本文選題：延續(xù)護理 + 奧馬哈系統(tǒng)��； 參考：《蚌埠醫(yī)學院》2017年碩士論文

【摘要】：目的:應用奧馬哈系統(tǒng)對永久性結腸造口患者實施延續(xù)護理,歸納患者出院后延續(xù)護理問題及干預措施,為提高造口患者自護意愿、自我護理知識、造口自我護理能力,及降低造口并發(fā)癥提供科學理論及實踐指導。方法:選取2016年1月-9月某市三所三甲醫(yī)院90名永久性結腸造口患者為研究對象,1月-4月為對照組,5月-9月為實驗組,每組各45例。對照組給予常規(guī)出院指導和隨訪;實驗組在對照組的基礎上實施以奧馬哈系統(tǒng)為框架的延續(xù)護理。通過查閱文獻、專家小組討論,以奧馬哈系統(tǒng)為框架,在整體護理理論、馬斯洛人類基本需求層次論、自我效能理論指導下,根據(jù)永久性結腸造口患者康復特點、《中國腸造口護理指導意見(2013版)》制定永久性結腸造口患者延續(xù)護理評估干預評分記錄表,研究者通過評估采集實驗組患者出院后的護理問題后,造口治療師對其實施個性化、系統(tǒng)化的延續(xù)護理干預措施,并從認知、行為、狀況3個方面對延續(xù)護理問題效果進行動態(tài)評價。使用自我護理意愿問卷、自我護理知識問卷及造口自我護理能力量表評價兩組患者在出院時、出院1個月及出院3個月的自我意愿、自我護理知識及自我護理能力得分情況,分析兩組患者在出院當天、出院1個月及出院3個月的造口照顧情況和造口并發(fā)癥的發(fā)生率。結果:(1)實驗組永久性結腸造口患者出院當天現(xiàn)存的延續(xù)護理問題主要分布在心理社會領域3個(35.05%)和健康相關行為領域5個(34.69%),其次是生理領域5個(23.25%),環(huán)境領域2個(7.01%)。其中,個人照顧、角色改變、精神健康、消化-水合、睡眠和休息型態(tài)、社交、營養(yǎng)的發(fā)生率超過50%。(2)實驗組永久性結腸造口患者出院當天潛在的護理問題2個,分別是造口并發(fā)癥和造口周圍皮膚并發(fā)癥。其中造口周圍皮膚并發(fā)癥44個(100%),造口并發(fā)癥42個(95.5%)。(3)實驗組患者出院當天發(fā)生率超過30%的延續(xù)護理問題進行效果評價分析發(fā)現(xiàn)精神健康、社交、角色改變、個人照顧、睡眠和休息型態(tài)、營養(yǎng)和消化-水合延續(xù)護理問題上的認知、行為、狀況3方面評分在延續(xù)護理不同階段差異均有統(tǒng)計學意義(P0.05)。(4)兩組患者并發(fā)癥發(fā)生情況在出院當天、出院一個月比較差異無統(tǒng)計學意義(P0.05),而在出院三個月時,兩組患者并發(fā)癥發(fā)生情況比較差異有統(tǒng)計學意義(P0.05)。(5)兩組患者造口照顧情況和自我護理知識得分在出院當天、出院三個月時比較差異無統(tǒng)計學意義(P0.05),而在出院一個月時,兩組患者比較差異有統(tǒng)計學意義(P0.05)。(6)兩組患者自我意愿得分和造口自我護理能力得分在出院當天比較差異無統(tǒng)計學意義(P0.05),而在出院一個月時、出院三個月時,兩組患者比較差異有統(tǒng)計學意義(P0.05)。結論:(1)奧馬哈系統(tǒng)能夠對永久性結腸造口患者延續(xù)護理問題提供全面評估。(2)奧馬哈系統(tǒng)能夠對永久性結腸造口患者延續(xù)護理問題提供全面的干預指引。(3)以奧馬哈系統(tǒng)為框架的延續(xù)護理能夠改善永久性結腸造口患者主要護理結局,提高永久性結腸造口自護意愿、自我護理知識、自我護理能力得分,降低造口并發(fā)癥的發(fā)生。
[Abstract]:Objective: to use the Omaha system to carry on continuous nursing for patients with permanent colostomy, to sum up the continuous nursing problems and intervention measures after discharge from the hospital, to provide scientific theory and practical guidance for improving self care will, self nursing knowledge, self nursing ability of stomatostomy, and reducing the complications of stoma. Methods: select the -9 month of January 2016. 90 permanent colostomy patients in three third class hospital of three city were studied. In January, the control group was used as the control group and the experimental group in May was the experimental group, with 45 cases in each group. The control group was given the routine discharge guidance and follow-up. The experimental group implemented the continuation nursing with the framework of the Omaha system on the basis of the control group. The Omaha system is the framework. Under the guidance of the holistic nursing theory, the Maslow human basic requirement hierarchy, the self efficacy theory, according to the characteristics of the patients with permanent colostomy, "Chinese enterostomy nursing guidance (2013 Edition) > to establish a permanent colostomy patient's continuous nursing assessment intervention score record table, the researchers are evaluated through the assessment." After collecting the nursing problems after the discharge of the patients in the experimental group, the stoma therapist applied individualized, systematic and continuous nursing intervention, and made a dynamic evaluation of the effect of continuing nursing problems from 3 aspects of cognition, behavior and condition. The self nursing willingness questionnaire, self nursing knowledge questionnaire and self nursing ability scale of stoma were evaluated two. The patients were discharged from hospital for 1 months and 3 months of discharge, self care, self-care knowledge and self-care ability, and the incidence of stoma care and stoma complications of two groups of patients on the day of discharge, 1 months discharged and 3 months discharged from discharge. Results: (1) permanent colostomy patients in the experimental group were discharged on the day of discharge. The problem of continuing care was mainly distributed in 3 (35.05%) and 5 health related fields (34.69%) in the psychosocial field, followed by 5 physiological fields (23.25%) and 2 (7.01%) in the environmental field. Among them, personal care, role change, mental health, digestion - hydration, sleep and rest patterns, social, and nutrition rates exceeded the 50%. (2) experimental group perpetual There were 2 potential nursing problems on the day of discharge from patients with sexual colostomy, which were complications of stoma and skin complications around stoma, including 44 (100%) complications around the stoma, 42 (95.5%) complications of stoma, and (3) the effect evaluation analysis of the patients in the experimental group that had an incidence of more than 30% on the day of discharge and found mental health, Social, role change, personal care, sleep and rest patterns, nutrition and digestive and hydration continuity nursing problems were statistically significant (P0.05) in different stages of continuous nursing (P0.05). (4) there was no significant difference between the two groups in the day of discharge and one month discharge (P0.05 And at three months after discharge, there was a significant difference in the incidence of complications between the two groups (P0.05). (5) the scores of stoma care and self nursing knowledge in the two groups were not statistically significant (P0.05) on the day of discharge and three months after discharge (P), and the difference between the two groups was statistically significant (P) at one month's discharge. 0.05) (6) there was no significant difference between the scores of self will and self nursing ability of the two groups in the day of discharge (P0.05), and the difference between the two groups was statistically significant (P0.05) at the discharge of the hospital for one month and three months after discharge (1) the Omaha system was able to continue the nursing problem for patients with permanent colostomy. Provide comprehensive assessment. (2) the Omaha system can provide comprehensive intervention guidelines for permanent colostomy patients. (3) continuing care based on the framework of the Omaha system can improve the main nursing outcomes of patients with permanent colostomy, improve permanent colostomy self-care willingness, self-care knowledge, and self-care ability Score, reduce the incidence of stoma complications.
【學位授予單位】：蚌埠醫(yī)學院
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R473.73

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