèi)容和考核方法。該指標體系涵蓋腦卒中急性期到康復期護理全程,共29項,同時,附有部分標準操作流程和評估工具。4、實證研究表明,本研究所構(gòu)建的腦卒中護理質(zhì)量評價指標體系臨床適宜可行,有利于指導臨床護理和管理工作。同時,試點機構(gòu)應用表明:借助腦卒中護理質(zhì)量評價指標體系,實施護理質(zhì)量控制,可達到“以評促改”,改善卒中患者的自理能力與肢體功能,患者平均住院天數(shù)由實施前的(98.69±15.72)縮短至實施后的(90.73±12.25)天,差異有統(tǒng)計學意義(p0.05);患者人均住院總費用無統(tǒng)計學差異(p0.05),但實施腦卒中單病種護理質(zhì)控后,患者的日均護理費用由質(zhì)控前的(27.18±4.54)元減少為(25.16±3.68)元,差異有統(tǒng)計學意義(p0.05)。研究結(jié)論:1、本研究通過文獻回顧、現(xiàn)況調(diào)研、循證研究以及專家咨詢構(gòu)建了上海市老年醫(yī)療護理機構(gòu)腦卒中護理質(zhì)量評價指標體系,該質(zhì)量評價指標體系涵蓋腦卒中急性期到康復期護理全程,共29項指標。2、實證研究表明,本研究所構(gòu)建的腦卒中護理質(zhì)量評價指標體系臨床適宜可行,可實施性強,各條目評分區(qū)分度好,有利于指導臨床護理和管理工作。在老年醫(yī)療護理機構(gòu)實施腦卒中單病種護理質(zhì)量控制,可提升腦卒中患者自理能力,改善其肢體功能,減少患者住院天數(shù),降低腦卒中患者護理費用,有效控制護理不良事件及相關(guān)并發(fā)癥的發(fā)生,該質(zhì)量評價體系臨床適宜可行。
[Abstract]:Research purposes: Aiming at the status of the Shanghai city elderly medical care nursing of patients with stroke, "construction of Shanghai city of quality and nursing of elderly health care institutions stroke evaluation index system", and the evaluation index system of the quality of clinical validation studies, in order to improve the medical care institutions of Shanghai City elderly stroke nursing quality, improve patient outcomes stroke, provide the basis for the efficient use of health care resources. Methods: in the nursing for the old Shanghai City Hospital (medical), basic stroke care in research community health service centers and set the elderly health care beds Comprehensive Hospital of three elderly medical care institutions on clinical nursing path for single disease guided by evidence-based nursing research, preliminary construction of Shanghai city of quality nursing care for the elderly medical care institutions stroke evaluation index system; then through two rounds of expert Delphy Consultation, establish the evaluation index system of nursing quality for the elderly health care institutions for stroke in Shanghai city in Shanghai city. The elderly nursing management quality control inspection center of a nursing home for the elderly within the scope of the pilot, the empirical research on the evaluation index system of the quality, in order to verify the validity and feasibility of the clinical research results: 1, the status. Research shows that: at present, in the city of Shanghai elderly health care institutions in elderly patients with stroke is aging, patients over 80 years old in 2015 accounted for elderly health care institutions were 55.39% of the total number of stroke patients; the female patients than male, accounting for 55.40%; brain hospital stay between 10~637 days in patients with stroke; assessment agencies the activities of daily living ability of patients with stroke, neurological function assessment and nursing assessment of the implementation of different.2, according to evidence-based methods, through the retrieval system and guide Quality evaluation, finally 20 articles were included, including 10 systematic reviews, 6 pieces of evidence collection and 4 guide, summed up the nursing of stroke high level of evidence related to the 52. On this basis, combined with the previous research status, referring to Guo Yanhong editor of the "stroke secondary nursing department", to discuss the formation of Shanghai City, the quality of nursing care for the elderly medical care institutions stroke evaluation index system of the draft.3, through 2 rounds of Delphi method, set up "Shanghai city of quality nursing care for the elderly medical care institutions stroke evaluation index system", including the index name index, evaluation content and evaluation methods. The index system covers acute stroke to rehabilitation nursing, a total of 29, at the same time, a part of the standard operating procedures and assessment tools.4, the empirical study shows that the construction of the nursing quality evaluation index system for clinical stroke is feasible and advantageous To guide the clinical nursing and management. At the same time, show that the application of the pilot institutions: with the evaluation index system of nursing quality of cerebral stroke, nursing quality control, can achieve the "assessment and reform", improve the self-care ability of patients with stroke in patients with limb function, the average hospitalization days before the implementation of the (98.69 + 15.72) to shorten the implementation after the (90.73 + 12.25) days, the difference was statistically significant (P0.05); per capita total hospitalization expenses of patients no significant difference (P0.05), but the implementation of single disease nursing quality after stroke, the average daily cost of patients by nursing quality control before (27.18 + 4.54) yuan (25.16 + 3.68) to reduce the yuan. The difference was statistically significant (P0.05). Conclusions: 1 in this study, through literature review, current research, evidence-based research and expert consultation to construct the evaluation index system of nursing quality for the elderly health care institutions for stroke in Shanghai City, the quality evaluation index system To cover the acute stage of stroke rehabilitation nursing course, a total of 29 indicators of.2, the empirical study shows that the construction of the nursing quality evaluation index system for clinical stroke is feasible and easy to implement. Each item is rated partition indexing, to guide the clinical nursing and management. The implementation of the stroke in the elderly the medical care of single disease nursing quality control, enhance self-care ability of patients with stroke, improve the limb function, reduce hospitalization days, reduce the cerebral stroke patients nursing cost, effective control of nursing adverse events and related complications, the quality evaluation system of clinical feasible.

【學位授予單位】：第二軍醫(yī)大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R473.74

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