综合医院手术出院病人不同时期的社区护理需求

[目的]了解综合医院手术出院病人在出院当日、出院1周、出院4周的社区护理需求变化,为建立区域性综合医院和社区护理网络,开展出院病人社区护理服务提供理论依据.[方法]采用整群抽样的方法选取综合医院257例手术病人,运用自制调查表,在病人出院当日、出院1周、出院4周时进行随访调查.[结果]98.4%的被调查者出院时存在1项以上社区护理需求.居前5位的社区护理需求项目是活动指导、复查就诊指导、定期体检、伤口护理、并发症识别与护理.在出院当日、1周、4周时 13项社区护理服务项目需求得分差异有统计学意义(P<0.05).对疾病护理、健康指导类项目的需求程度总体上呈下降趋势,但出院1周时症状护理、自我护理技能指导的需求程度增高.[结论]以需求为导向,根据手术病人实际情况,提供有针对性的社区护理服务,对于促进疾病完全康复与健康具有重要意义.     

泌尿外科日间手术患者延续性护理需求分析

目的 调查泌尿外科日间手术患者对延续性护理的需求状况,分析其影响因素,为构建科学、有效的延续性护理模式提供依据。方法 采用自行编制的调查问卷对武汉市某三甲医院泌尿外科行日间手术的患者进行延续性护理需求调查,采用有序多分类logistic回归模型分析其影响因素。结果 本次调查中有65%的患者希望接受延续性护理服务。需求内容上“术后感染的护理”和“术后血尿的护理”排名最前；服务方式上电话或短信随访和出院健康指南接受度最高；服务人员方面患者更希望由医生、护士为其提供延续性护理服务；在随访时间和随访频次方面,患者的需求较为多元。日间手术患者的延续性护理服务需求与年龄、性别、文化程度、婚姻状况、付费方式、职业、手术次数和手术类型有关。结论 泌尿外科日间手术患者的延续性护理服务需求较高,需求的内容以专科护理需求和并发症护理需求为主,需求的形式灵活多样,在为泌尿外科日间手术患者提供延续性护理服务时应把握重点人群,以患者需求为导向,采取多模式的随访方式,构建医院—社区一体化延续性护理团队,为患者提供科学、有效的延续性护理。     

手术患者出院后对延续护理服务需求的调查分析

目的:调查分析适合手术患者出院后延续护理服务的模式和内容。方法:采用自行设计的需求调查问卷对128例患者进行调查。结果:47.7%~68.8%的患者表示需要基本健康和疾病方面的相关知识,72.7%~83.6%的患者表示不需要介入性治疗护理操作和专科护理操作知识;延续护理服务以门诊复查和电话为主;55.6%的患者表示希望由医生进行延续服务,35.1%的患者希望由护士进行。结论:延续护理以门诊复查和电话方式为主。     

前列腺癌根治术后患者延续护理服务需求的调查

目的调查前列腺癌根治术后患者延续护理服务需求情况,为制定个性化护理措施提供理论和实践依据。方法采用自行设计的调查问卷对96例前列腺癌根治术后患者的延续护理服务需求内容和方式进行调查。结果在延续护理服务内容上,前列腺癌患者对术后切口护理(96.9%)、术后并发症预防(93.8%)、活动锻炼(96.9%)、出院后复诊及预约(91.7%)、后续治疗(96.9%)、复发及预后信息咨询(96.9%)的服务内容有较高的需求;在延续护理服务方式上,99.0%患者选择医院专科门诊随访,81.3%患者选择电话、短信、网络咨询疾病的康复知识,仅有8.3%患者选择到社区医疗服务部门复诊。结论前列腺癌根治术后患者有较多延续性护理服务需求,医护人员应根据患者疾病及需求提供针对性延续护理服务。     

乌鲁木齐市高血压病人社区卫生服务需求及利用情况分析

[目的]了解乌鲁木齐市高血压病人对社区卫生服务的需求、利用情况以及影响因素。[方法]采用分层整群抽样方法,随机抽取乌鲁木齐市三级甲等医院及二级甲等医院心血管内科316例高血压出院病人进行调查。[结果]病人出院后2周就诊率为47.15%;其中,社区就诊率仅为7.38%。出院后2周内采用家庭护理方式的病人占44.6%,80.7%的被调查对象出院后2周内有自购药品。多元逐步回归分析结果显示:婚姻、就业、文化程度、医疗费用支付方式等因素影响病人对社区卫生服务的利用。[结论]高血压病人出院时仍有较高水平的社区卫生服务需求,应大力发展社区卫生服务,缓解高需求低利用的矛盾。     

肛肠疾病患者健康教育需求调查及对策

目的了解肛肠疾病住院手术患者对健康教育需求情况,以采取更合理的教育方式,满足患者需求,提高护理质量。方法采用自拟的健康教育内容与方式需求调查表,专人负责一对一询问方式,对肛肠疾病住院手术患者进行调查。结果患者术前最关心疾病病情、手术效果、住院费用及病程;术后最关心切口信息,需要了解疾病自我护理知识及肛门功能锻炼方式;出院后最关注疾病预防措施,以防复发。住院期间最受欢迎的教育方式是医护人员的讲解和示范,以及病友之间的经验交流;出院后以电话咨询为主。结论在开展健康教育时,要针对患者对健康教育知识的需求特点,有针对性地进行宣教。     

南昌市糖尿病患者社区护理需求调查及其影响因素分析

目的调查分析南昌市糖尿病患者社区护理需求现状及其影响因素。方法选取南昌市3个社区卫生服务中心的292例糖尿病患者作为调查对象,利用自制调查表进行调查。结果南昌市糖尿病患者社区护理总需求处于中等水平,得分为(3.99±0.19)分,患者对健康促进方面需求最高,并发症防护方面需求最低。从具体项目看,提供血糖、血压、肝、肾功能等的定期检查在糖尿病疾病护理方面需求最高,达100%;并发症防护方面,低血糖的预防宣教和紧急救护需求较高,占98.6%;健康促进方面,提供健康行为与生活方式指导的需求占96.9%。影响糖尿病患者对社区护理各方面需求的主要因素有糖尿病并发症状况、治疗方式、年龄及主要照顾对象等,其中有无并发症是影响糖尿病患者社区护理需求的重要因素。结论积极开展糖尿病社区护理须以患者需求为导向,根据影响需求的因素,切实在疾病护理、并发症防护和健康促进3方面拓展服务内容和完善服务模式。     

妇科患者延续护理服务需求现状调查

目的 探讨适合妇科患者的延续护理服务模式和服务内容.方法 采用自行设计的调查问卷对131例患者于出院当天进行延续护理服务的需求调查.结果 所有患者均认为延续护理服务是必要的,其中78.63%的患者认为"电话随访"是较合适的服务模式,70.23%的患者需要"意外情况(如发热、腹痛、阴道出血等)的处理"方面的指导.结论 妇科需要开展以电话随访为主的延续护理服务,以提高出院患者生活质量.     

先天性心脏病延续护理服务内容需求认知情况的调查研究

目的 调查临床护士对先天性心脏病延续护理服务需求的认知状况。方法 对我院胸心血管外科及心血管内科 95 名临床 护士展开问卷，调查内容包括服务内容需求，服务方式需求，服务执行者需求，服务意义与现状和服务障碍与挑战的认知。结 果 临床护士认为出院患儿需求较高的延续护理项目为出院计划（98.9%）、用药指导（97.8%）、病情观察（97.8%）。延续护理 服务方式较多的为出院宣教（98.9%）、电话/短信随访（78.9%）、建立健康教育网络平台（75.7%）。执行者为社区护士（90.5%）、 社区医生（89.4%）、医院—社区一体化小组（84.2%）。60.5%的护士认为应为患儿提供延续护理服务，92%的护士认为开展延 续护理服务能够促进疾病康复，减少并发症。76.3%护士认为延续服务会增加工作压力；62.7%护士认为缺乏医院—社区联网协 作机制。结论 护士对先天性心脏病术后出院患儿的出院后的出院计划、用药指导、病情观察是非常重视的。同时医院临床护 士也希望社区医生及护士能参与患儿术后的康复治疗。     

老年糖尿病社区医疗满意度及护理需求调查与分析

目的:探讨老年糖尿病患者对社区医疗服务满意状况及护理需求。方法:采用分层整群随机抽样方法抽取银川市4个社区老年糖尿病患者216例,调查患者对社区医疗机构的满意状况及护理需求。结果:银川市老年糖尿病患者208例完成调查,对社区医疗机构不满意154例,主要表现在药品品种少(41.83%)和医疗设备简陋(40.38%);在社区护理需求方面,需求较高的主要是老年慢性病预防宣教与护理(67.31%)、患病时护士上门护理(63.46%)和眼部疾病预防知识宣教(61.54%)等。结论:在老年糖尿病患者聚居的小区社区卫生服务机构应以老年慢性病的预防宣教与护理、患病时护士上门护理和眼部疾病预防知识宣教等为重点内容。     

不同学历护生对优质护理认知现状的调查分析

目的 调查不同学历护生对优质护理的认知现状,归纳分析其对优质护理观点的异同.方法 采用问卷调查法,对哈尔滨市某三级甲等医院105名实习护生进行调查,了解不同学历护生对优质护理的认知现状,并对结果进行分析.结果 不同学历护生在优质护理6个维度即:护士的工作态度、专业技术和能力、优质护理的先提条件、病区环境、护理操作是否及时以及与患者家属的合作性方面的认知程度比较无显著差异,在6个维度下的14个条目中认知程度比较有显著差异.结论 不同学历护生均认为护士的工作态度是优质护理中最重要的,而对与患者家属的合作性这一维度认识不足.     

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.     

成立“病人服务中心”的做法与成效

目的完善护理服务，提高病人满意度。方法成立“病人服务中心”，对住院病人进行床前访视；对出院病人实施电话随访及上门访视：开展免费服务项目，尽力满足病人需求。结果病人满意度提高（P〈0．01）。2005年与2004年相比、2006年与2005年相比，住院病人增长率分别为15．31％、30．20％；业务收入增长率分别为30．20％、19．59％；床位周转增长率分别为53．19％、20．37％。结论“病人服务中心”在优化医院服务流程、提高病人满意度、提升医院服务品牌等方面起到了重要作用。     

Assessment of dependency levels of older people in the community and measurement of nursing workload

AIM: This paper is a report of a study to explore the relationship between the dependency levels of older people who are part of the community nurse's caseload and the volume and nature of nursing input required. BACKGROUND: International healthcare policy has consistently emphasized the reorientation of health services from hospital to community care. It is necessary to determine ways to use nursing resources appropriately to meet service needs of an increasing older population. METHOD: This quantitative study was conducted in one region of Ireland, which included a city and sparsely populated rural areas. Over a 4-week period in 2004, a volunteer sample of 44 nurses assessed all older people (1482) on their community caseload using the Community Client Need Classification System. In addition, participants recorded the amount of care time spent with each individual client by all members of the community nursing team. FINDINGS: The vast majority of clients were seen in their own homes (85%, n = 1259). On the 5-point Community Client Need Classification System, the majority (39%, n = 571) were assessed at level 2 (low level of need) and 4% (n = 61) at level 5 (high level of need). As client need level increased, the consumption of community nursing time also increased. CONCLUSION: The tool was successful in discriminating between care needs levels of older people and may be useful in predicting the type and amount of human resources required by individuals who need community nursing services. Lack of information on demographic variables may limit the transferability of these findings.     

Nurse discharge planning in the emergency department: a Toowoomba, Australia, study

Aim. This study aimed to ascertain whether a model of risk screening carried out by an experienced community nurse was effective in decreasing re‐presentations and readmissions and the length of stay of older people presenting to an Australian emergency department. Objectives. The objectives of the study were to (i) identify all older people who presented to the emergency department of an Australian regional hospital; (ii) identify the proportion of re‐presentations and readmissions within this cohort of patients; and (iii) risk‐screen all older patients and provide referrals when necessary to community services. Design. The study involved the application of a risk screening tool to 2139 men and women over 70 years of age from October 2002 to June 2003. Of these, 1102 (51·5%) were admitted and 246 (11·5%) were re‐presentations with the same illness. Patients presenting from Monday to Friday from 08:00 to 16:00 hours were risk‐screened face to face in the emergency department. Outside of these hours, but within 72 hours of presentation, risk screening was carried out by telephone if the patient was discharged or within the ward if the patient had been admitted. Results. There was a 16% decrease in the re‐presentation rate of people over 70 years of age to the emergency department. Additionally during this time there was a 5·5% decrease in the readmission rate (this decrease did not reach significance). There was a decrease in the average length of stay in hospital from 6·17 days per patient in October 2002 to 5·37 days per patient in June 2003. An unexpected finding was the decrease in re‐presentations in people who represented to the emergency department three or more times per month (known as ‘frequent flyers’). Conclusions. Risk screening of older people in the emergency department by a specialist community nurse resulted in a decrease of re‐presentations to the emergency department. There was some evidence of a decreased length of stay. It is suggested that the decrease in re‐presentations was the result of increased referral and use of community services. It appears that the use of a specialist community nurse to undertake risk screening rather than the triage nurse may impact on service utilization. Relevance to clinical practice. It is apparent that older people presenting to the emergency department have complex care needs. Undertaking risk screening using an experienced community nurse to ascertain the correct level of community assistance required and ensuring speedy referral to appropriate community services has positive outcomes for both the hospital and the patient.     

Demands for religious care in the Taiwanese health system

In order to care ethically nurses need to care holistically; holistic care includes religious/spiritual care. This research attempted to answer the question: Do nurses have the resources to offer religious care? This article discusses only one aspect--the provision of religious care within the Taiwanese health care system. It is assumed that, if hospitals do not provide enough religious services, nurses working in these hospitals cannot be fully ethical beings or cannot respect patients' religious needs. The relevant literature was reviewed, followed by a survey study on the provision of religious facilities and services. Aspects considered are: the religions influences in and on Taiwanese society; the religious needs of patients and their families; strategies that patients use to enable them to cope with their health care problems; professional motives for attuning to patients' religious needs; and hospital provision for meeting the religious and spiritual needs of patients. A survey of nursing executives showed differences between religious service provision in hospitals with and without a hospice ward. The practical implications for hospital management and nursing practice are discussed.     

Effects of reduction of acute hospital services on district nursing services: implications for quality assurance

Two questions of importance to those concerned with maintaining standards and increasing the efficiency of Community Nursing are: (1) does reducing hospital provision alter the number of patients referred for Community Nursing or the type of care provided; (2) are Community Nursing Services directed towards those who most require them? A base-line study was carried out in the first quarter of 1988, before the closure of one of two general hospitals in an inner London Health Authority and was replicated in the same quarter of 1989, after all acute inpatient services had been transferred to the other hospital. Comparison of patients discharged before and after closure showed no significant differences in patients' age, sex, proportion living alone, length of stay in hospital, readmissions or deaths within one month of discharge. There was some decline in general nursing care. Total discharges declined by 20% while the number of referrals remained the same, indicating that proportionately more patients were discharged with a referral. Comparing referred and unreferred patients showed that Community Nursing Services were already being directed towards those most in need both before and after hospital closure. Results suggest that Community Nursing helps to maintain patients in the community.     

Probable alcohol abuse or dependence: a risk factor for intensive-care readmission in patients undergoing elective vascular and thoracic surgical procedures. Mayo Perioperative Outcomes Group.

OBJECTIVE: To determine whether alcohol abuse or dependence is a risk factor for perioperative complications, increased duration of hospital stay, and increased utilization of nursing resources in patients undergoing thoracic and vascular surgical procedures. MATERIAL AND METHODS: We conducted a prospective study of all adult patients who underwent an elective vascular or thoracic surgical procedure and who received postoperative care in an intensive-care setting. Patients were screened for alcohol abuse or dependence, and actual versus expected durations of stay were evaluated. The patients' medical records were reviewed for preoperative comorbidities and perioperative complications. Fisher's exact test and the rank sum test were used in the analyses. RESULTS: Of 321 study subjects, 290 were classified as nonalcoholic and 31 as probable alcoholic patients. Patients in the probable alcohol abuse group had a significantly increased rate of alcohol withdrawal (12.9% versus 1.7%; P = 0.006) in comparison with patients in the nonalcoholic group. Patients in the probable alcohol abuse group were readmitted to an intensive-care unit more frequently (19.4% versus 7.9%; P = 0.047) and required sedation more often (32.3% versus 13.5%; P = 0.014) than those in the nonalcoholic group. No significant differences were found between the two study groups in intensive-care unit and hospital durations of stay or in utilization of nursing resources. A dismissal diagnosis of alcoholism was recorded for only one of four patients who had a documented withdrawal episode among those categorized in the probable alcoholic group and for three of five patients with alcohol withdrawal symptoms categorized in the nonalcoholic group. CONCLUSION: Except for the occurrence of alcohol withdrawal syndrome, study patients classified in the probable alcohol abuse group did not have more medical or surgical perioperative complications than patients in the nonalcoholic group. They did have significantly more intensive-care setting readmissions. Patients with documented alcohol withdrawal episodes frequently were dismissed without a diagnosis of substance abuse or dependence.     

Research in the community hospital.

Research is an essential component in professional nursing practice. Although nursing research efforts have increased, there is little evidence of a consistent infrastructure within the community hospital to promote research utilization and the conduct of nursing research. There are multiple mechanisms for nurse administrators to support research efforts in the community hospital. We discuss the value of research and research utilization in the community hospital and suggest some practical strategies for nurse administrators to support research efforts.     

上海市金山区居家腹膜透析患者的延续性护理需求研究

目的：明确上海市金山区居家腹膜透析患者的护理服务需求,以指导社区卫生服务中心明确腹膜透析延续护理服务内容,以供同行参考和推广。方法：采用全样本纳入,选取上海市金山区所有居家腹膜透析患者开展问卷调查。调查工具包含基本情况、护理问题评分、护理需求评分三个部分。由社区卫生服务中心护理人员于2018年12月～2019年4月期间,针对各自辖区内的居家腹膜透析患者,当场发放和回收问卷。共发放问卷91份,回收问卷91份,有效问卷91份,有效回收率为100.0%。结果：本次调查的91例金山区居家腹膜透析患者,男性39例(占42.9%),女性52例(占57.1%),居家腹膜透析5.21±2.7年。在4个护理问题领域存在21个护理问题和42种症状体征；建档与随访管理需求4.14±0.69分,健康教育需求4.02±0.93分,个体化指导需求3.95±0.91分,专科护理需求3.84±1.01分。不同街道患者的专科护理需求(p<0.001,H=67.757)、建档随访需求(p<0.001,H=48.191)、健康教育需求(p<0.001,H=67.401)、个体化指导需求(p<0.001,H=65.000)评分差异有统计学意义。生理护理问题与建档随访管理需求之间呈现正相关关系(p=0.042,rs=0.214),与个体化指导需求之间呈现正相关关系(p=0.029,rs=0.229)。结论：现阶段上海市金山区居家腹膜透析患者,其护理需求集中在建档随访管理和个体化指导方面,不同居住街道的患者在护理需求方面存在一定差异。社区在提供相关延续护理服务时,可以将护理重点首先放在为患者建立长期随访档案、根据生理健康情况给予针对性宣教和心理疏导。