脊髓病后神经源性膀胱患者肠道膀胱扩大术的护理

目的总结脊髓病后神经源性膀胱患者行乙状结肠膀胱扩大术围手术期护理。方法回顾性分析脊髓病后神经源性膀胱行乙状结肠膀胱扩大术31例患者的围手术期护理及术后随访资料。结果术后出现肠梗阻2例,短暂精神障碍1例,膀胱内真菌感染1例,均治愈。2例失访,余29例随访6个月～4年,恢复良好,能长期坚持间歇导尿。结论术前正确健康指导、肠道及膀胱准备,术后严密病情观察、胃肠减压及引流管道的护理,出院前间歇导尿的训练,出院后定期随访,是护理的关键内容,也是保证手术疗效的重要环节。     

膀胱全切回肠膀胱术患者的护理

目的:探讨膀胱全切回肠膀胱术的护理措施及效果。方法:对行膀胱全切回肠膀胱术的患者由专人负责实施全程系统化护理,包括术前的心理护理、肠道准备,术后的病情观察、引流管护理、造瘘口护理、集尿袋的佩带与护理、出院指导及出院后随访等。结果:患者术后恢复良好,无并发症发生,自理能力强。结论:专人负责的系统化护理提高了手术的安全,有效预防了并发症;提高了患者的自理能力和生活质量。     

膀胱全切原位回肠新膀胱术患者的围手术期护理

总结了膀胱全切原位回肠新膀胱术患者的围手术期护理要点,包括术前心理护理、术前全身性准备、术前肠道准备、术后一般护理、各引流管的护理、饮食护理、预防术后并发症、新膀胱排尿方法训练以及出院指导。认为良好的围手术期护理可以缓解患者的紧张及恐惧心理,减少术后并发症,可以促进患者术后的恢复。     

腹腔镜下根治性膀胱全切回肠代膀胱术的围术期护理

总结和探讨腹腔镜下根治性膀胱全切回肠代膀胱术的围术期护理要点。包括术前做好心理护理、充分的肠道准备,术后严密的病情观察、加强引流管护理及膀胱造口的护理,积极预防并发症的发生。41例患者均顺利康复出院。认为加强膀胱全切回肠代膀胱术围手术期的护理可以有效降低术后并发症的发生,促进患者康复,缩短住院时间。     

膀胱癌患者膀胱全切回肠代膀胱术的围手术期护理

总结25例膀胱癌患者膀胱全切回肠代膀胱术围手术期护理。护理重点为术前做好心理护理、肠道准备及造口定位,术后加强引流管及泌尿造口的护理,重视并发症的观察及护理,加强出院康复指导。25例患者住院9~51d康复出院。     

阑尾输出道可控性肠膀胱术2例患儿围术期护理

总结2例阑尾输出道可控性肠膀胱术围术期的护理。护理重点为术前做好心理护理及肠道准备,术后严密观察病情,做好引流管、腹壁肠造口护理,及时处理尿失禁等并发症,加强阑尾输出道居家清洁导尿、膀胱容量扩大训练及远期并发症预防的宣教指导。2例患儿经治疗和护理无护理并发症发生,术后15～20d出院。出院后随访1～2月,2例患儿居家阑尾造口清洁导尿操作正确,无远期并发症发生。     

68例膀胱全切乙状结肠原位膀胱替代术患者的护理

总结了68例膀胱全切乙状结肠原位膀胱替代术患者的护理经验，主要包括术前心理护理、术前准备及手术后一般护理、引流管、饮食及并发症的护理。认为加强膀胱全切乙状结肠原位膀胱替代术患者的术前术后护理是患者顺利恢复的重要保证。     

经尿道膀胱肿瘤电切术后羟喜树碱定期灌注化疗患者的护理

总结了38例经尿道膀胱肿瘤电切术后羟喜树碱定期灌注化疗患者的护理.主要包括心理护理、灌注前准备、不良反应观察、饮食与锻炼指导、康复指导等.认为做好患者的心理护理及灌注前准备,规范导尿操作,加强灌注后指导及观察,是取得药物最佳疗效的保证.     

脊神经吻合重建脊髓损伤后弛缓性膀胱排尿功能的护理

目的 探讨脊神经吻合重建脊髓损伤后弛缓性膀胱排尿功能的护理体会.方法 回顾性总结我院7例行脊神经吻合术患者的围手术期护理要点.结果 7例患者经过悉心的治疗护理均得到良好康复出院,1例女性患者术后18个月后自行排尿,每次排尿300～400ml;1例男性患者随访4年,由于患未能坚持膀胱功能训练,一直依赖术前的膀胱造瘘;余5例仍处于随访期.结论 术前尿流动力学检查及配合,患者的准备(术区皮肤准备、药物准备、体位训练、尿路感染的控制、留置导尿和心理准备),术后体位护理,膀胱功能的康复锻炼,并发症的预防均对于手术成功与否有着重要的影响.     

膀胱全切回肠膀胱术腹壁造口的护理干预

目的：探讨膀胱全切回肠膀胱术腹壁造口患者的护理干预措施及效果。方法对10例膀胱全切回肠膀胱术腹壁造口患者的护理干预进行总结分析。术前干预重点做好心理护理,术前准备,讲明手术过程,手术治疗的效果,帮助患者树立起战胜疾病的信心;术后密切观察病情变化,预防并发症,注重造口及各引流管的护理,并指导患者掌握造口的护理知识和技巧等。结果10例患者术后顺利出院,术后并发症少,康复时间短,患者掌握造口袋更换及自我护理方法。结论有效的护理干预可降低膀胱全切回肠代膀胱腹壁造口患者的紧张、焦虑情绪,减少术后并发症,促进机体的康复,能提高患者造口自我护理能力及生活质量。     

Predictors of nursing home placement and home nursing services utilization by elderly patients after hospital discharge in Taiwan

BACKGROUND: Providing appropriate follow-up health/long-term care services after hospital discharge for elderly persons is important to enhance health and quality of life. Therefore, identifying factors that affect follow-up service utilization has become an important concern. Most studies of predictors of follow-up service utilization for elderly persons after discharge were conducted in the United States of America (USA). Taiwan differs substantially from the USA in health care system, clinical practice, case-mix, culture, and social organization; thus the findings from the USA need to be validated in Taiwan to ensure appropriate discharge referrals. AIM: To investigate pre-discharge predictors of follow-up care including home nursing services and nursing home placement for elderly patients, discharged from hospitals in Taiwan. METHODS: A prospective study with a case-control design was used. FINDINGS: The strongest predictors of institutionalization in a nursing home at 1, 3 and 6 months after discharge were the elderly person's pre-admission institutionalization (0.33 to 0.48) and the caregiver's preference for institutional displacement (0.23 to 0.85). The strongest predictors of use of home nursing services were the elder's self-care ability (0.69 to 0.76), conscious level (0.51 to 0.73), and tubes remaining before discharge (0.58 to 0.79). These predictors were stable at 1, 3 and 6 months after discharge and could correctly classify 60-89% of sample. CONCLUSIONS: When taking nursing home and home nursing utilization into considerations at the same time, the elderly person's pre-admission institutionalization and the caregiver's preference for institutional displacement strongly predicted nursing home utilization after hospital discharge. The elder's self-care ability, conscious level, and tubes remaining before discharge strongly predicted the use of home nursing services after discharge.     

出院准备服务对早产儿家庭出院准备度及其生长发育的影响

目的 探讨出院准备服务对早产儿家庭出院准备度的影响,以促进早产儿生长发育、减少再入院率。方法 以2021年1-6月收治于复旦大学附属中山医院青浦分院新生儿重症监护室的40例早产儿及其主要照护者作为对照组,给予常规护理干预;以2021年7-12月收治的40例早产儿及其主要照护者作为观察组,采用“评估-指导-再评估-再指导”的院内外护理。比较出院时两组早产儿家庭的出院准备度评分,出院3个月后主要照顾者对延续护理的满意度,以及两组早产儿的再入院情况及身高、体质量的达标率。结果 出院时,观察组早产儿出院家庭准备度评分为（23.28±7.23）分,高于对照组（19.28±5.95）分（P<0.05）。出院3个月后,观察组照顾者对延续护理服务的满意度得分高于对照组（P<0.05）;观察组早产儿再入院率为0,低于对照组的7.5%(P<0.05),且观察组早产儿身高及体质量达标率均高于对照组（均P<0.05）。结论 出院准备服务可提高早产儿家庭出院准备度及照顾者对延续护理的满意度,有利于促进早产儿生长发育、降低其再入院率,有助于促进患儿健康及护理质量提升。     

The Johnson Behavioral Systems Model as a framework for patient outcome evaluation

Background: Although there is a great deal of interest in the outcome of the nursing care of psychiatric patients, there is little empirical research about the effectiveness of nursing care.Methods: This study evaluated the medical record documentation by nurses as an important database (N = 380 patients). The predicted patient outcome instrument developed by the authors was used to collect the data related to patient demographics, acuity, nursing diagnosis, short-and long-term goals, and nursing interventions. The Johnson Behavioral System Model was the nursing conceptual framework used.Findings: Overall, 80% of the predicted patient outcomes were achieved by the time of discharge, with increased length of stay being a factor in increasing the likelihood of achievement of goals. A positive link was found between achievement of outcomes at time of discharge and nursing interventions. A nursing theoretical framework made it possible to prescribe nursing care as a distinction from medical care.Conclusion: This study showed the importance of the nursing database in the medical records and the effectiveness of nursing interventions on predicted patient outcomes achieved by the time of discharge.     

延续性护理在神经源性膀胱行清洁间歇导尿患者中的应用

目的:探讨延续性护理在神经源性膀胱行清洁间歇导尿(CIC)患者中的应用方法及效果。方法:将47例神经源性膀胱行CIC患者随机分为对照组23例和观察组24例,对照组给予出院常规护理,观察组在此基础上给予以专科护士为主导的延续性护理服务,比较两组护理效果。结果:观察组患者出院后3个月CIC依从性优于对照组(P<0.05),并发症发生率低于对照组(P<0.05)。观察组出院3个月残余尿量少于出院当天及对照组出院后3个月(P<0.05)。两组患者出院后1、3个月健康调查简表(SF-36)评分高于对照组(P<0.05)。结论:延续性护理可提高神经源性膀胱行CIC患者的依从性,减少膀胱残余尿量,降低并发症发生率,提高患者的生活质量。     

自我效能在中老年患者出院准备度和“互联网+护理服务”采纳意愿间的中介作用分析

目的：探讨中老年出院患者自我效能、出院准备度和“互联网+护理服务”采纳意愿之间的关系及内在作用机制。方法：选取天津市某三级甲等医院即将出院的中老年患者共307例,采用一般资料问卷、出院准备度量表、一般自我效能量表及“互联网+护理服务”采纳意愿问卷开展调查,测量其自我效能水平、出院准备度及“互联网+护理服务”采纳意愿,使用SPSS 21.0 和AMOS 21.0对数据进行统计分析。结果：患者出院准备度、自我效能和“互联网+护理服务”采纳意愿之间呈正相关（P<0.001）;出院准备度既可直接影响患者对“互联网+护理服务”的采纳意愿,又可以通过自我效能对“互联网+护理服务”采纳意愿起间接作用。结论：自我效能在中老年患者出院准备度与“互联网+护理服务”意愿之间起中介作用,管理者应充分重视提高此类人群的自我效能水平,提升其互联网医疗就诊意愿。     

Nursing diagnoses, diagnosis-related group, and hospital outcomes

BACKGROUND AND OBJECTIVE: There are no nursing centric data in the hospital discharge abstract. This study investigates whether adding nursing data in the form of nursing diagnoses to medical diagnostic data in the discharge abstract can improve overall explanation of variance in commonly studied hospital outcomes. METHOD: A retrospective analyses of 123,241 sequential patient admissions to a university hospital in a Midwestern city was performed. Two data sets were combined: (1) a daily collection of patient assessments by nurses using nursing diagnosis terminology (NDX); and (2) the summary discharge information from the hospital discharge abstract including diagnosis-related group (DRG) and all payer refined DRG (APR-DRG). Each of 61 daily NDX observations were collapsed as frequency of occurrence for the hospital stay and inserted into the discharge abstract. NDX was then compared to both DRG and APR-DRG across 5 hospital outcome variables using multivariate regression or logistic regression. RESULTS AND CONCLUSIONS: In all statistical models, DRG, APR-DRG, and NDX were significantly associated with the 5 hospital outcome variables (P <.0001). When NDX was added to models containing either the DRG or the APR-DRG, explanatory power (R2) and model discrimination (c statistic) improved by 30% to 146% across the outcome variables of hospital length of stay, ICU length of stay, total charges, probably of death, and discharge to a nursing home (P <.0001).The findings support the contention that nursing care is an independent predictor of patient hospital outcomes. These nursing data are not redundant with the medical diagnosis, in particular, the DRG. The findings support the argument for including nursing care data in the hospital discharge abstract. Further study is needed to clarify which nursing data are the best fit for the current hospital discharge abstract data collection scheme.     

基于云平台的院外远程护理干预在脑卒中患者中的应用

目的:探讨基于云平台的院外远程护理干预在脑卒中患者中的应用效果。方法:将2016年1月1日~2017年12月31日收治的61例脑卒中患者作为对照组,实施传统的出院后随访模式;将2017年1月1日~2018年12月31日收治的59例脑卒中患者作为观察组,采用基于云平台的远程护理干预模式进行延续护理管理。比较两组出院当日、出院3个月后生活质量[采用脑卒中专用生活质量量表(SS-QOL)]及治疗依从性、满意度。结果:出院3个月后,观察组SS-QOL评分、治疗依从性及护理满意度均高于对照组(P<0.01,P<0.05)。结论:对急性脑卒中患者实施基于云平台的远程护理干预模式,能明显提高其生活质量和治疗依从性,同时提升其护理满意度。     

综合护理干预对腰椎间盘突出症患者院外依从行为及复发率的影响

目的分析腰椎间盘突出症患者实施综合护理干预后对其院外依从行为及复发率的影响。方法选择本院中接受治疗的腰椎间盘突出症患者148例,随机分为2组,实验组和对照组各74例,实验组患者给予综合护理干预,对照组患者给予常规护理,患者出院后均随访3个月,观察患者院外依从行为情况及复发情况,比较出院时、出院3个月后的下腰痛情况及失能情况。结果出院时,2组患者下腰痛、失能评分差异无统计学意义(P0.05);出院3个月后,实验组患者各项依从行为占比、下腰痛评分高于对照组(P0.05),复发率、失能评分低于对照组(P0.05)。结论腰椎间盘突出症患者治疗期间,给予患者综合护理干预后,可提高患者出院后自我管理依从性,降低复发率,提升出院后疾病恢复效果。     

Patients' Status at Home Care Discharge

This study describes patients' status following home care nursing discharge, and explores the relationship of sociodemographic characteristics, medical conditions and nursing needs to patients' status at discharge. The sample consisted of 367 adult patients receiving nursing services from a certified home health agency. The majority (61 percent) of patients could manage independently or only with the help of family providers at home care nursing discharge. The rest (39 percent) required at least some help from community service providers, were institutionalized or had died. Patients' discharge status was more closely related to nursing needs such as nursing problems, functional status and coping ability than to medical conditions.     

延伸性护理对子宫内膜癌患者术后生存质量的影响

目的:探讨延伸性护理对子宫内膜癌患者术后生存质量的影响.方法:将80例患者随机分为观察组45例和对照组35例,对照组患者采用传统护理服务模式进行常规出院宣教,观察组患者出院后接受延伸性护理干预.采用问卷调查法了解患者及家属出院后的护理需求,并根据患者病情分析影响其术后生存质量的诸多因素,制订相应的延伸性护理计划.采用欧洲研究治疗组织癌症患者生存质量测定量表\[EORTC-C30(V3.0)\]测评两组患者出院时和出院后6个月后的生存质量.结果:观察组患者出院后6个月后躯体功能、角色功能、认知功能、社会功能、总体健康状况、疼痛、恶心和呕吐得分均优于对照组(P＜0.05).结论:子宫内膜癌患者术后生存质量与实施有计划的延伸性护理呈正相关.