新型护理干预法对老年髋部骨折术后功能锻炼依从性的影响

目的 探讨新型护理干预法对提高老年髋部骨折术后功能锻炼依从性的效果。方法 选择2010年3月~2011年5月,在我院骨科老年髋部骨折手术患者160例,采用随机分组的方法,分为实验组和对照组各80例,实验组采用新型的护理干预方法,对照组采用普通的护理干预方法。结果 154例得到随访,随访时间6-12个月。实验组的依从率为80%,对照的依从率为50%。实验组的平均Harris评分94.6%,对照组的平均Harris评分为85.1%。两组对比差异有统计学意义(p<0.05),结论 采用新型护理干预法能有效促进患者康复,改善患者术后功能锻炼依从性,从而提高患者的生活质量。     

老年髋部骨折患者术后功能锻炼依从性影响因素的研究进展

髋部骨折指股骨颈与股骨转子间的骨折,其致残率较高,老年人是该症的高危人群,且随着年龄的增长发生率显著增高,严重威胁老年人的生命健康安全。近年来,其治疗大多倾向于手术治疗,由于术后的康复期较长,患者通常在术后2周内即出院,其康复需要患者在自己的家中完成。术后如果不能得到正确的护理和后续的功能锻炼,很容易导致术后日常活动功能障碍。葛向煜等研究显示术后肢体功能障碍不仅严重影响老年患者的身心健康, 更影响其生活质量。依从性是指患者在执行医疗或康复措施中行为的客观倾向及程度,患者依从性的优劣往往对疾病的预后或康复效果起着决定性作用。本文就近几年老年髋部骨折术后功能锻炼依从性影响因素进行综述,为提高患者锻炼依从性提供参考。     

家庭护理对老年髋部骨折患者术后肢体功能恢复的影响

目的：探讨家庭护理对老年髋部骨折患者术后肢体功能恢复的影响。方法将40例老年髋部骨折患者随机分为干预组和对照组各20例。干预组分别于出院后1周、2周、4周、3个月、6个月、1年给予上门家庭护理,指导其患肢功能锻炼;对照组出院后常规门诊随诊复查。结果采用老年髋关节术后肢体功能评定表进行评分,干预组在髋关节总评分、疼痛、活动度、步行能力、日常生活活动（上楼、穿脱鞋袜、坐）等五个方面评分均高于对照组。结论家庭护理不仅可以减轻患者外出就医诊治的负担,还可以及时纠正其错误的锻炼方法,指导其进行有效的、循序渐进的功能锻炼,促进老年患者的康复,提高其生活质量。     

老年髋部骨折患者术后功能锻炼现状及影响因素分析

目的探讨老年髋部骨折患者术后功能锻炼现状及其影响因素。方法采用自制问卷对68例老年髋部骨折患者的功能锻炼现状及其影响因素进行分析。结果老年髋部骨折患者术后防脱位知识知晓率62％,正确掌握功能锻炼方法者56％,能做到主动功能锻炼者仅26％、运动时间≥30min／d者32％、患肢膝关节活动度≥80&#176;者34％;疼痛、惰性、缺少督导及家庭支持系统缺陷是患者术后功能锻炼的主要影响因素。结论老年髋部骨折患者功能锻炼现状不容乐观,且影响因素较多,针对影响因素有的放矢地采取有效对策非常重要。     

老年髋部骨折行髋关节置换术后患者出院时延续护理需求的质性研究

目的深入了解老年髋部骨折行髋关节置换术后患者出院时的延续护理需求。方法采用目的抽样法,于2019年1—3月对15例接受全髋关节置换的老年髋部骨折患者出院时进行半结构式访谈,并用Colaizzi 7步法分析资料,了解其需求问题。结果通过分析、整理和提炼,得出患者术后关心的3个主题,分别为对健康教育的需求、对改善不良心理的需求、对卫生服务资源的需求。结论接受全髋关节置换术的髋部骨折患者在生理、心理、社会等方面存在诸多负担与需求。护理人员应加强对此类患者的关注,做好针对性的疏导干预,为出院患者提供详尽的健康教育,以提高其自我照护能力。     

老年髋部骨折术后患者跌倒恐惧心理体验的质性研究

目的 了解老年髋部骨折术后患者跌倒恐惧的心理体验.方法 采用描述性质性研究方法,以最大差异抽样法选取2019年12月—2020年5月河南省某三级甲等骨科医院老年髋部骨折术后患者12例进行半结构式访谈,使用内容分析法整理分析访谈资料.结果 老年髋部骨折术后患者跌倒恐惧的体验可归纳为3个主题:对跌倒恐惧的感知(被打乱的生活...     

临床路径在老年髋部骨折术后患者功能锻炼中的应用效果

目的:探讨临床路径在老年髋部骨折术后患者功能锻炼中的实施效果。方法:将65例老年髋部骨折术后患者随机分为对照组32例和观察组33例,对照组采用常规的功能锻炼指导方式,观察组将临床路径引入到临床护理中,有计划、有组织地对患者及其家属给予全程、个体化功能锻炼指导。结果:观察组患者首次功能锻炼时间、首次离床站立时间早于对照组(P<0.05),功能锻炼内容掌握程度、参与功能锻炼的主动性、对护理工作的满意程度高于对照组(P<0.05)。结论:临床路径可提高老年髋部骨折术后患者功能锻炼的主动性、康复效果,患者能在短时间内掌握最基本的技巧,提高了患者的满意度。     

颈椎骨折术后护理及功能锻炼

颈椎骨折病人在骨科较多见,常由于外伤出血、骨片移位等因素影响脊髓和脊神经的功能而产生高位截瘫或不完全性截瘫。由于及时采取内固定和减压术治疗,可使多数病人恢复其正常功能一般说来,病人的康复有赖于原始损伤的程度和及时恰当的手术治疗,但在很大程度上取决于术后的妥善护理和适当的     

老年髋部骨折患者术后肢体功能恢复的护理干预

目的 研究护理干预对老年髋部骨折患者手术后的肢体功能恢复的影响.方法 将60例老年髋部骨折患者随机分为A、B2组各30例,A组采用渐进式的锻炼方式,B组采用传统的骨折术后护理方式.采用Harris评分比较2组的康复效果.结果 A组的Harris评分显著高于B组.结论 对老年髋部骨折患者术后采用渐进式的功能锻炼,可以有效地促进患者髋部关节的功能恢复.     

Community ambulation before and after hip fracture: a qualitative analysis

Purpose.?This qualitative study explored mobility levels around the home and in the community before and after hip fracture.

Methods.?Twenty-four people receiving rehabilitation after hip fracture were interviewed using an in-depth semi-structured format: 12 who were receiving rehabilitation as inpatients, and 12 who had been discharged home from inpatient rehabilitation and were continuing therapy as outpatients. The recorded interviews were transcribed and coded independently by two researchers. From these codes themes were developed.

Results.?Before their fracture, participants were independent about their houses, but their level of community ambulation had been reducing over recent months or years, often associated with another health problem. Participants who had returned home after inpatient rehabilitation for hip fracture reported much reduced levels of mobility both in their house and in the community compared with their pre-fracture performance. This reduced level of mobility was associated with psychological factors (fear, lack of confidence, frustration), physical factors (pain, the presence of another health problem) and social/environmental factors (reliance on daughter, and car). The level of optimism expressed by people receiving inpatient rehabilitation contrasted with the pessimism of those receiving outpatient rehabilitation.

Conclusions.?Patients living back in the community after hip fracture described a reduced level of functioning and a pessimism that contrasted with the optimism expressed by people who were still in the inpatient phase of rehabilitation. These findings, and the importance of psychological factors and social support, may be considered when designing rehabilitation strategies to support the successful transition of people to their community after hip fracture.     

臀肌挛缩症患儿手术后护理

笔者报道对25例臀肌挛缩症患儿手术后的护理。认为术后根据患儿的生理、病理特点进行悉心的护理,加强心理护理、伤口护理,妥善的体位与适当的功能锻炼,做好出院后康复指导,是巩固手术效果、改善髋关节功能的重要措施。     

人工全髋关节置换手术的康复护理

目的总结和探讨髋关节置换术后的康复护理措施，方法对96例髋关节置换术患者术后康复护理及科学的功能锻炼。结果96例患者均取得良好效果。结论正确的康复护理及科学的功能锻炼方法能帮助患者顺利度过康复期，明显提高患者生活自理能力及参加社会活动的能力。     

老年慢性病出院患者护理需求及影响因素分析

目的 探讨老年慢性病出院患者的护理需求及影响因素,为制订针对性的出院指导提供依据。方法 采用老年慢性病患者护理需求调查问卷对232例出院老年慢性病患者进行调查,了解老年慢性病出院患者护理需求状况。结果 在20项护理需求项目中排在前5位的分别是出现紧急情况时医护人员的救护、定期提供体检、安全用药指导、上门提供护理及慢性病的长期护理。经单因素分析,年龄、有无配偶、文化程度、体育活动频率与护理需求总分在统计学上有差异（P<0.05）,高龄、无配偶、小学及以下程度老人和大专及以上老人、从不参加体育活动者其护理需求总分最高。经多重线性回归分析,影响老年慢性病出院患者的护理需求的主要因素有年龄、文化程度、独居与否、参加体育活动、疾病对日常生活影响、有无后遗症以及首要住院原因（高血压）（p<0.05）。结论老年慢性病出院患者的护理需求是多方面的,护士在实施出院护理时,重点应关注患者不同护理需求,特别是高龄、无配偶、独居的患者,并有针对性地做好出院指导,满足老年慢性病患者的护理需求。     

Postoperative variation in neurocognitive and functional status in elderly hip fracture patients

Regaining independence in the performance of activities of daily living (ADL) is a nursing priority in the postoperative care of hip fracture patients, though often impeded by a temporary yet reversible decrease in cognitive status postoperatively. This study investigated the incidence and evolution of decreased cognitive status in geriatric hip fracture patients from admission through to the fifth postoperative day, and the relationship between cognitive abilities and functional (ADL) status. Twenty-six elderly hip fracture patients (f: 21, m: 5) with a mean age of 79·5 years ( SD =8·2) admitted to the emergency room of an academic medical centre were monitored longitudinally from admission until the fifth postoperative day regarding neurocognitive status and ADL status, as measured by the mini-mental state exam (MMSE; including subscales of memory, linguistic ability, concentration and psychomotor executive skills) and an adapted version of the Katz ADL-scale, respectively. Patients were categorized on the basis of cognitive status as follows: no cognitive impairment (MMSE≥24), moderate (MMSE≤23 but ≥18) and severe impairment (MMSE≤17). Nineteen of the 26 patients (73·1%) showed cognitive impairment (MMSE≤23) at some point in time before and/or after surgery. Some improvement in cognitive status was observed yet only selectively across patient cohorts and neurocognitive dimensions. Cognitive status, especially memorial ability and psychomotor executive skills, seemed to be most vulnerable to becoming impaired after hip fracture surgery. A relationship was found between cognitive and functional status, specifically, strong associations between memory and psychomotor skills relative to ADL and modest associations between linguistic ability and concentration relative to ADL. Further, patients with decreased cognitive status postoperatively remained more ADL-dependent than non-impaired patients. This study underscores the importance of a systematic assessment of the cognitive status of elderly hip fracture patients and linking these observations to functional ability in order to enhance the postoperative rehabilitation of this patient group.     

术后早期康复锻炼处方对股骨颈骨折患者髋关节功能康复的影响

目的探讨术后早期康复锻炼处方在股骨颈骨折患者术后髋关节功能康复中的应用。方法将采用术后早期康复锻炼处方的40例股骨颈骨折患者设为观察组,将采用术后常规护理的40例股骨颈骨折患者设为对照组,比较2组术后的疼痛情况、康复积极性以及恢复情况。结果观察组术后1 d、3 d、5 d、7 d的疼痛评分低于对照组,术后康复积极性高于对照组,差异有统计学意义(P<0.05)。观察组的住院时间短于对照组,术后髋关节功能评分、生活能力评分以及髋关节功能优良率高于对照组,差异有统计学意义(P<0.05)。结论术后早期康复锻炼处方能够提高股骨颈骨折患者术后康复锻炼的积极性,促进髋关节功能的恢复。     

循证护理在髋关节置换术后患者功能锻炼中的应用

目的:探讨循证护理(EBN)在髋关节置换术后患者功能锻炼中的应用价值。方法:将2015年5月至2016年5月收治的髋关节置换术后患者60例分为对照组、观察组(n=30)。对照组按骨科护理常规要求进行功能锻炼;观察组根据患者情况提出护理问题,运用软件检索查找循证护理依据,分析髋关节置换术后患者功能锻炼的开始时间、早期功能锻炼的时长与方法、最佳功能锻炼的方法、减轻患者功能锻炼时疼痛的方法及提高患者功能锻炼依从性的方法,制定功能锻炼方案。比较两组患者功能锻炼时疼痛程度、Harris髋关节评分、脱位发生率、功能锻炼依从性。结果:功能锻炼时疼痛方面,观察组与对照组术后3d数字评定量表(NRS)评分差异无统计学意义;观察组术后1周、2周NRS评分明显低于对照组,差异有统计学意义(P0.05)。观察组术后2周Harris髋关节评分优于对照组,差异有统计学意义(P0.05)。观察组与对照组均无脱位发生。观察组功能锻炼依从性明显优于对照组,差异有统计学意义(P0.05)。结论:基于EBN的护理模式可减轻髋关节置换术后患者功能锻炼时的疼痛,有利于促进患者髋关节功能的恢复,同时能够有效提高患者功能锻炼的依从性。     

Discharge planning for patients receiving rehabilitation after hip fracture: A qualitative analysis of physiotherapists' perceptions

Purpose.?To explore the perceptions of clinicians about walking requirements and discharge criteria for patients being discharged home in the community from rehabilitation after hip fracture.

Methods.?Twelve experienced clinicians (all females) (mean experience in rehabilitation 13 years) were interviewed using an in-depth semi-structured format. The recorded interviews were transcribed and coded independently by two researchers. From these codes themes were developed.

Results.?For discharge planning, all clinicians considered personal/psychosocial factors such as patient goals and social support. Almost all clinicians considered that the performance factor of safe and independent ambulation was important to consider when planning the patient's discharge, but did not set specific distances or speeds. Clinicians expected that pain, a lack of confidence, and walking outdoors would affect the mobility at home but these factors were considered little in discharge planning.

Conclusions.?In planning discharge after rehabilitation for hip fracture, clinicians place more emphasis on the individual needs and goals of the patient than on specifying objective performance criteria that must be met. The expectation that lack of confidence could be a problem after returning home suggests that this factor could be considered more in discharge planning.     

23例强直性脊柱炎病人行全髋关节置换术的护理

[目的]总结强直性脊柱炎病人行全髋关节置换术的护理措施。[方法]回顾性分析23例强直性脊柱炎病人行全髋关节置换术的临床资料。[结果]本组病人均顺利手术,术后未发生坐骨神经或股神经麻痹、压疮、肺部感染、髋关节脱位等并发症;术后Harris评分62.55分～86.25分,平均72.7分;随访6个月～12个月,病人髋关节屈伸收展及内外旋主动活动度达100°～230°,屈伸主动活动65°～110°;均能达到生活基本自理。[结论]加强强直性脊柱炎病人行全髋关节置换术的护理有利于预后。