本文選題：老年患者　切入點：出院6個月內(nèi)　出處：《寧夏醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的了解出院后6個月內(nèi)非計劃性再入院老年患者的臨床特征,并分析導(dǎo)致老年患者非計劃性再入院的影響因素,為老年患者的出院指導(dǎo)及延續(xù)性護理干預(yù)提供理論依據(jù)。方法采用描述性研究方法,對2014年7月1日-2015年6月31日由寧夏醫(yī)科大學(xué)總醫(yī)院出院后6個月內(nèi)非計劃性再入該院的60歲及以上老年患者1206例進行一般資料、臨床特征等描述性分析。在此基礎(chǔ)上,采用病例對照研究方法從1206例患者中隨機抽取90例為病例組;并按照年齡(±5歲)、性別、病種配對選取同時期內(nèi)未再入院老年患者90例為對照組,采用日常生活活動能力量表(ADL)、家庭照護能力量表(FCCS)、健康促進生活形態(tài)量表Ⅱ(HPLP-Ⅱ)、社會支持評定量表(SSRS)、健康自評量表進行問卷調(diào)查。使用SPSS17.0統(tǒng)計軟件進行統(tǒng)計分析,計量資料懫用均數(shù)、標(biāo)準差描述,計數(shù)資料采用頻數(shù)、百分比描述,采用單因素分析、多因素條件logistic回歸分析老年患者出院后6個月內(nèi)非計劃性再入院的影響因素。結(jié)果1.非計劃性再入院老年患者的人口學(xué)特征:本次調(diào)查的1206例患者中,年齡為60~90(70.02±7.58)歲,其中,60-69歲者627例,占51.99%;70-79歲者411例,占34.08%;80歲以上者168例,占13.93%。男性771例,女性435例,男女比為1.8:1。有配偶者1179例,占97.76%;無配偶者27例,占2.24%。漢族989例,占82.01%;回族191例,占15.84%;其他26例,占2.15%。2.非計劃性再入院老年患者的臨床特征:主要診斷排前3位的是冠心病255例,占21.14%;肝硬化153例,占12.69%;膽囊膽管炎138例,占11.44%。出院后非計劃性再入院的平均時間為(52.49±47.77)天,其中,出院后0-30天再入院者543例,占45.02%;31-60天再入院者255例,占21.14%;61-90天再入院者144例,占11.94%;其他時間再入院者264例,占21.90%。3.老年患者非計劃性再入院的影響因素:單因素分析結(jié)果顯示,老年患者的文化程度、職業(yè)、居住情況、居住地區(qū)、經(jīng)濟來源、醫(yī)療保障、對疾病的了解程度、出院指導(dǎo)、出院帶藥、生活自理能力、健康自評、健康飲食、人際關(guān)系、健康職責(zé)、體育運動、照護者健康、照護者時間、疾病認知、家庭關(guān)系、替代能力、周邊支援、客觀支持、主觀支持各項差異有統(tǒng)計學(xué)意義(P0.05)。多因素條件logistic回歸分析結(jié)果顯示:患者的生活自理能力、健康飲食、人際關(guān)系、照護者健康、替代能力、家庭關(guān)系是老年患者非計劃性再入院的獨立影響因素�；颊叩纳钭岳砟芰υ胶�(OR=0.047,95CI=0.003-0.775)、健康飲食意識越強(OR=0.660,95CI=0.462-0.942,)、人際關(guān)系越好(OR=0.426,95CI=0.228-0.796)、照護者健康(OR=0.224,95CI=0.056-0.899)、有輔助照護者(OR=0.195,95CI=0.043-0.877)、家庭關(guān)系越和睦(OR=0.204,95CI=0.046-0.899),老年患者發(fā)生非計劃性再入院的風(fēng)險越小。結(jié)論1.老年患者出院后非計劃性再入院的時間以2個月內(nèi)再入院者最多,主要診斷以心血管系統(tǒng)、消化系統(tǒng)疾病所占比例最多。2.患者的生活自理能力、健康飲食、人際關(guān)系、照護者健康、替代能力、家庭關(guān)系是老年患者非計劃性再入院的獨立影響因素。提示臨床護士在出院指導(dǎo)以及延續(xù)性護理服務(wù)時,應(yīng)重點關(guān)注這些影響因素,針對不同的個體特征制定相應(yīng)的護理應(yīng)對策略,從而減少老年患者非計劃性再入院的發(fā)生。
[Abstract]:Objective to understand the 6 months after discharge and unplanned clinical features at admission in senile patients, and analyze the causes of non factors affecting the planned readmission of elderly patients, and provide a theoretical basis for the intervention of elderly patients with discharge guidance and continuity of care. Methods descriptive research methods, on the July 1, 2014 -2015 year in June 31st by the General Hospital of Ningxia Medical University after 6 months the unplanned reentry of the hospital elderly patients aged 60 years and over 1206 cases of general data, descriptive analysis of clinical features. On this basis, a case-control study from 1206 patients randomly selected 90 cases; and according to age (+ 5 years), sex, disease at the same time were chosen period before the re admission of 90 cases of elderly patients as the control group, the activities of daily living scale (ADL), family care ability scale (FCCS), Health Promoting Lifestyle Scale II (HPLP- II), social support rating scale (SSRS), health self rating scale questionnaire. Statistical analysis was performed using the SPSS17.0 statistical software was used for measurement data Zhi, standard deviation, count data using frequency, percentage, single factor analysis, multivariate logistic regression analysis of factors in 6 months of unplanned readmission of elderly patients after discharge. Results 1. of unplanned readmission of elderly patients with demographic characteristics: 1206 cases of the patients, age of 60~90 (70.02 + 7.58) years old, among them, 60-69 years old in 627 cases, accounting for 51.99%; 70-79 in 411 cases, accounting for 34.08%; 168 patients over the age of 80, accounting for 13.93%. male 771 cases, female 435 cases, male and female ratio of 1.8:1. has a spouse in 1179 cases, accounting for 97.76%; 27 cases without a spouse, accounted for 2.24%. of 989 cases of Han, Hui accounted for 82.01%; 191 cases, accounting for 15.84%; other 26 cases, accounting for 2.15%.2. of unplanned re hospitalized elderly patients The main clinical features: diagnosis ranked the first 3 of 255 cases of coronary heart disease, accounted for 21.14%; 153 cases of cirrhosis, 12.69%; gallbladder cholangitis in 138 cases, accounting for 11.44%. after discharge of unplanned readmission for an average of (52.49 + 47.77) days, including 0-30 days after discharge and readmission in 543 cases. Accounted for 45.02%; 31-60 day readmission in 255 cases, accounting for 21.14%; 61-90 day readmission in 144 cases, accounting for 11.94%; 264 cases of other time readmission, accounting for non planned factors affecting readmission of elderly patients with 21.90%.3.: single factor analysis showed that the degree of culture, elderly patients with occupation, living conditions, living area, economic source, medical security, discharge guidance to the degree of the disease, discharge medication, self-care ability, self-rated health, healthy diet, interpersonal relationship, health responsibility, sports, health care, caregiver time, disease awareness, family relationships, the ability to replace, peripheral support, Objective support, subjective support and the difference was statistically significant (P0.05). Multivariate logistic regression analysis showed that patients with self-care ability, healthy diet, interpersonal relationship, ability to substitute health, caregivers, family relations are the factors in elderly patients with unplanned readmission. The independent effect of patient self-care ability is better (OR=0.047,95CI=0.003-0.775), the stronger consciousness of health diet (OR=0.660,95CI=0.462-0.942), better interpersonal relationship (OR=0.426,95CI=0.228-0.796), health care (OR=0.224,95CI=0.056-0.899), secondary caregivers (OR=0.195,95CI=0.043-0.877), more harmonious family relations (OR=0.204,95CI=0.046-0.899) in elderly patients, the risk of unplanned readmission was smaller. Conclusion 1. elderly patients after non planning the time of readmission within 2 months readmission most, mainly in diagnosis of cardiovascular system, digestive system The disease accounted for the largest proportion of.2. patients' self-care ability, healthy diet, interpersonal relationship, ability to substitute health, caregivers, family relations are the factors in elderly patients with unplanned readmission. The independent effect of the clinical nurses in discharge guidance and continuity of care services, should focus on these factors, nursing strategy to deal with the corresponding different individual characteristics, so as to reduce unplanned readmission occurred in elderly patients.

【學(xué)位授予單位】：寧夏醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R473

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