运用循证护理探讨留置导尿管的更换时间

目的探讨留置导尿管患者更换导尿管的最佳时间。方法通过提出循证问题、循证支持、循证观察和循证应用4个步骤,对28例留置尿管患者运用循证护理：（1）动态监测尿液pH值;（2）严密观察患者的尿量、颜色及性质;（3）严格无菌操作,保持外阴部清洁。结果28例患者中,有3例患者为高危堵塞类（pH〉6．8）,每2周更换1次导尿管;25例患者为非堵塞类（pH〈6．7）,每4周更换1次导尿管,其中有3例因尿液混浊有沉淀,留置3周后给予更换。28例患者均未发生泌尿系感染。结论：运用循证护理更科学地提出了留置尿管患者更换导尿管的时间,减轻了患者的痛苦、减少了护理工作量,促进了护理学科的发展和护理人员知识的更新,有利于不断提高临床护理质量。     

危重病人留置导尿管更换周期的研究

[目的]探讨ICU留置导尿管病人不同更换周期对尿路感染阳性率及导尿管内腔细菌茵落计数的影响,为临床合理选择更换导尿管时间提供依据。[方法]根据导尿管更换时间不同,将病人随机分为每周更换组（A组）和2周更换组（B组）,共63例。在病人留置导尿管当天、第7天、第14天,分别采集晨起清洁中段尿,进行尿培养、尿常规检测。无菌剪刀留取导尿管膀胱内段气囊处2cm样本,进行细菌培养和计数。[结果]A组尿培养阳性率为29．03％,B组尿培养阳性率为33．33％,两组比较差异无统计学意义（P=0．777）;革兰氏阴性杆菌、革兰氏阳性球菌、真菌在两组间分布比较差异均无统计学意义义（P〉0．05）;两组导尿管内腔菌落计数比较差异无统计学意义（P=0．351）;A组导尿管细菌培养阳性率为41．92％,B组导尿管细菌培养阳性率为51．52％,两组比较差异无统计学意义（P=0．443）。[结论]长期留置尿管病人可2周更换1次导尿管。     

循证护理在留置导尿中的应用

通过对留置导尿过程中膀胱冲洗方法、时间、集尿袋及导尿管更换的时间的循证护理,认为循证是临床护理的基础,既提高了护理质量,又丰富了护理人员的知识,提高了护理人员分析问题解决问题的能力,进而提高了护理人员的专业性和技术性.     

国内长期留置导尿管患者硅胶导尿管更换时间的Meta分析

目的探讨长期留置导尿管患者更换硅胶导尿管的最佳时间。方法检索国内相关文献,采用Cochrane系统评价方法对符合纳入、排除标准的随机对照试验进行Meta分析。研究对象为已发表的有关长期留置导尿管患者硅胶导尿管更换时间研究的临床对照试验,观察指标为留置导尿管患者硅胶导尿管不同更换频率(每2周更换、每3周更换及每4周更换1次)下的泌尿系感染率。干预有效性的效应量采用相对危险度(relative risk,RR)。结果共检索到11篇合格文献。Meta分析结果提示:长期留置导尿管患者硅胶导尿管每2周更换1次与每4周更换1次、每3周更换1次与每4周更换1次发生泌尿系感染的RR值分别为0.51[95%CI(0.40,0.66),P0.001]、0.79[95%CI(0.58,1.08),P=0.14],每2周更换1次者泌尿系感染率明显高于每4周更换1次者,但每3周更换1次者与每4周更换1次者泌尿系感染率没有差异。结论结合硅胶导尿管的材料性质及其观察指标,根据临床最优原则,得出硅胶导尿管每4周更换1次为宜。     

循证护理在留置导尿中的应用

通过对留置导尿过程中膀胱冲洗方法、时间、集尿袋及导尿管更换的时间的循证护理，认为循证是临床护理的基础，既提高了护理质量，又丰富了护理人员的知识，提高了护理人员分析问题解决问题的能力，进而提高了护理人员的专业性和技术性。     

泌尿系造瘘病人造瘘管更换时间探讨

[目的]探讨泌尿系造瘘病人造瘘管最佳更换时间。[方法]选择2013年5月—2014年5月在黄石市中心医院门诊治疗室更换肾造瘘管和膀胱造瘘管病人57例,根据尿液pH值将57例长期留置肾造瘘管病人分成A组和B组:A组26例病人尿液pH值<6.7,为低危感染类病人;B组31例病人尿液pH值≥6.8,为高危感染类病人。观察两组病人泌尿系感染和造瘘管堵塞情况。[结果]尿液pH值<6.7者第2周肾造瘘管通畅,无一例发生造口感染;第3周末3例出现造口感染,第4周末9例出现造口感染,其中有2例合并糖尿病,经口服抗生素和降糖治疗并加强换药后好转,无一例发生肾结石和血尿。尿液pH值≥6.8者第2周3例出现造口感染,第3周、第4周造口感染发生率明显增加。[结论]尿液pH值≥6.8病人发生造瘘管堵塞的几率高,应2周更换造瘘管1次。     

危重病人留置导尿管更换周期的研究

[目的]探讨ICU留置导尿管病人不同更换周期对尿路感染阳性率及导尿管内腔细菌菌落计数的影响,为临床合理选择更换导尿管时间提供依据。[方法]根据导尿管更换时间不同,将病人随机分为每周更换组(A组)和2周更换组(B组),共63例。在病人留置导尿管当天、第7天、第14天,分别采集晨起清洁中段尿,进行尿培养、尿常规检测。无菌剪刀留取导尿管膀胱内段气囊处2cm样本,进行细菌培养和计数。[结果]A组尿培养阳性率为29.03%,B组尿培养阳性率为33.33%,两组比较差异无统计学意义(P=0.777);革兰氏阴性杆菌、革兰氏阳性球菌、真菌在两组间分布比较差异均无统计学意义义(P0.05);两组导尿管内腔菌落计数比较差异无统计学意义(P=0.351);A组导尿管细菌培养阳性率为41.92%,B组导尿管细菌培养阳性率为51.52%,两组比较差异无统计学意义(P=0.443)。[结论]长期留置尿管病人可2周更换1次导尿管。     

循证护理在前列腺增生症尿潴留病人留置导尿管中的应用

目的:探讨循证护理在前列腺增生症尿潴留病人留置导尿管中的应用。方法:将80例前列腺增生症的病人随机分成实验组44例和对照组36例,对照组按常规方法留置导尿管,实验组在循证护理的指导下留置导尿管,比较两组病人在留置导尿管过程中尿路黏膜损伤、一次插管成功率和插管后感染及病人满意度。结果:实验组尿道黏膜损伤、感染发生率低于对照组(P0.05),一次插尿管成功率及病人满意度高于对照组(P0.01)。结论:在循证护理指导下留置导尿管是前列腺增生症尿潴留病人最佳的选择。     

泌尿系造瘘病人造瘘管更换时间探讨

[目的]探讨泌尿系造瘘病人造瘘管最佳更换时间。[方法]选择2013年5月—2014年5月在黄石市中心医院门诊治疗室更换肾造瘘管和膀胱造瘘管病人57例,根据尿液pH值将57例长期留置肾造瘘管病人分成A组和B组:A组26例病人尿液pH值6.7,为低危感染类病人;B组31例病人尿液pH值≥6.8,为高危感染类病人。观察两组病人泌尿系感染和造瘘管堵塞情况。[结果]尿液pH值6.7者第2周肾造瘘管通畅,无一例发生造口感染;第3周末3例出现造口感染,第4周末9例出现造口感染,其中有2例合并糖尿病,经口服抗生素和降糖治疗并加强换药后好转,无一例发生肾结石和血尿。尿液pH值≥6.8者第2周3例出现造口感染,第3周、第4周造口感染发生率明显增加。[结论]尿液pH值≥6.8病人发生造瘘管堵塞的几率高,应2周更换造瘘管1次。     

尿液pH值分析结果与导尿管更换时间探讨

留置导尿管的病人,常规更换导尿管的时间是每2周进行1次。但更换导尿管会增加病人的痛苦,同时也增加了尿路感染的发生率。为此,2007年1月—2007年6月对我科40例留置导尿管病人进行观察,根据尿液pH值分析结果决定更换导尿管的时间,减轻了病人的痛苦,同时也降低了尿路感染的发生率。现报告如下。1临床资料40例留置导尿管病人,其中男27例,女13例;年龄40岁~79岁;留置尿管时间28d~70d,平均48d。2方法动态检测病人尿液的pH值,并根据尿液pH值,决定更换导尿管的间隔时间。3结果本组观察40例留置尿管病人,39例无尿路感染,1例尿道口有少许分泌物,经…     

循证护理在预防宫颈癌术后尿潴留中的应用

目的探讨循证护理在预防宫颈癌术后尿潴留中的应用效果。方法选取86例宫颈癌患者为研究对象,随机分为观察组和对照组各43例,对照组采用常规护理,观察组采用循证护理预防术后尿潴留,比较2组的排尿情况、尿潴留发生率以及生活质量。结果观察组术后的膀胱功能恢复好于对照组,首次排尿后残余尿量少于对照组,术后14 d尿路感染少于对照组,尿潴留的发生率低于对照组,住院时间短于对照组,差异有统计学意义(P0.05);观察组术后14 d的躯体功能、宫颈癌特异性模块、功能状况等评分高于对照组(P0.05)。结论循证护理能够有效促进宫颈癌患者术后排尿,预防尿潴留的发生,改善患者的生活质量。     

不同年资护理人员掰启安瓿引起手损伤原因分析

目的 探讨不同年资护理人员掰启安瓿造成手损害的危险因素及防范措施。 方法 随机抽查护理人员因掰启安瓿而造成手损害的情况,并分析其原因。结果 1176人中有1011人发生手损伤,发生率为85.92%。实习护生手损伤发生率高于其他组(工作时间<5年、5~10年和>10年组)。实习护生组和<5年组因心理紧张导致手割伤的比率均高于护龄>10年组。实习护生和护龄＜5年组因操作不熟练和操作方法错误致手损伤的比率分别为49.35%和32.33%,而5~10年和>10年组仅为11.64%和7.66%。 结论 心理紧张、操作不熟练和操作方法错误是实习护生和低年资护理人员掰安瓿致手割伤的主要原因。应加强培训,提高护理人员的防范意识,规避高风险行为,减少手损伤的发生。     

预防泌尿外科留置尿管患者尿路感染的护理研究

目的分析预防泌尿外科留置尿管患者尿路感染的护理方法。方法将84例留置导尿管患者随机分为对照组和试验组,每组32例,对照组采用常规导尿管护理方式,试验组在对照组的基础上加强导尿管安全规范化操作,重点预防尿路感染。比较两组的护理效果。结果试验组的导尿管感染安全事故总发生率低于对照组(P<0.05)。试验组的护理满意度高于对照组(P<0.05)。结论泌尿外科留置导尿管的预防导尿管感染和脱管规范化管理是一项系统安全工程,能够有效预防尿路感染,提高医院患者安全护理效率和质量,减少医院安全事故。     

改革护理工作模式对提高优质护理服务的效果

目的探讨改革护理工作模式对提高优质护理服务的效果。方法选择2009年6-12月本院心血管内科收治的120例病人为对照组,选择2010年1-6月同科室的120例病人为实验组。对照组采用传统护理模式对病人实施护理,实验组采用改革后的护理工作模式对病人实施护理。比较两组病人日均输液呼叫铃声次数、护士到位时间、病人对护理工作的满意度及健康教育知晓率。结果实验组日均输液呼叫铃声少于对照组,护士到位时间短于对照组,病人对护理工作的满意度及健康教育知晓率高于对照组(均P<0.05)。结论改革护理工作模式,推行责任制护理和开展床边工作制,能更好地为患者提供连续、全程的优质护理服务,增强了护士的责任感,密切了护患关系,提高了病人对护理工作的满意度。     

Current status of long‐term indwelling urinary catheter management by visiting nurses

Patients with indwelling catheters at home are more likely to receive home‐visit nursing care. However, the condition of patients with indwelling catheters among those receiving home‐visit nursing care, as well as the actual status of catheter management practised by visiting nurses, has not been studied. The aim of this study was to study the condition of long‐term indwelling urinary catheter users receiving home‐visit nursing care and the status of catheter management by visiting nurses. Thirty visiting nurses with experience in home‐visit nursing care for patients with long‐term indwelling catheters participated in this study. The questionnaire covered (1) attributes of visiting nurses, (2) the condition of indwelling catheter users, and (3) the state of implementation of catheter management by visiting nurses and difficulties experienced. It was found that patients receiving home‐visit nursing care had used indwelling catheters for a prolonged period for both disease management and other reasons, and they developed various abnormal symptoms and complications such as urinary tract infection. A high percentage of visiting nurses implemented all the items of observation, practice, guidance and cooperation in catheter management. Items of catheter management that caused difficulty for visiting nurses included detection of urinary tract infection or other complications, catheter insertion, obtaining catheter replacement supplies, encouraging ingestion of water and cooperation with physicians. This study concludes by throwing light on the condition of long‐term indwelling urinary catheter users receiving home‐visit nursing care, and the status of catheter management by visiting nurses.     

留置导尿病人护理中应注意的问题

留置导尿是临床上一项常规操作，但如果操作不当，易引起泌尿系感染。所以在留置导尿护理中应注意无菌操作，保持引流管通畅。当病人恢复自主排尿功能后应及时拔除尿管，以降低医源性尿路感染的发生率。     

预防性护理干预对脑卒中患者留置尿管并发症发生的影响

目的探讨预防性护理干预对脑卒中患者留置尿管并发症发生的影响。方法选择2010年1月～2011年12月本院收治的脑卒中留置导尿管患者258例,随机分为对照组128例与观察组130例。对照组患者采取常规护理方法,观察组患者在常规护理的基础上分析患者发生并发症的原因,有针对性地采取预防性护理干预措施预防并发症的发生。比较两组患者留置尿管后并发症发生情况,患者及家属对护理服务满意度情况。结果观察组患者留置尿管后并发症发生率明显低于对照组,患者及家属对护理服务质量满意度明显高于对照组,两组比较,均P<0.05,差异具有统计学意义。结论根据脑卒中患者留置尿管后尿液外漏、尿路感染、尿管堵塞、尿管脱落等并发症发生的原因,采取针对性的预防性护理干预措施,能预防脑卒中患者留置尿管并发症的发生,从而减轻患者的痛苦,提高患者生活质量及满意度。     

Evidence-based practice and school nursing.

School nurses need to demonstrate that their practice is based on the best evidence available, which is usually data obtained from research. Evidence-based practice involves combining the best evidence available with nursing expertise and patient and family preferences to determine optimum care. Evidence-based practice guidelines are developed by carefully reviewing the available evidence on a topic and synthesizing this information into recommendations for practice. This article defines evidence-based practice and best evidence, describes the development of evidence-based practice guidelines, discusses factors that affect the use of research and evidence-based practice guidelines in school nursing, and reviews current sources of evidence-based practice guidelines for school nurses. Strategies that school nurses can use to incorporate evidence into their practice are discussed. One recommendation is that school nurses partner with nurse leaders and nurse researchers to develop evidence-based practice guidelines relevant to school nurse practice.     

三黄液用于留置尿管患者的会阴护理观察

目的探讨三黄液用于留置尿管患者的会阴护理。方法对47例留置尿管患者用三黄液稀释后进行会阴护理，每天2次，上下午各1次。结果47例患者通过精心护理，均未发生尿路感染。结论三黄液用于会阴护理预防尿路感染效果显著。     

Factors facilitating and inhibiting evidence-based nursing in Iran

AIM: This paper is a presentation of a study to clarify the concept of evidence-based nursing and to explore the factors that influence evidence-based nursing by Iranian nurses. BACKGROUND: Evidence-based practice was introduced as an approach to high-quality care intended to improve results for patients. Several nurse researchers have studied factors affecting implementation of evidence-based nursing in western countries. However, there is little or no research on the perceptions of evidence-based nursing and its barriers in eastern countries, especially Iran. METHODOLOGY: Grounded theory method was used. Interviews with 21 participants and 30 hours of observation were conducted in hospitals in Iran during 2005. Constant comparative analysis was used to analyse the data. FINDINGS: Two main categories, 'the meaning of evidence-based nursing', and 'factors affecting it', emerged from the data. From participants' perspectives, evidence-based nursing was defined as 'caring for patients based on the nurse's professional knowledge in meeting patients' needs'. The second category, factors affecting evidence-based care, had six subcategories: possessing professional knowledge and experience; having time and opportunity; becoming accustomed; self-confidence; the process of nursing education; and the work environment and its expectations. CONCLUSION: Managers and educators need to be committed to the principles of EBP, provide resources and create a supportive environment for its implementation. Individual nurses also have a responsibility to carry out evidence-based nursing, and researchers should work with practitioners to generate high quality evidence to support nursing practice.