延续护理在ICU出院患者中应用的范围综述

目的对延续护理在重症监护病房(ICU)出院回家患者中应用的研究进行范围审查,以识别其延续护理内容及结局,为未来该领域的研究提供指导。方法检索PubMed、The Cochrane Library、Medline、CINAHL Complete、EMbase、中国知网(CNKI)、维普资源总库(VIP)、万方数据库(Wanfang Database)和中国生物医学文献数据库(SinoMed),检索时限为1980年1月—2021年3月,由2名研究员独立筛选、提取资料。结果纳入9篇文献。延续护理干预要素包括电话随访、家访、在线访视、门诊随访、同伴支持、健康教育、医院门诊或居家康复运动支持,一定程度上改善患者躯体功能、心肺功能和心理状况,提高生活自理能力和生活质量。结论多要素结合的延续护理对ICU直接出院回家患者结局起到积极影响,后续有待关注家属和探究科学的延续护理个案管理模式。     

医院—社区延续护理方案对结直肠癌术后出院患者生活质量的影响

目的探讨医院-社区延续护理方案对结直肠癌术后出院患者生活质量的影响。方法 2015年4月至2016年3月,便利抽样法选取上海交通大学医学院附属同仁医院肛肠外科行结直肠癌根治术后出院患者为研究对象。按出院先后将患者分为对照组(n=47)和观察组(n=48)。对照组采用常规门诊随访,观察组出院后接受医院-社区延续护理方案,比较两组患者出院当日、出院后1、3个月生活质量指标。结果出院后1个月两组患者总体生活质量评分差异无统计学意义(P0.05),但观察组患者躯体功能和情绪功能评分优于对照组,疲劳、恶心呕吐,食欲降低、便秘、腹泻症状少于对照组,差异均有统计学意义(均P0.05)。出院3个月后,观察组患者生活质量各项评分均高于对照组,差异均有统计学意义(均P0.05)。结论医院-社区延续护理方案在改善结直肠癌术后患者出院1个月后的部分功能和症状方面体现了初步效果,在提高患者出院3个月后的生活质量方面有显著积极意义。     

对出院精神分裂症患者开展延续护理服务的效果观察

目的探讨对出院精神分裂症患者开展延续护理服务的效果。方法将116例出院精神分裂症患者随机分为对照组58例和实验组58例。对对照组采用门诊随访、传统应答措施;对实验组进行为期1年的延续护理服务,采用护患沟通、病友交流、播放录像、电话随访与支持等形式开展延续护理服务。比较2组患者对精神分裂症的认知程度、服药依从性、病情复发率及社会功能方面的差异。结果实验组患者在疾病知识认知度、服药依从性、病情复发率、社会功能恢复方面均显著优于对照组,p<0.05。结论对出院精神分裂症患者开展延续护理服务有助于患者出院后疗效的维持及疾病的恢复,能够减少疾病复发,对其社会的功能改善有十分积极的意义。     

延续护理对肾移植出院患者生活质量和自我管理的影响

目的:探讨延续护理对肾移植出院患者生活质量和自我管理的影响。方法 :选择2014年8月~2016年8月在我院行肾移植手术患者64例。将患者随机等分为观察组和对照组。对照组出院后予以常规随访,观察组予以延续性护理。在患者出院时(干预前)和出院6个月后(干预后)进行生活质量评价和自我管理能力评价。结果:观察组患者干预后的生理功能、心理功能、社会功能、疾病治疗、认知功能和生活质量总评分及运动锻炼、症状管理、心理调适等自我管理评分均高于对照组(P0.05)。结论:为肾移植出院患者提供延续护理,能够改善患者自我管理能力和生活质量,值得临床推广应用。     

ICU后门诊的建立与运行实践

目的 :评价ICU后门诊的实践效果。方法 :设立ICU后门诊,采用医护协作诊疗模式,对ICU出院患者进行综合评估,制定康复方案并指导实施,必要时专科转诊,同时提供动态延续护理服务。结果 :ICU后门诊开设2年多来,共随访患者146例,健康评估346例次,运动方案指导及日常生活能力训练334例次,呼吸训练214例次,健康指导379例次,ICU后门诊随访患者的再住院率低于电话随访组(P0.05),重返工作率高于电话随访组(P0.05)。患者及家属满意度为99.07%,出诊护士认为ICU后门诊有利于提高自我专业问题处理能力。结论:ICU后门诊可有效解决ICU出院患者康复问题,有利于患者身体及社会功能恢复,提升患者满意度及护士专业能力。     

电话回访式延续护理对精神分裂症出院患者服药依从性及生活质量的影响

目的探讨电话回访式延续护理对精神分裂症出院患者服药依从性及生活质量的影响。方法将80例精神分裂症患者按住院号末位数单双号随机分为观察组和对照组各40例,观察组出院后进行电话回访式延续护理,对照组出院后进行常规门诊随诊,在患者出院1年时调查两组服药依从性、复发率,用生活质量综合评定问卷(GQOLI-74)评价两组的生活质量情况。结果出院1年后,观察组的服药依从性明显好于对照组,且复发率低于对照组,GQOLI-74评分高于对照组,差异具有统计学意义(P0.05)。结论电话回访式延续护理能提高精神分裂症出院患者服药依从性,降低复发率,从而提高社会功能和生活质量,对精神分裂症患者的康复具有积极作用。     

食管癌患者延续护理服务的文献研究

目的 系统检索、阅读和分析相关文献,以识别食管癌延续护理的关键组成部分,探索敏感性结局指标.方法 英文数据库检索The cochrane library,Pubmed,MEDLINE,Wiley,EBSCO Host;中文数据库检索中国学术期刊全文数据库、中国科技期刊全文数据库、万方科技期刊全文数据库.检索食管癌延续护理相关文献,以Donabedian结构-过程-结果质量评价模式为框架对文献进行分析.结果 纳入15篇相关文章：4篇指南,3篇RCT和8篇其他类型文献.纳入的文献中均强调了食管癌患者随访的重要性,但研究随访对患者健康结局影响的文献较少,且缺乏特异性食管癌延续护理指南.结论 食管癌及其他病种的延续护理项目进一步发展需要考虑：（1）对医院结构、延续护理实践者、食管癌患者的特点、照护过程、患者临床结局等进行综合评估;（2）关注患者、多学科合作小组、患者的家庭照顾者或社会工作者共同参与的多维度干预模式;（3）标准化文件工具如过渡医疗记录单、评估表、照护计划等的构建;（4）敏感性结局指标.     

中医延续护理对提高脑卒中患者出院后生活能力和运动功能的应用研究

目的探讨中医延续护理对脑卒中患者出院后日常生活能力和运动功能的影响。方法选择脑卒中患者142例分为试验组和对照组,对照组给予常规出院指导和出院后连续3个月每周一次电话随访,试验组在对照组的基础上进行中医延续护理。结果出院后3个月试验组脑卒中患者日常生活能力和运动功能均高于对照组(P<0.01)。结论中医延续护理能有效改善脑卒中患者出院后的日常生活能力和运动功能,提高患者满意度和生活质量。     

延续护理服务在肠造口患儿出院早期的应用研究

目的探讨延续护理服务在肠造口患儿出院早期的应用效果。方法选择2013年12月-2014年12月在我科住院的60例肠造口患儿及其家庭为研究对象,在患儿出院时及出院2周内,通过造口知识培训、电话随访、建立肠造口患儿康复群和开设造口门诊预约等方式,采用延续护理测评量表,对居家造口护理指导前、后患儿的相关情况进行评价和比较。结果延续护理提高了患儿及家长造口护理知识和技能,改善了患儿自身健康管理依从性,无造口并发症发生,与实施前相比差异有统计学意义(P0.01)。结论延续护理服务能改善患儿的健康结局,保证专业护理的连续性,提高护理满意度。     

延续护理及时长对人工全膝关节置换术后患者康复效果影响的Meta分析

目的 通过Meta分析,系统评价延续护理及随访时间差异对人工全膝关节置换术后患者康复的影响。 方法 系统检索Cochrane Library、PubMed、Embase、web of science、中国生物医学文献数据库、万方数据库、中国知网数据库中延续护理对人工全膝关节置换术后患者康复效果影响的随机对照试验,由2名研究人员独立筛选文献并提取资料,对符合质量标准的随机对照试验进行Meta分析。结果 共纳入13篇文献,包括1 211例研究对象。延续护理可提高患者膝关节功能[MD=8.02,95%CI (5.60,10.44),P<0.001],日常生活能力[MD=4.13,95%CI (2.50,5.75),P<0.001],以及生活质量的生理功能、躯体疼痛、总体健康、活力、社会功能、情感职能、心理健康维度;但随访时间是否超过6个月对以上结局指标的影响比较,差异无统计学意义。 结论 延续护理能促进全膝关节置换术后患者膝关节功能恢复、改善患者日常生活能力。最佳随访时间可能为术后6个月。     

Early Palliative Care Initiation: Role of the Primary Care Clinician

Palliative care provided to patients with chronic life-limiting illnesses shows improvement in symptom management, quality of life, and caregiver support while reducing cost of care. Early initiation of palliative care faces a multitude of barriers in the primary care setting, including provider confidence, coordination and implementation, education, and family and patient misconceptions. A team-based approach along with additional education, clear referral triggers, and resources for advanced-care planning discussions allows providers to overcome many of these barriers. With the population’s advancing age, it is essential that primary care providers are properly prepared for early initiation of palliative care.     

Advance care planning in Belgium and The Netherlands: a nationwide retrospective study via sentinel networks of general practitioners

Context

Advance care planning (ACP) is an important part of patient-centered palliative care. There have been few nationwide studies of ACP, especially in Europe.

Objectives

To investigate the prevalence and characteristics of ACP in two European countries and identify the associated factors.

Methods

A mortality follow-back study was undertaken in 2007 via representative nationwide Sentinel Networks of general practitioners (GPs) in Belgium and The Netherlands using similar standardized procedures. All GPs reported on each non-suddenly deceased patient in their practice. Our main outcome measure was whether or not ACP, that is, an agreement for medical treatment and/or medical decisions in the last phase of life in the case of the patient losing competence, was present.

Results

Among 1072 non-sudden deaths, ACP was done with 34% of patients and most often related to the forgoing of potential life-prolonging treatments in general (24%). In 8% of cases, ACP was made in consultation with the patient and in writing. In 23% of cases, care was planned with the patient’s family only. Multivariate analysis revealed that ACP was more often made with patients if they were capable of decision making during the last three days of life (odds ratio [OR] 3.86; 95% confidence interval [CI] 2.4-6.1), received treatment aimed at palliation in the last week (OR 2.57; 95% CI 1.6-4.2), had contact with a GP in the last week (OR 2.71; 95% CI 1.7-4.1), died of cancer (OR 1.46; 95% CI 1.1-2.0), or died at home (OR 2.16; 95% CI 1.5-3.0).

Conclusion

In these countries, ACP is done with approximately one-third of the studied terminally ill patient population. Most agreements are made only verbally, and care also is often planned with family only. ACP relates strongly both to patient factors and to health care measures performed at the very end of life.     

Consensus of the Millennium Conference on Teaching High Value Care

Issue: Healthcare costs have spiraled out of control, yet students and residents may lack the knowledge and skills to provide high value care, which emphasizes the best possible care while reducing unnecessary costs. Evidence: Mainly national campaigns are aimed at physicians to reconsider their test ordering behaviors, identify overused diagnostics, and disseminate innovative practices. These efforts will fall short if principles of high value care are not incorporated across the spectrum of training for the next generation of physicians. Implications: Consensus findings of an invitational conference of 7 medical school teams consisting of academic leaders included strategies for institutions to meaningfully incorporate high value care into their medical school, residency, and faculty development curricula.     

人文关怀在优质护理服务工作中的应用

目的探讨人文关怀在优质护理服务中的运用,强化护理责任感、落实基础护理,提高护理质量,提高患者满意度。方法通过营造良好的病区环境,增强护士综合素质和主动服务的意识,夯实基础护理,提供安全的护理,实施出院后的延续护理等措施,为患者提供优质护理。结果人文关怀在优质护理服务中的运用,切实提高了护士主动服务的意识,患者满意度和护理质量得到了提高,护理纠纷减少,患者满意度由85.77%提高到97.50%(P<0.01)。结论人文关怀在优质护理服务活动中,提升了护士与患者主动沟通的能力,促进患者的恢复,达到真正意义上的护患和谐、医患和谐和社会的和谐。     

ICUs worldwide: an overview of critical care medicine in South Africa

South Africa has undergone rapid changes in the political and social arenas since 1994. With new policy-makers in the Department of Health, the distribution of health care resources are being rationalised and redirected to benefit the majority of the previously disadvantaged population of the country. The role and rationalisation of intensive care medicine has to be re-evaluated to ascertain that it is at a level appropriate for a developing country. Despite progress made, the subspecialty of intensive care medicine faces challenges from changing disease patterns and from lack of human and financial resources as these are redirected to primary health care and other priorities facing the country.     

Use of Care by Home-dwelling Stroke Patients during Three Years following Hospital Discharge

Of 82 stroke survivors who had been discharged from hospital, 49 were still living at home after a three-year period. Thirty-three of these patients formed the population of the present study of the use of care at home. Sixty-one percent had received professional care and 88% had received family care. Although their overall functional status indicated only mild handicaps, after three years patients still reported a large number of disabilities and problems. The average weekly amount of family care was 37 h, and many family carers experienced a high burden of care and had emotional problems coping with the patients' disabilities. Concerning factors related to the use of care, in spite of the relatively small number of study patients, some interesting hypotheses can be advanced.     

A Case of Perceived Lack of Prenatal Caring

This qualitative case study tells the story of one woman’s experience of prenatal care through her own words and those of her mother, who is a nurse. Frequent sonograms, referral to a maternal–fetal medicine physician, and the unexpected recommendation to schedule an induction made this woman anxious about the well-being of her fetus, influenced her experience of pregnancy, and affected her developing identity as a mother. She felt neither cared for nor included as a partner in her own prenatal care. Although she reported feeling strong and capable in every other aspect of her life, she felt powerless to self-advocate with regard to her prenatal care experience. Ultimately, she asked her mother to accompany her to a prenatal appointment to advocate on her behalf.