社区卫生服务中心开展康复护理的探讨

康复护理是护士职能扩展的一个重要方面 ,社区卫生服务开展康复护理势在必行 ,有许多新的问题值得探讨和研究。1　社区卫生服务开展康复护理的必要性1.1　老年人和伤残人对康复护理的需求　据统计 ,宁波市 6 0岁以上老年人口占全市人口的 13%左右 ,有的居民区高达 19% ;70 %以上的老年人患有各种疾病。工业创伤和交通事故所致的伤残人员增加 ,残疾人的康复问题困扰着许多家庭。社区卫生服务开展康复护理 ,实施家庭康复 ,可减轻社会、家庭负担 ,便于病人早日恢复健康。1.2　患者出院后对康复护理的需求　治愈或好转的病人出院后多需康复护理…     

30例腰椎压缩性骨折的家庭康复护理

目的 按照护理程序的科学针对性进行家庭康复护理,解决护理对象重建健康的问题。方法 通过对30例腰椎压缩性骨折病人运用整体护理模式即生命、心理、环境护理模式进行了针对性家庭康复护理。一是管床医务人员做好家属的培训,帮助患者实践健康的生活方式和行为;二是护士运用所学的知识去预见病情,对病人潜在的护理问题进行分析,制定护理计划,指导康复。结果 30例患者经过家庭康复护理,3个月后复查腰椎X片,骨愈合良好,功能恢复。结论 家庭康复护理减少了医院众议院病人拥护和压力,减轻了病人的经济负担,消除了患者因住院而造成的家庭成员间“分离性焦虑”。为病人的康复提供了一个优良的治疗环境,虽医院护理工作的连续,是医院服务方向新形式的发展。     

408例分裂症康复护理观察

精神分裂症病人在治疗康复中,存在着病情易复发、易衰退倾向,患者常常丧失了生活自理能力、与人交往能力、社会适应能力、职业能力以及独立生存能力,他们不能与人正常沟通,在正常的饮食、起居、生活习惯和生存能力等方面存在一定程度的受损和缺失,单一的用药物治疗病人根本达不到的身、心和社会功能全面康复,需要在临床治疗、家庭和社区康复工作中,实施有计划、有目的 、有针对性的采取有效的全面康复护理尤为重要,下面就我多年来对精神分裂症病人实施了集医院、家庭、社会为一体的康复护理新举措,实践证明,康复护理是可行的,是有一定临床意义的.本文通过对国家重性精神疾病管理治疗项目(686项目)中牡丹江市林口县农村示范区和爱民区城市示范区的408例精神分裂症患者临床采取全面康复护理,并借鉴香港的社区精神卫生服务个体服务计划开展模式,结合当地实际,针对精神分裂症病人系统的集医院、家庭、社区为一体的康复护理服务措施,实施全程康复服务计划.为患者回归社会提供一条有效途径.是以患者为中心,主要对精神分裂症病友个体采取相应措施,充分发掘现有的资源,按照康复护理程序进行新的康复护理措施,探索了一条精神分裂症康复之路.     

脑血管病患者的康复护理

脑血管病是常见多发病之一,死亡率高,致残率高,康复治疗时间长.患者即使存活也将遗留不同程度的残疾,往往给家庭和社会带来沉重的负担.根据我科200名患者治疗结果表明:经过康复治疗,日常生活能自理者达60%;在复杂活动中需要帮助者占20%;需较多帮助者占15%;完全依靠帮助者只占5%,效果良好.所以在护理脑血管疾病患者时,要深入了解病情、心态,精心护理,及时采取正确的康复措施,以求获得满意的康复效果.     

中青年腰椎间盘突出症家庭康复护理

2000～2006年，我们利用医院与家庭、家庭与病人、病人之间形成的康复区域网，以电话咨询、上门技术服务等方式，对39例中青年腰椎间盘突出症病人进行康复护理指导，效果满意。报道如下：[第一段]     

神经外科术后病人家庭康复护理

随着社会的发展,护理工作领域日益扩大,家庭将成为护理人员实施整体护理的重要场所,对神经外科术后病人实施家庭康复护理,对帮助病人提高生存质量,早日实现生活自理具有重要的意义.分析家庭护理在神经外科疾病手术后康复期病人中的作用.目的促进病人康复、实现早日生活自理、减轻家庭及社会经济负担等具有现实而长远的意义.方法对2011年1月-12月150例神经外科疾病手术后出院时存在着失语、偏瘫、行走困难、生活不能自理或带胃管、尿管出院的病人实施家庭护理,以观察期内康复的效果.结果90%偏瘫患者能重新步行和生活自理.其中又有30%能恢复一些工作.     

偏瘫病人家庭康复护理体会

偏瘫多见于脑血管疾病后遗症。由于受家庭条件的制约，大多数脑血管疾病病人在医院度过急性期就回归家庭，偏瘫病人的家庭康复护理显得尤为重要。近几年我院在通过护士角色转换，提高病人生存质量上做了许多工作，效果较好。     

酒依赖患者康复后复饮的原因及相关对策和护理

目的 探讨戒酒病人康复饮原因,应对对策略及护理措施.方法 选取50例住院戒酒康复后的病人进行讨论.结果 出院后未复饮者11例,占22%,复饮者39例,占78%,复饮原因与缺乏相关酒方面的知识,缺乏良好的家庭支持.婚姻状况较差,社会因素,心理因素及人格特征,家庭饮酒史等有关.结论 分析复饮原因采取必要的应对策略及护理.     

农村脑溢血病人的家庭康复护理

目的 探讨农村脑溢血患者家庭康复护理,提高农村脑溢血病人的家庭生活质量.方法 对5例农村脑溢血康复期的病人进行家庭康复护理后的随访.结果 5例患者中有1例出现褥疮,其他无褥疮和并发症发生,偏瘫肢体功能得到不同程度的恢复.结论 良好的农村家庭康复护理有利于农村脑溢血病人的康复.     

重型脑外伤的家庭康复护理指导

重型颅脑损伤病人虽经临床积极救治，病死率明显下降，存活率明显提高，但存活的病人中常常存在不同程度的后遗症。从轻度的头晕、耳鸣、健忘到严重的失语、偏瘫，恢复需要很长时间，不可能长期住院。也有的因家庭经济拮据，很多病人在病情稳定后便出院回家疗养。本文通过对54例重型脑外伤病人实施家庭康复护理指导，旨在说明家庭康复护理指导对促进病人康复，减轻家庭及社会经济负担，提高病人生存质量具有现实而深远的意义，现就家庭康复护理指导做一简单阐述。     

全国社区卫生服务现状调查--医院服务与社区卫生服务的可及性比较

目的比较社区居民对医院服务与社区卫生服务的可及性。方法应用问卷调查的方法,对3省市医院就诊患者和社区卫生服务机构的就诊患者进行调查,比较患者就诊距离、医疗费用负担方式、就诊等候时间和上门服务的情况。结果医院和社区卫生服务机构就诊患者从家到就诊机构的时间在15min之内的分别为25·05%和81·15%,在30min以上的分别为32·43%和2·92%;两类机构就诊患者的等候时间在10min以内的分别为28·53%和74·59%,在30min以上的分别为28·00%和3·15%;两类机构就诊患者中,医疗费用能够报销者的比例分别为51·92%和53·74%;两类机构就诊患者接受过就诊机构提供上门服务的比例分别为13·76%和81·54%。结论社区卫生服务在可及性方面具有明显优势;应进一步加强在医保政策方面对社区卫生服务的倾斜,提倡社区卫生服务与医院服务的有机结合,充分发挥医院与社区卫生服务机构两方面的优势,为居民提供高质量的、方便可及的卫生服务。     

PICC带管出院患者居家维护的可行性Meta分析

目的 比较经外周静脉置入中心静脉导管(peripherally inserted central catheter,PICC)带管出院患者居家维护和返院维护的效果,评价居家维护方式的可行性。 方法 通过计算机检索Cochrane Library、Pub Med、Embase、中国期刊全文数据库(CNKI)、维普数据库(VIP)、中国生物医学文献数据库(CBM)、万方数据库中收集2016年8月以前国内外公开发表的关于PICC带管出院患者返院维护与居家维护效果比较的临床试验,采用Stata 12.0软件对资料进行Meta分析,结局指标是PICC相关并发症的发生率。 结果 共纳入15篇文献,全体样本量共计1 374例患者,其中返院维护组730例患者,居家维护组644例患者。Meta分析结果显示:居家维护组的局部感染率[RR=3.82,95%CI(2.51~5.83)]、静脉炎发生率[RR=5.51,95%CI(2.08~14.61)]、导管脱出率[RR=2.36,95%CI(1.28~4.34)]、导管堵塞率[RR=1.75,95%CI(1.26~2.43)]、血栓形成率[RR=3.77,95%CI(1.30~10.90)]低于返院维护组;居家维护组的导管相关性感染率[RR=0.93,95%CI(0.57~1.53)]、导管破损率[RR=0.58,95%CI(0.15~2.27)]、皮肤过敏率[RR=1.08,95%CI(0.36~3.28)]与返院维护组比较,差异无统计学意义。 结论 当前临床证据表明:与返院维护方式比较,PICC带管出院患者采用居家维护方式不会使PICC相关并发症的发生率增高,该维护方式是可行的。      

Five year prospective survey of risk of booking for a home birth in Essex

A prospective survey was undertaken in 26 practices in Essex to assess the risks associated with a home birth. The 202 women who were booked for a home confinement were compared with a similar group of 185 women who were booked for hospital delivery under consultant care. The principal difference in outcome was the induction rate of 19% in the hospital group compared with 8% in the group booked for delivery at home. A higher rate of episiotomy and second degree tears and more Apgar scores of 7 or below were found in those who were booked for hospital. There were no perinatal deaths in either group. The results of this study showed no evidence of an increased risk associated with home confinements but indicated that there were fewer problems than were encountered in the deliveries in mothers confined in hospital.     

Cognitive and behavioural impairment among elderly people in institutions providing different levels of care.

OBJECTIVE: To compare the prevalence and degree of cognitive and behavioural impairment in elderly patients in institutions providing different levels of care. DESIGN: Prevalence study. SETTING: A nursing home, a home for the aged and psychogeriatric wards in a provincial psychiatric hospital. PATIENTS: Only subjects 65 years of age or older were eligible for inclusion. A random sample was selected comprising 25% of the residents in the nursing home and the home for the aged; of the 119 asked to participate 95 agreed (44 in the nursing home and 51 in the home for the aged). All 50 on the psychogeriatric wards agreed to participate. MAIN OUTCOME MEASURES: The Mini-Mental State Examination (MMSE) and the Kingston Dementia Rating Scale (KDRS). RESULTS: An MMSE score of less than 24 (cognitive impairment) was given to 37 (84%) of the residents in the nursing home, 43 (84%) of those in the home for the aged and 48 (96%) of the patients in the psychiatric hospital; the corresponding numbers for a KDRS score of more than 0 (cognitive impairment) were 41 (93%), 48 (94%) and 50 (100%). The seven patients receiving the highest level of care at the home for the aged (special care) had more behavioural problems than those in the psychiatric hospital did (p less than 0.001). CONCLUSIONS: Cognitive and behavioural impairment was widespread in the three institutions regardless of the level of care. When planning services and allocating resources government funding agencies should consider the degree and prevalence of such impairment among elderly people in institutions.     

慢性单针血液透析动静脉瘘的成活率

本文报道101例病人使用单针透析中123个动静脉痿的应用期限和成活率,以及有关的并发症。虽然目前在国内透析工作尚未广泛开展,但国外回顾性调查对我们今后广泛开展透析工作,也有参考和借鉴的价值。     

Acute medical bed usage by nursing home residents.

An increasing number of elderly patients in nursing home care appears to be presenting to hospital for acute medical admission. A survey of acute hospital care was undertaken to establish accurately the number and character of such admissions. A total of 1300 acute medical beds was surveyed in Northern Ireland in June 1996 and January 1997 on a single day using a standardised proforma. Demographic details, diagnosis and length of admission were recorded. A total of 84 patients over the age of 65 (mean 79.5 years) admitted from nursing home care was identified in June 1996 and a total of 125 (mean 83.3 years) in January 1997. A total of 88 (70%) of admissions in 1997 were accompanied by a general practitioner's letter. The assessing doctor judged that 12 (9.6%) of admissions in 1997 could have had investigations and or treatment reasonably instituted in a nursing home. The proportion of acute medical beds occupied by nursing home residents was 6% in June 1996 rising to 10% in January 1997. The study accurately identifies the significant contribution of nursing home patients to acute medical admissions and the low proportion in whom admission was unnecessary. Closure of long stay hospital facilities should be accompanied by investment in community medical services and also reinvestment in acute hospital care for elderly people.     

Factors associated with location of death (home or hospital) of patients referred to a palliative care team.

OBJECTIVE: To identify factors associated with the location of death (home or hospital) of patients referred to a palliative care home support team. DESIGN: Retrospective case-control chart review. SETTING: Palliative care inpatient unit with a home support team in a large chronic care hospital. SUBJECTS: All 75 patients receiving services from the home support team who died at home between June 1988 and January 1990 and 75 randomly selected patients receiving the same services who died in hospital. OUTCOME MEASURES: Place of death (home or hospital). RESULTS: Of the 267 patients referred to the palliative care home support team during the study period 75 (28.1%) died at home. Factors significantly associated with dying at home were the patient's preference for dying at home recorded at the time of the initial assessment (p < 0.001), a family member other than the spouse involved in the patient's care (p = 0.021) and the use of private shift nursing (p < 0.001). The patients who died in hospital were more likely than the other patients to have had no home visits from the palliative care team after the initial assessment (p = 0.04). The patient's preference for dying at home was not met if the caregiver could not cope or if symptoms were uncontrolled. The patient's preference for dying in hospital was not met if his or her condition deteriorated rapidly or if the patient died suddenly. CONCLUSIONS: Patients' preference as to place of death, level of caregiver support and entitlement to private shift nursing were significantly associated with patients' dying at home. The determination of these factors should be part of every palliative care assessment. Patients and their families should be informed about available home support services.     

家庭氧生仪治疗慢性阻塞性肺病疗效观察

目的观察家庭氧生仪治疗慢性阻塞性肺病（ＣＯＰＤ）患者缺氧症状的效果。病人和方法选２０例有缺氧症状的ＣＯＰＤ患者，应用家庭氧生仪治疗并与医院中心供氧治疗效果相比较。结果两种方法供氧后，气促症状均有明显改善，血氧饱和度较治疗前均有明显提高（Ｐ＜０．０１），临床有效率分别为８０％、８５％（Ｐ＞０．０５）。结论家庭氧生仪在治疗ＣＯＰＤ患者缺氧症状方面可替代医院的持续低流量供氧，为患者（尤其是ＣＯＰＤ缓解期患者）的家庭氧疗提供极大的方便。     

Costs and benefits of a community special care baby service

Between January 1981 and December 1986 3829 low birthweight (less than 2500 g) infants and 1980 other high risk infants were cared for at home after they were discharged from hospital by a specialist neonatal nursing service. Of the infants who were referred to this service, 720 (12%) weighed under 2000 g and 1919 (33%) under 2250 g at the time of discharge home. The infants were visited by the community neonatal sisters on an average of 11 occasions, but the number of visits varied from six to over 100 depending on the needs of the child and parents. There was close liaison with other community and hospital staff. Two hundred and thirty (4%) referred infants were readmitted to hospital while under the care of the specialist nursing service. In 1985 the cost of the service was pounds 127,000, or pounds 123 for each infant referred. Providing this specialist support at home allowed much earlier discharge of low birthweight infants from hospital. When compared with the cost of providing continuing inpatient neonatal care earlier discharge was estimated to have saved roughly pounds 250,000 in 1985. Low birthweight infants have an increased risk of serious illness or death that extends beyond the neonatal period. Many are born to young and socially disadvantaged parents who can benefit from expert guidance and support at home. A community neonatal nursing service has advantages for high risk infants and their parents, is cost effective, and allows more efficient use of limited hospital resources.     

Where patients with cancer die in South Australia

In a sample of 1582 deaths among South Australian patients with cancer (795 deaths in 1981 and 787 deaths in 1985), 67% of deaths occurred in a hospital, 9% of deaths in a hospice, 10% of deaths in a nursing home, and 14% of deaths in a private residence. More patients died in a hospice or nursing home in 1985 than in 1981, and fewer died in a hospital. With increasing age, fewer patients died in a hospital and more in a nursing home. Compared with men, women were less likely to die at a private residence and more likely to die in a nursing home. A greater proportion of men with a living wife died at a private residence than was so among single or widowed men. However, conjugal status was not associated with the place of death of women. Patients who lived in the more affluent metropolitan suburbs tended more to die at a private residence than did those from poorer suburbs or country areas. Patients with haematological malignancies died in major metropolitan public hospitals more frequently than did patients with other tumours. Possible explanations are given for these findings.