家庭护理健康教育对肾病综合征出院患儿的影响

目的:探讨家庭护理健康教育对肾病综合征(NS)出院患儿的影响。方法:将288例NS患儿随机分为干预组196例和对照组92例,对照组给予常规健康教育,干预组在此基础上给予家庭护理健康教育。比较两组患儿出院后疾病复发情况及遵医服药、复诊依从性。结果:干预组出院后疾病复发率低于对照组(P0.01),遵医服药及复诊依从性高于对照组(P0.01);干预组出院后复发诱因少于对照组(P0.05,P0.01)。结论:家庭护理健康教育可使NS患儿及家长掌握家庭护理知识,提高其出院后治疗依从性,降低疾病复发率,改善生活质量。     

“医院-社区-家庭”延续性护理对脑卒中患者遵医依从性的影响

目的探讨"医院-社区-家庭"延续性护理对脑卒中患者遵医依从性的影响。方法便利抽样法选取2014年7月至2015年1月上海市闸北区中心医院老年医学科及神经内科收治的脑卒中患者108例,按入院先后将其分为观察组和对照组各54例,对照组患者给予常规出院指导,观察组患者出院后给予"医院-社区-家庭"延续性的护理干预,观察并比较两组患者出院后的遵医依从性。结果观察组患者的遵医依从性优于对照组,差异有统计学意义(P0.05)。结论对脑卒中患者实行"医院-社区-家庭"延续性护理干预,有助于提高患者的遵医依从性,促进患者康复。     

延续性护理对出院哮喘患儿遵医行为及生活质量的影响

研究延续性护理对出院哮喘患儿遵医行为及生活质量的影响。选取2013年5月~2015年10月在我院就诊且即将出院的哮喘患儿70例,将其随机分为两组,各35例。对照组患儿给予出院指导,观察组患儿在对照组基础上给予延续性护理,对比分析两组患儿的遵医行为及生活质量。对照组患者的治疗依从性明显差于观察组,差异显著(P<0.05);观察组患者的生活质量明显优于对照组,差异显著(P<0.05)。延续性护理能够帮助患儿家长深入了解哮喘的相关知识,提高患儿遵医行为,减少疾病的发作次数,提高患儿出院后的生活质量。     

电话随访对提高出院患者遵医行为及健康行为的影响

目的探讨电话随访对出院患者遵医行为及健康行为的影响。方法选择820例手术出院患者按出院先后顺序随机分为对照组和观察组,每组各410例,两组患者均在出院前进行出院指导,观察组患者出院后实施电话随访,时间1w-3个月。比较两组患者出院后遵医行为与健康行为的差异。结果观察组患者出院后在遵医行为和健康行为方面优于对照组患者,两组比较,差异具有统计学意义(均P﹤0.01)。结论电话随访能提高患者出院后的依从性和健康行为。     

出院病人随访护理服务模式的实践及效果

[目的]探讨出院病人随访护理服务模式的实践效果。[方法]选取2013年1月—2015年6月出院病人500例为观察组,选取2010年7月—2012年12月出院病人500例为对照组,对照组采用常规随访模式,观察组采用随访护理服务模式。比较两组的随访效果。[结果]观察组病人对随访护理的满意率高于对照组(96.6%vs 76.8%,P0.05),随访后的自我效能评分高于对照组[(36.74±5.41)分vs(30.08±5.69)分,P0.05],遵医行为的依从性高于对照组(P0.05)。[结论]出院病人采用随访护理服务模式可提高病人的满意率、遵医行为的依从性、自我效能评分,效果优于常规随访模式。关键词:护理服务模式;随访;出院病人;满意率;自我效能评分;遵医行为     

多元化健康教育护理干预在早产儿眼底筛查中的作用

目的探讨多元化健康教育护理干预在早产儿眼底筛查中的作用,提升家属疾病认知以及筛查意识。方法2016年8月至2017年8月于我院出生的200例早产儿以及其家长,随机数字表法分为对照组和观察组各100例,对照组家长采用发放宣传手册等常规健康教育,观察组家长采用多元化健康教育护理干预。完成健康教育后对所有家长进行眼底疾病知识调查和家长满意度调查,并比较两组家长的遵医情况,记录两组早产儿的眼底疾病筛查结果。结果两组家长干预后对视网膜出血、视网膜病、家族性渗出性玻璃体视网膜病变知识得分均显著高于干预前,且观察组得分高于对照组(P0.05);观察组满意度(92.00%)显著高于对照组(65.00%)(P0.05);观察组家长预防眼部感染、疾病认知、观察视力发展、定期检查等遵医率均显著高于对照组(P0.05);两组早产儿眼底疾病有视网膜出血、视网膜病、家族性渗出性玻璃体视网膜病变、视网膜色素沉积、先天性白内障,组间比较差异无统计学意义(P0.05)。结论开展多元化健康教育护理干预,提高了早产儿家长对新生儿眼底疾病知识、筛查意识以及遵医性,有助于早产儿眼底疾病的筛查与防治。     

微信公众平台与电话交互式随访在鼻咽癌放疗患者延续护理中的应用

目的探讨微信公众平台与电话交互式随访在鼻咽癌放疗患者延续护理中的影响与效果。方法选取对2016年7月～2017年7月鼻咽癌放疗患者68例,随机等分为观察组和对照组。对照组仅使用普通的电话随访进行出院护理干预,观察组在患者出院前采用自制问卷调查,收集每个患者住院期间功能锻炼情况及对疾病健康知识掌握情况,采用微信公众平台联合电话随访进行6个月相关护理干预。结果出院后2组的遵医依从性均呈下降状态,出院后6个月,观察组各方面遵医依从性高于对照组各方面遵医依从性,差异有统计学意义(P 0. 05);放射性口腔黏膜疼痛情况,观察组低于照组差异有统计学意义(P 0. 05)。结论通过微信公众平台联合电话随访延续护理,显著提高了鼻咽癌患者遵医依从性、生活质量,同时放射性口腔粘膜疼痛情况缓解,有效提高了出院随访的运行质量。     

对留置双J管出院病人实施连续性健康教育的效果评价

[目的]探讨连续性健康教育对留置双J管出院病人遵医行为及带管期间并发症的影响。[方法]抽取2014年1月—2014年6月入住我科的100例诊断为泌尿系结石且均行输尿管镜钬激光碎石术术后带双J管的病人,随机分为观察组和对照组各50例,对照组出院前接受常规健康教育,观察组在常规健康教育基础上实施由专业健康教育护士提供的出院后1个月的连续健康教育。1周和4周后通过比较两组病人并发症的发生率和遵医依从性来评价健康教育的效果。[结果]观察组病人4周后并发症发生率低于对照组(P0.05),遵医依从性高于对照组(P0.05)。[结论]实施出院后连续性健康教育能有效地提高留置双J管病人的遵医依从性,从而减少并发症的发生。     

电话回访式健康教育在脑卒中患者管理中的应用

目的：通过对出院的脑卒中患者进行电话回访式健康教育,以观察其遵医行为及治疗依从性,旨在减少脑卒中致残及再发,提高患者生活质量。方法：将单号出院脑卒中患者112例作为观察组,双号出院脑卒中患者96例作为对照组。对照组患者只做出院指导,观察组患者在出院指导的基础上进行电话回访式健康教育指导,4周后比较两组患者对疾病基本知识了解程度、遵医行为及治疗依从性。结果：进行电话回访式健康教育的观察组患者对疾病基本知识了解程度和遵医行为及治疗依从性较对照组明显提高（P〈0.05）。结论：在脑卒中患者管理中应用电话回访式健康教育,效果明显,患者对疾病基本知识了解增多,能提高患者的遵医行为及治疗依从性,提高患者的生活质量。     

电话随访对早产儿视网膜病变筛查遵医行为的影响

目的 通过电话随访对出院早产儿的家属进行健康教育,提高遵医行为,及早发现和治疗早产儿视网膜病变(ROP).方法 将60名出院后早产儿随机分为两组,观察组和对照组,每组30名,对观察组进行电话随访方式健康教育.分别于1周、1个月、3个月、6个月进行,内容包括定期眼科门诊眼底检查、对ROP相关知识的了解、观察早产儿视力发展情况、预防早产儿眼部感染.结果 经χ2检验,对照组和观察组遵医行为的差异具有统计学意义(P<0.05).结论 电话随访式健康教育的开展,体现了护理模式的转变,将医院健康教育延伸到出院早产儿的治疗康复中,提高早产儿出院后家属的遵医行为,完善整体护理的内涵,增加了医患双方的互动,提高了社会效益和经济效益.     

Reducing the risk of healthcare‐associated infections through Lean Six Sigma: The case of the medicine areas at the Federico II University Hospital in Naples (Italy)

Rationale, aims, and objectives

Lean Six Sigma (LSS) has been recognized as an effective management tool for improving healthcare performance. Here, LSS was adopted to reduce the risk of healthcare‐associated infections (HAIs), a critical quality parameter in the healthcare sector.

Methods

Lean Six Sigma was applied to the areas of clinical medicine (including general medicine, pulmonology, oncology, nephrology, cardiology, neurology, gastroenterology, rheumatology, and diabetology), and data regarding HAIs were collected for 28,000 patients hospitalized between January 2011 and December 2016. Following the LSS define, measure, analyse, improve, and control cycle, the factors influencing the risk of HAI were identified by using typical LSS tools (statistical analyses, brainstorming sessions, and cause‐effect diagrams). Finally, corrective measures to prevent HAIs were implemented and monitored for 1 year after implementation.

Results

Lean Six Sigma proved to be a useful tool for identifying variables affecting the risk of HAIs and implementing corrective actions to improve the performance of the care process. A reduction in the number of patients colonized by sentinel bacteria was achieved after the improvement phase.

Conclusions

The implementation of an LSS approach could significantly decrease the percentage of patients with HAIs.     

The intersection of disability and healthcare disparities: a conceptual framework

Abstract

Purpose: This article provides a conceptual framework for understanding healthcare disparities experienced by individuals with disabilities. While health disparities are the result of factors deeply rooted in culture, life style, socioeconomic status, and accessibility of resources, healthcare disparities are a subset of health disparities that reflect differences in access to and quality of healthcare and can be viewed as the inability of the healthcare system to adequately address the needs of specific population groups. Methods: This article uses a narrative method to identify and critique the main conceptual frameworks that have been used in analyzing disparities in healthcare access and quality, and evaluating those frameworks in the context of healthcare for individuals with disabilities. Specific models that are examined include the Aday and Anderson Model, the Grossman Utility Model, the Institute of Medicine (IOM)’s models of Access to Healthcare Services and Healthcare Disparities, and the Cultural Competency model. Results: While existing frameworks advance understandings of disparities in healthcare access and quality, they fall short when applied to individuals with disabilities. Specific deficits include a lack of attention to cultural and contextual factors (Aday and Andersen framework), unrealistic assumptions regarding equal access to resources (Grossman’s utility model), lack of recognition or inclusion of concepts of structural accessibility (IOM model of Healthcare Disparities) and exclusive emphasis on supply side of the healthcare equation to improve healthcare disparities (Cultural Competency model). In response to identified gaps in the literature and short-comings of current conceptualizations, an integrated model of disability and healthcare disparities is put forth. Conclusion: We analyzed models of access to care and disparities in healthcare to be able to have an integrated and cohesive conceptual framework that could potentially address issues related to access to healthcare among individuals with disabilities. The Model of Healthcare Disparities and Disability (MHDD) provides a framework for conceptualizing how healthcare disparities impact disability and specifically, how a mismatch between personal and environmental factors may result in reduced healthcare access and quality, which in turn may lead to reduced functioning, activity and participation among individuals with impairments and chronic health conditions. Researchers, health providers, policy makers and community advocate groups who are engaged in devising interventions aimed at reducing healthcare disparities would benefit from the discussions.

• Implications for Rehabilitation

• Evaluates the main models of healthcare disparity and disability to create an integrated framework.

• Provides a comprehensive conceptual model of healthcare disparity that specifically targets issues related to individuals with disabilities.

• Conceptualizes how personal and environmental factors interact to produce disparities in access to healthcare and healthcare quality.

• Recognizes and targets modifiable factors to reduce disparities between and within individuals with disabilities.

     

Implementation of an electronic health records system within an interprofessional model of care

Abstract

Implementation of electronic health records (EHR) systems is challenging even in traditional healthcare settings, where administrative and clinical roles and responsibilities are clearly defined. However, even in these traditional settings the conflicting needs of stakeholders can trigger hierarchical decision-making processes that reflect the traditional power structures in healthcare today. These traditional processes are not structured to allow for incorporation of new patient-care models such as patient-centered care and interprofessional teams. New processes for EHR implementation and evaluation will be required as healthcare shifts to a patient-centered model that includes patients, families, multiple agencies, and interprofessional teams in short- and long-term clinical decision-making. This new model will be enabled by healthcare information technology and defined by information flow, workflow, and communication needs. We describe a model in development for the configuration and implementation of an EHR system in an interprofessional, interagency, free-clinic setting. The model uses a formative evaluation process that is rooted in usability to configure the EHR to fully support the needs of the variety of providers working as an interprofessional team. For this model to succeed, it must include informaticists as equal and essential members of the healthcare team.