本文選題：病毒性腦炎　切入點(diǎn)：后遺癥　出處：《貴州醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:基于家長(zhǎng)在重癥病毒性腦炎后遺癥兒童延續(xù)性護(hù)理需求的調(diào)查基礎(chǔ)上,建立了重癥病毒性腦炎后遺癥兒童的延續(xù)性護(hù)理模式,并驗(yàn)證該模式的有效性。方法:類實(shí)驗(yàn)研究,非同期對(duì)照。2015年7月—10月通過自行設(shè)計(jì)的問卷,采用方便抽樣的方法,抽取貴州醫(yī)科大學(xué)附屬醫(yī)院、貴州省人民醫(yī)院、貴州省兒童醫(yī)院即將出院的重癥病毒性腦炎后遺癥患兒家長(zhǎng)126例,探討其延續(xù)性護(hù)理的需求。2015年10月—12月采取德爾菲法對(duì)貴州省6所醫(yī)院和1所護(hù)理院校22名專家開展兩輪函詢,根據(jù)函詢結(jié)果,最終確立重癥病毒性腦炎后遺癥兒童的延續(xù)性護(hù)理模式。將2015年7月—12月于貴州醫(yī)科大學(xué)附屬醫(yī)院就診的重癥病毒性腦炎后遺癥患兒及家長(zhǎng)44例設(shè)為對(duì)照組,并實(shí)施常規(guī)出院護(hù)理。將2016年1月—6月于貴州醫(yī)科大學(xué)附屬醫(yī)院就診的重癥病毒性腦炎后遺癥患兒及家長(zhǎng)設(shè)為實(shí)驗(yàn)組,并開展延續(xù)性護(hù)理模式。實(shí)驗(yàn)組在出院時(shí)、離院1個(gè)月、離院3個(gè)月分別用兒童生存質(zhì)量普適性核心量表進(jìn)行患兒的生存質(zhì)量本身的評(píng)估對(duì)比,對(duì)照組在出院時(shí)、離院1個(gè)月、離院3個(gè)月分別用兒童生存質(zhì)量普適性核心量表進(jìn)行患兒的生存質(zhì)量本身的評(píng)估對(duì)比,再將兩組患兒不同時(shí)期生存質(zhì)量評(píng)分進(jìn)行效果評(píng)價(jià)對(duì)比,并且實(shí)驗(yàn)組分別于出院時(shí)、離院3個(gè)月進(jìn)行SVE后遺癥兒童家長(zhǎng)照護(hù)知識(shí)問卷評(píng)分。采用獨(dú)立樣本t檢驗(yàn)、?2檢驗(yàn)和Mann-Whitney U秩和檢驗(yàn)、配對(duì)樣本t檢驗(yàn)、重復(fù)測(cè)量方差分析進(jìn)行數(shù)據(jù)分析,使用SPSS 22.0軟件進(jìn)行統(tǒng)計(jì)分析。結(jié)果:(1)通過對(duì)126例即將出院的患兒家長(zhǎng)進(jìn)行調(diào)查,94%家長(zhǎng)希望獲得出院延續(xù)性護(hù)理,在21項(xiàng)延續(xù)性護(hù)理內(nèi)容需求中,結(jié)果顯示家長(zhǎng)對(duì)延續(xù)性護(hù)理內(nèi)容需求有:100.00%家長(zhǎng)對(duì)精神心理咨詢有強(qiáng)烈需求、約96.04%家長(zhǎng)對(duì)運(yùn)動(dòng)功能障礙等并發(fā)癥指導(dǎo)有需求,此外,患兒家長(zhǎng)還對(duì)社會(huì)支持、日�；顒�(dòng)、知識(shí)指導(dǎo)、照顧能力方面存在一定需求。家長(zhǎng)對(duì)延續(xù)性護(hù)理需求方式占前3位的分別是電話短信占88.12%、門診復(fù)診占83.17%、網(wǎng)絡(luò)交流占76.24%,其中家庭訪視需求最低。(2)通過兩輪函詢后,專家積極系數(shù)為100%,權(quán)威系數(shù)(Cr)為0.87,各級(jí)指標(biāo)的協(xié)調(diào)系數(shù)(W)依次為0.324、0.516,且所有的統(tǒng)計(jì)檢驗(yàn)水準(zhǔn)α=0.05。最后確定的延續(xù)性護(hù)理模式包含4個(gè)一級(jí)指標(biāo)和25個(gè)二級(jí)指標(biāo),一級(jí)指標(biāo)條目的評(píng)分均數(shù)±標(biāo)準(zhǔn)差為3.93±0.86~4.87±0.35;變異系數(shù)(CV)為0.07~0.20;滿分比為46.67%~86.67%,選擇率為73.33%~100.00%。二級(jí)指標(biāo)條目的評(píng)分均數(shù)±標(biāo)準(zhǔn)差為4.21±0.87~4.94±0.27;變異系數(shù)(CV)為0.07~0.22;滿分比為40.00%~93.33%,選擇率為73.33%~100.00%。(3)實(shí)施延續(xù)性護(hù)理模式方案,兩組患兒及家庭基線資料在出院時(shí)差異無統(tǒng)計(jì)學(xué)意義(P0.05),5~7歲和8~12歲實(shí)驗(yàn)組與對(duì)照組患兒出院時(shí)生存質(zhì)量各維度評(píng)分差異無統(tǒng)計(jì)學(xué)意義(P0.05);5~7歲和8~12歲兩組患兒出院時(shí)、離院1個(gè)月、離院3個(gè)月患兒生存質(zhì)量各維度評(píng)分逐漸增加,差異有統(tǒng)計(jì)學(xué)意義(P0.05),且實(shí)驗(yàn)組增長(zhǎng)幅度高于對(duì)照組(P0.05)。實(shí)驗(yàn)組患兒出院時(shí)、離院3個(gè)月后家庭照護(hù)知識(shí)得分差異有統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論:(1)延續(xù)性護(hù)理需求的調(diào)查是建立延續(xù)性護(hù)理模式的基礎(chǔ)。(2)延續(xù)性護(hù)理模式的形成的方案具有創(chuàng)新性、針對(duì)性,可以為兒科護(hù)理提供依據(jù)和參考。(3)生存質(zhì)量的評(píng)價(jià)反映了重癥病毒性腦炎后遺癥患兒通過延續(xù)性護(hù)理模式的實(shí)施效果,并且增強(qiáng)了家長(zhǎng)對(duì)疾病知識(shí)的掌握程度,在臨床工作中值得推廣。
[Abstract]:Objective: Based on the survey of parents based continuous care needs in patients with severe viral encephalitis sequela in children, a continuing nursing mode of severe sequelae of viral encephalitis in children, and verify the validity of the model. Methods: experimental study,.2015 in July October by the self-designed questionnaire of non control over the same period, with convenient sampling method, Guizhou People's Hospital Affiliated Hospital of Guizhou Medical University, extraction, 126 cases of severe viral encephalitis sequelae in children with parents of children's Hospital of Guizhou province to the hospital, to explore the continuity of care needs.2015 in October December by Delphy Fa carried out two rounds consultation in 6 hospitals in Guizhou Province and 1 nursing colleges in 22 experts, according to the letter the final establishment of continuity of care in children with severe viral encephalitis sequela. July 2015 - December in the Affiliated Hospital of Guizhou Medical University Treatment of severe sequelae of viral encephalitis of children and parents in 44 cases as control group, and routine nursing. In January 2016 to June in Guizhou Medical University Affiliated Hospital with severe sequelae of viral encephalitis of children and parents for the experimental group, and carry out continuous nursing mode. In the experimental group when discharged from hospital, 1 a month away from the hospital, 3 months respectively suitable core scale comparative assessment of quality of life for children itself with ordinary children's living quality, the control group at the time of discharge from the hospital, 1 months, 3 months respectively from the hospital of core scale comparative assessment of quality of life of children with itself with ordinary quality the survival of children, the quality of life in different periods in two groups were evaluated and compared the effect, and the experimental group were discharged from the hospital, 3 months for parents of children with sequelae of SVE care knowledge questionnaire score. Using independent sample t test Experiment 2? Mann-Whitney test and U rank sum test, paired samples t test, analysis of variance of repeated measurement data analysis, using SPSS 22 software for statistical analysis. Results: (1) according to a survey of parents of children with 126 cases to be discharged, 94% parents hope to obtain discharge continuity of care, in 21 continuity nursing needs, results showed that the parents of the continuing nursing care content needs: 100% parents have a strong demand for psychological counseling, about 96.04% parents have needs, to guide the movement dysfunction and other complications in addition, parents of social support, daily activities, knowledge guidance, there needs care ability. The parents of the continuation of demand nursing mode of the top 3 were telephone messages accounted for 88.12%, accounted for 83.17% of outpatient visits, network exchange accounted for 76.24%, the family visit demand the lowest. (2) through two rounds of expert consultation, expert product A coefficient of 100%, authority coefficient (Cr) was 0.87, the coordination coefficient of each index (W) were 0.324,0.516, including continuity of care and statistical test level a =0.05. all the final 4 indexes and 25 two level indicators, level indicators to score standard deviation 3.93 + 0.86~4.87 + 0.35; the coefficient of variation (CV) for 0.07~0.20; out than to 46.67%~86.67%, select the rate of 73.33%~100.00%. two level index to score standard deviation was 4.21 + 0.87~4.94 + 0.27; the coefficient of variation (CV) for 0.07~0.22; out of more than 40% ~93.33%, the selectivity of 73.33%~100.00%. (3) implementation continuous nursing mode, two groups of children and families in the baseline data of discharge and no significant difference (P0.05), 5~7 and 8~12 years old experimental group and the control group were all dimensions of quality of life score no significant difference (P0.05); 5~7 and 8~12 At the age of two groups of patients discharged from hospital, 1 months, 3 months away from the hospital in all dimensions of quality of life score gradually increased, the difference was statistically significant (P0.05), and the growth rate of experimental group was higher than the control group (P0.05). In the experimental group when discharged from the hospital after 3 months of family care knowledge scores there was statistical significance (P0.05). Conclusion: (1) survey of extended care needs is the basis of continuous nursing mode. (2) continuous nursing mode scheme for the formation of innovative, targeted, can provide the basis and reference for pediatric nursing. (3) the quality of life evaluation reflects children the sequelae of severe viral encephalitis by the effect of continuous nursing mode, and enhance the parents' mastery of the knowledge of disease, worthy of promotion in clinical work.

【學(xué)位授予單位】：貴州醫(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)】：R473.72

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