基于个案分析理念的医护一体化护理在使用BiPAP呼吸机治疗的呼吸衰竭患者中的应用价值

目的 探讨基于个案分析理念的医护一体化护理在使用双水平气道正压(BiPAP)呼吸机治疗的呼吸衰竭患者中的应用价值.方法 本研究选取2020年1月—2021年4月在河南省某医院就诊的80例行BiPAP呼吸机治疗的呼吸衰竭患者为研究对象.采用随机数字表法,将患者分为对照组与观察组,每组40例.对照组患者实施常规辅助BiPAP呼吸机治疗的护理干预,观察组患者实施基于个案分析理念的医护一体化护理.比较2组患者的治疗依从性、住院时间、呼吸机通气时间.比较2组患者干预前及出院时的焦虑、抑郁自评量表(SAS、SDS)评分.比较2组患者在住院期间的不良事件发生情况.结果 观察组患者治疗依从性明显高于对照组,差异有统计学意义(P＜0.05).观察组患者住院时间、呼吸机通气时间,明显短于对照组,差异均有统计学意义(P＜0.05).干预前,2组患者SAS及SDS评分比较,差异无统计学意义(P＞0.05).出院时,2组患者SAS及SDS评分均低于干预前,且观察组低于对照组,差异均有统计学意义(P＜0.05).观察组患者不良风险事件发生率明显低于对照组,差异有统计学意义(P＜0.05).结论 基于个案分析理念的医护一体化护理应用于使用BiPAP呼吸机治疗的呼吸衰竭患者的护理中,临床效果显著,可有效改善患者负性情绪,提高治疗依从性,缩短康复时间,减少不良事件的发生,值得临床推广.     

糖尿病护理小组在糖尿病人临床护理中的作用分析

目的:分析糖尿病护理小组模式在糖尿病人临床护理中效果.方法:选取2015年4月-2016年12月120例糖尿病患者,随机分组,观察组(n=60)给予糖尿病护理小组模式,对照组(n=60)给予常规护理方法,对比2组患者护理干预情况.结果:观察组饮食、用药、血糖监测、运动等方面治疗依从性均高于对照组,组间差异明显(P＜0.05).观察组患者护理干预后血糖水平(餐前、餐后2h)改善程度均优于对照组(P＜0.05).结论:糖尿病护理小组模式应用效果明显,可改善患者术后睡眠质量,降低疼痛感,并缓解抑郁情绪.     

社区跟进式护理对脑卒中患者生活能力、康复依从性和护理满意度改善作用

目的探讨社区跟进式护理对脑卒中患者生活能力、康复依从性和护理满意度的改善作用。方法 170例脑卒中患者随机分为对照组(n=85)和观察组(n=85),对照组给予常规护理,观察组给予社区跟进式护理,干预后比较两组临床疗效。结果观察组完全依从率和满意度显著高于对照组,差异有统计学意义(P0.05);干预后3个月,两组患者运动功能量表(FMA)评分和Barthel指数均显著提高,差异有统计学意义(P0.05);观察组提高更为明显,差异有统计学意义(P0.05)。观察组干预后物质生活、躯体功能、心理功能、社会功能和生活质量总分均较对照组提高,差异有统计学意义(P0.05)。结论社区跟进式护理可显著改善患者康复依从性,提高患者生活能力和对医院护理服务满意度,从而改善护患关系。     

知信行模式在胃癌患者围手术期护理中的运用效果分析

目的 探讨知信行(knowledge attitude belief practice,KAP)模式在胃癌根治术患者围手术期应用的效果.方法 对比观察围术期接受常规护理(对照组)和常规护理+KAP模式(观察组)后,胃癌根治术患者KAP的掌握情况、术后康复情况及护理满意度.结果 观察组的KAP知识、态度、行为得分以及总分均显著高于对照组(P＜0.05).观察组的术后并发症少于对照组,住院时间短于对照组,护理满意度高于对照组,差异均有统计学意义(P＜0.05).结论 KAP能够提高胃癌根治术患者的知信行行为,加快术后康复.     

分级监控管理联合精细化护理在重症颅脑损伤患者护理中的应用效果

目的 探讨分级监控管理联合精细化护理在重症颅脑损伤患者护理中的应用效果.方法 选择2017年6月—2020年8月于河南省某医院就诊的120例重症颅脑损伤患者为研究对象.采用随机数字表法将患者分为观察组与对照组,每组60例.对照组患者接受常规护理.观察组患者在常规护理基础上,接受分级监控管理联合精细化护理干预.比较2组患者住院费用、急救时间(急救时间为入院至急诊治疗完成的时间)、住院时间.比较2组患者护理前及出院时Fugl-Meyer运动功能量表(FMA)、美国国立卫生研究院卒中量袁(NIHSS)、生存质量综合评定问卷(GQLI)评分.比较2组患者护理前及出院时细胞间黏附分子-1(ICAM-1)、白介素-6(IL-6)、白介素-8(IL-8)水平.出院时比较2组患者压疮发生率.结果 观察组患者住院费用低于对照组,急救、住院时间短于对照组,差异均有统计学意义(P＜0.05).护理前,2组患者FMA、NIHSS及GQLI评分比较,差异无统计学意义(P＞0.05).出院时,2组患者FMA、NIHSS评分均低于护理前,且观察组低于对照组,差异均有统计学意义(P＜0.05).出院时,2组患者GQLI评分均高于护理前,且观察组高于对照组,差异均有统计学意义(P＜0.05).护理前,2组患者ICAM-1、IL-6、IL-8水平比较,差异无统计学意义(P＞0.05).出院时,2组患者ICAM-1、IL-6、IL-8水平均低于护理前,且观察组低于对照组,差异均有统计学意义(P＜0.05).观察组患者压疮发生率为6.67％,低于对照组的21.67％,差异有统计学意义(x2=5.551,P＜％.05).结论 分级监控管理联合精细化护理干预可改善重症颅脑损伤患者的炎症状态,促进运动、神经功能的恢复,提高生活质量,降低压疮发生率,有助于缩短急救、住院时间,减少住院费用,值得临床推广应用.     

疼痛护理对髋关节置换术后患者康复效果的影响

目的:研究疼痛护理对髋关节置换术后患者康复效果的影响.方法:选取2014年6月至2015年6月本院收治的髋关节置换患者84例,根据随机数字表将患者分为观察组及对照组各42例,对照组给予常规性护理,观察组给予疼痛护理,比较两组患者术后疼痛情况、锻炼依从性及康复训练效果.结果:观察组患者1月内康复训练总完成率为95.7％,显著高于对照组康复训练总完成率87.0％,差异具有统计学意义(P＜0.05);观察组患者术后24h、48h、96h疼痛评分均显著低于对照组,差异具有统计学意义(P＜0.05).结论:疼痛护理可有效降低髋关节置换术后患者的疼痛程度,有利于提高康复训练完成率,强化手术效果,改善活动功能,值得临床推广应用.     

预防维持性血液透析患者发生动静脉内瘘失功的护理对策

目的 探讨预防维持性血液透析患者发生动静脉内瘘失功的护理对策.方法 选取河南省某医院于2017年1月—2021年1月收治的60例维持性血液透析患者为研究对象.采用随机数字表法将患者分为对照组和观察组,每组30例.对照组患者给予常规护理干预.观察组患者给予针对性护理干预.比较2组患者干预前及干预6个月时焦虑自评量表(SAS)、抑郁自评量表(SDS)评分、健康知识掌握情况及生活质量;比较2组患者干预6个月时并发症发生情况.结果 干预前,2组患者SAS及SDS评分比较,差异无统计学意义(P＞0.05).干预6个月时,2组患者SAS及SDS评分均低于干预前,且观察组低于对照组,差异均有统计学意义(P＜0.05).干预前,2组患者健康知识掌握评分比较,差异无统计学意义(P＞0.05).干预6个月时,2组患者健康知识评分均高于干预前,且观察组高于对照组,差异均有统计学意义(P＜0.05).干预前,2组患者生活质量量表中躯体功能、认知功能及社会功能评分比较,差异无统计学意义(P＞0.05).干预6个月时,2组患者生活质量量表中躯体功能、认知功能及社会功能评分均高于干预前,且观察组高于对照组,差异均有统计学意义(P＜0.05).观察组患者并发症发生率低于对照组,差异有统计学意义(P＜0.05).观察组患者动静脉内瘘失功发生率低于对照组,差异有统计学意义(P＜0.05).结论 对维持性血液透析患者采用针对性护理措施可有效改善患者不良的心理状态,提高健康知识水平和生活质量,降低并发症发生率及动静脉内瘘失功发生率,进而提高患者透析质量.     

综合干预对降低急性胰腺炎合并心肌损害等并发症的临床研究

目的 探讨综合护理干预对减少急性胰腺炎合并心肌损害等并发症的临床效果.方法 2007年9月～2011年12月在某院住院治疗的急性胰腺炎合并心肌损害患者167例,根据护理方式的不同将两组患者分为观察组(n=78)和对照组(n=89),观察组采用综合护理干预模式,对照组采用常规护理模式,比较两组患者住院时间、住院期间并发症的发生情况.结果 观察组临床效果优于对照组,差异有统计学意义(P＜0.05);采用综合护理干预组患者对冠心病知识的掌握率和对护理工作的满意度分别为93.6％、96.2％,显著高于对照组76.4％、85.4％,差异有统计学意义(P＜0.05);对照组住院期间各种并发症的发生率均显著高于观察组,差异均有统计学意义(P＜0.05).结论 采用综合护理干预能显著提高患者的临床疗效,减少住院期间各种并发症的产生.     

阶段性护理干预在乳腺癌患者手术后康复中的应用效果分析

目的:探讨阶段性护理干预在乳腺癌患者手术后康复中的影响.方法:选取我院2014-2016年30例乳腺癌术后患者作为观察组,对乳腺癌患者术后康复进行阶段性护理干预.选取2014年以前我院收治的30例乳腺癌术后患者作为对照组,对照组患者术后采用乳腺癌术后康复的常规护理措施.对比两组患者在术后60天的上肢功能评分以及生存质量量表(HQOL)评分.结果:观察组乳腺癌术后上肢功能康复的评分在术后60天明显大于对照组患者,并且在上肢功能上升趋势上明显大于对照组患者.观察组乳腺癌术后康复患者的生存质量量表(HQOL)评分显著高于对照组患者.对比两组差异有统计学意义(P＜0.05).结论:阶段性护理干预可促进乳腺癌患者术后的康复,提高患者的生活质量.     

健康教育联合护理干预在肛周疾病术后护理中的实效

目的:探讨健康教育联合护理干预对肛周疾病患者术后护理的实效性及生存质量的改善情况.方法:选取2012年3月至2013年12月期间绍兴市第二医院肛肠诊疗中心收治的肛周疾病患者1 200例,随机分为对照组(600例)和观察组(600例).对照组患者采用常规护理治疗,观察组患者在常规护理的基础上进行健康教育联合护理干预,对两组患者的负面情绪及生存质量情况进行比较分析.结果:对照组出现焦虑、忧郁等心理问题的患者为305例,占50.8％,观察组心理问题患者有232例,占38.7％,两者有显著差异(P＜0.05).观察组患者对医护人员的护理工作满意度较对照组升高,观察组总满意率为95.83％(575/600),而在对照组总满意率为75.00％(450/600),差异具有统计学意义(P＜0.05).观察组患者各项生存质量指标与对照组相比均有显著提高(P＜0.05).结论:健康宣教联合护理干预应用于肛周疾病患者术后护理有良好的实效性,可以有效减少患者心理问题,改善患者的生存质量.     

Cancer care. Palliative care. The last days of care

The government has promised a further 12m pounds over three years for end-of-life care, on top of the 50m pounds a year for palliative care. A framework developed by Macmillan Cancer Relief has identified seven gold standards of care including communication, coordination, control of symptoms, carer support and care in the dying phase. The government has committed to doubling the number of palliative care consultants by 2015.     

Quality of care for primary care patients with depression in managed care

OBJECTIVE: To evaluate the process and quality of care for primary care patients with depression under managed care organizations. METHOD: Surveys of 1204 outpatients with depression at the time of and after a visit to 1 of 181 primary care clinicians from 46 primary care clinics in 7 managed care organizations. Patients had depressive symptoms in the previous 30 days, with or without a 12-month depressive disorder by diagnostic interview. Process indicators were depression counseling, mental health referral, or psychotropic medication management at index visit and the use of appropriate antidepressant medication during the last 6 months. RESULTS: Of patients with depressive disorder and recent symptoms, 29% to 43% reported a depression-specific process of care in the index visit, and 35% to 42% used antidepressant medication in appropriate dosages in the prior 6 months. Patients with depressive disorders rather than symptoms only and those with comorbid anxiety had higher rates of depression-specific processes and quality of care (P < .005). Recurrent depression, suicidal ideation, and alcohol abuse were not uniquely associated with such rates. Patients visiting for old problems or checkups received more depression-specific care than those with new problems or unscheduled visits. The 7 managed care organizations varied by a factor of 2-fold in rates of depression counseling and appropriate anti-depressant use. CONCLUSIONS: Rates of process and quality of care for depression as reported by patients are moderate to low in managed primary care practices. Such rates are higher for patients with more severe forms of depression or with comorbid anxiety, but not for those with severe but "silent" symptoms like suicide ideation. Visit context factors, such as whether the visit is scheduled, affect rates of depression-specific care. Rates of care for depression are highly variable among managed care organizations, emphasizing the need for process monitoring and quality improvement for depression at the organizational level.     

Perioperative care: preoperative care

With a subject as vast as preoperative care its is impossible in an article of this length to do more than sketch in the broad outlines of assessment and preparation, using a few examples to illustrate certain aspects. Unfortunately the pressure of work in most hospitals is such that the standard of preoperative care is not as high as it might be. Many authors have stressed its values not only in making anaesthesia safer but especially in reducing the incidence of postoperative morbidity--a field that has received too little attention for too long.     

Nutritional care in care homes: experiences and attitudes of care home staff

Background: The Food Award Barnsley (FAB) is organised for care homes that meet nutritional criteria based on national recommendations. Research (Thompson, 2003) highlighted that meeting FAB criteria is not an assurance that residents are receiving adequate nutrition. This is supported by studies demonstrating multiple individual/organisational factors influencing rates of malnutrition in care establishments (Abbasi & Rudman 1994; Health Advisory Services, 2000). To develop a training intervention to support FAB, an understanding of the role, perceptions and attitudes of care staff in the process of nutritional care was required. The main research aims were to describe staff's experiences of nutritional care of service users, to explore staff's attitudes towards nutritional care of service users and to highlight issues relating to nutritional care which could be considered when developing training programmes or provide the basis for future research. Methods: A care home that held the silver FAB, offered nursing and residential care and had more than 20 beds was chosen. Maximum variation sampling was used to select a cross‐section of staff in terms of position, level of education and length of service. Twelve semi‐structured interviews were recorded, transcribed and analysed using the template approach as developed by King (1998). The process from which the conclusions of the study were drawn was made clear through documentation. The audit trail within the final report demonstrates dependability and confirmation and hence the rigour of the study. Results: In general staff felt they were effective in identifying and addressing issues of malnutrition. However, from a dietetic perspective there was a fragmented approach to nutritional care. At all levels ‘confused role expectations’, lack of clear action planning, poor communication and attitudes towards malnutrition represented a significant barrier to good nutritional care within the home. Despite using a nutritional screening tool, staff relied more heavily on their own subjective judgement to identify residents who they thought were malnourished. Care home staff at all grades considered a poor appetite to be a ‘normal’ part of ageing and some felt that in conditions such as Parkinson's Disease it was expected that residents would lose weight. Portion sizes were reduced regardless of the need for compensation for reduced nutritional intake. Discussion: The lack of a coherent approach to nutritional care coupled with poor communication at all levels resulted in the risk that residents were not receiving appropriate nutritional care. Staff relied on their own judgement, not an objective measure; to identify residents they thought were at risk of malnutrition. These problems were compounded by attitudes of staff at all levels to nutrition, weight and ageing which resulted in lack of intervention in residents who were malnourished or at risk of malnutrition. Conclusion: This study highlights barriers to changing the process of nutritional care within the home which should be addressed through training, whilst ensuring national nutritional standards for provision of food are met. References Abbasi, A. & Rudman, D. (1994) Under nutrition in the nursing home: Prevalence, consequences, cause and prevention. Nutr. Rev. 52, 113–122. Health Advisory Services. (2000) “Not Because they are Old”. An Independent Inquiry into the Care of Older People on Acute Wards in General Hospitals. London: Health Advisory Services. King, N. (1998) Template analysis. In Qualitative Methods and Analysis in Organisational Research. eds C. Cassell & G. Symons, pp. 118–134. London: Sage. Thompson, L. (2003) Nutritional Perceptions among Staff Working in a Care Home for Elderly People and the Potential for Nutrition Education. BSc thesis, Leeds Metropolitan University.