电话回访联合心脏康复手册在院外老年慢性心力衰竭患者中的应用效果

目的探讨电话回访联合心脏康复手册在院外老年慢性心力衰竭患者中的应用效果。方法选取2017年9月至2018年12月于我院出院的40例慢性心力衰竭患者为研究对象,随机将其等分为观察组与对照组,对照组给予常规宣教,观察组患者在此基础上于出院前2 d发放自制心脏康复手册,并于出院后进行电话回访,12周后比较两组患者各项生活质量和自我护理能力得分。结果观察组患者出院后身体领域、其他领域及生活质量总分均优于出院前且优于对照组(P<0.05),自我护理行为得分优于出院前且优于对照组(P<0.05)。结论电话回访联合心脏康复手册能有效提高院外老年慢性心力衰竭患者的生存质量和自我护理能力,值得推广应用。     

The 25-Item Ontario Child Health Study Emotional Behavioural Scales-Brief Version (OCHS-EBS-B): Test-Retest Reliability and Construct Validity When Used as Categorical Measures

ObjectiveChild and youth mental health problems are often assessed by parent self-completed checklists that produce dimensional scale scores. When converted to binary ratings of disorder, little is known about their psychometric properties in relation to classifications based on lay-administered structured diagnostic interviews. In addition to estimating agreement, our objective is to test for statistical equivalence in the test-retest reliability and construct validity of two instruments used to classify child emotional, behavioural, and attentional disorders: the 25-item, parent completed Ontario Child Health Study Emotional Behavioural Scales-Brief Version (OCHS-EBS-B) and the Mini International Neuropsychiatric Interview for Children and Adolescents-parent version (MINI-KID-P).MethodsThis study draws on independent samples (n = 452) and uses the confidence interval approach to test for statistical equivalence. Reliability is based on kappa (κ). Construct validity is based on standardized beta coefficients (β) estimated in structural equation models.ResultsThe average differences between the MINI-KID-P and OCHS-EBS-B in κ and β were −0.022 and −0.020, respectively. However, in both instances, criteria for statistical equivalence were met in only 5 of 12 comparisons. Based on κ, between-instrument agreement on the classifications of disorder went from 0.481 (attentional disorder) to 0.721 (emotional disorder) but were substantially higher (0.731 to 0.895, respectively) when corrected for attenuation due to measurement error.ConclusionsAlthough falling short of equivalence, the results suggest on balance that the reliability and validity of the two instruments for classifying child psychiatric disorder assessed by parents are highly comparable. This conclusion is supported by the high levels of agreement between the instruments after correcting for attenuation due to measurement error.     

Initial development of a patient-reported outcome measure of disability due to Katakori via evaluating patient comprehensibility and comprehensiveness

[Purpose] “Katakori” refers to a nonspecific symptom, including discomfort or dull pain, that is experienced around the occiput and that extends through the cervical spine to the acromion and scapular area. This study aimed to develop a patient-reported outcome measure of disability due to Katakori, namely the Katakori Disability Index, via evaluating patient comprehensibility and comprehensiveness. [Participants and Methods] We conducted a semi-structured interview among participants who had experienced Katakori consistently during the past month to examine patient comprehensibility and comprehensiveness; we particularly used the thinking-aloud method and cognitive debriefing to evaluate comprehensibility. [Results] We initially tested a provisional version of the Katakori Disability Index with 24 items using two 11-point numeric rating scales in a subset of 10 participants. Considering the issues identified concerning comprehensibility and comprehensiveness, we created a second draft of the Katakori Disability Index with two 6-point Likert scales, modified items, and four additional items. The second draft was tested in another subset of 10 participants. We eventually developed a 31-item Katakori Disability Index with modified instructions and items, two additional items, and a post-survey checklist; all these features addressed the concerns identified and suggestions obtained in the second round of interviews. [Conclusion] We developed a 31-item Katakori Disability Index with content validity.     

护士胜任特征的概念和成分分析

目的: 界定护士胜任特征的概念和成分,进而为选拔和培训出未来业绩优秀护士. 方法: 运用技术性文献分析、开放性译码、主轴译码等质性理论研究方法,结合问卷调查和相关分析等量性研究手段,以及行为事件访谈技术对护士胜任特征概念和成分进行了研究. 结果: ①护士胜任特征是以心理条件为基础的,受护士职业环境的影响,通过个体对外在事物的内化,在护士职业活动中表现出来的具有区别绩效优秀与一般护士的潜在的、发展的、持久的综合特征,包含有3个维度,16个成分. ②优秀组与普通组在访谈字数的长度上无明显差异(P>0.05),大多数胜任特征编码的频次与访谈长度不相关,说明编码指标采用胜任特征频数分析有较好稳定性,胜任特征归类一致性系数为80.05%,说明胜任特征评价法的编码者一致性相当高,所用的胜任特征编码程序的客观性、操作性是较高的. 结论: 培养优秀护士应将能力培养、品格塑造、心理动力激发以及行为表现的引导统一起来全面实施.     

Views of healthcare consumer representatives on defensive practice: ‘We are your biggest advocate and supporter… not the enemy’

BackgroundThe patient–clinician interaction is a site at which defensive practice could occur, when clinicians provide tests, procedures and treatments mainly to reduce perceived legal risks, rather than to advance patient care. Defensive practice is a driver of low‐value care and exposes patients to the risks of unnecessary interventions. To date, patient perspectives on defensive practice and its impacts on them are largely missing from the literature. This exploratory study conducted in Australia aimed to examine the views and experiences of healthcare consumer representatives in this under‐examined area.MethodsSemi‐structured interviews were conducted with healthcare consumer representatives involved in healthcare consumer advocacy organisations in Australia. Data were transcribed and analysed thematically.ResultsNine healthcare consumer representatives participated. Most had over 20 years of involvement and advocacy in healthcare, including personal experiences as a patient or carer and/or formal service roles on committees or complaint bodies for healthcare organisations. Participants uniformly viewed defensive practice as having a negative impact on the clinician–patient relationship. Themes identified the importance of fostering patient–clinician partnership, effective communication and informed decision‐making. The themes support a shift from the concept of defensive practice to preventive practice in partnership, which focuses on the shared interests of patients and clinicians in achieving safe and high‐value care.ConclusionThis Australian study offers healthcare consumers'' perspectives on the impacts of defensive practice on patients. The findings highlight the features of clinician–patient partnership that will help to improve communication and decision‐making, and prevent the defensive provision of low‐value care.Patient or Public ContributionHealthcare consumer representatives were involved as participants in this study.     

电话随访对抑郁症患者治疗依从性的研究

目的 探讨电话随访对抑郁症患者治疗依从性的影响.方法 对80例出院抑郁症患者随机分为实验组和对照组,实验组患者由护士进行电话随访,了解患者院外的病情变化、进行疾病知识指导,每月1次,1年后实验组和对照组患者均采用自行设计的问卷进行电话随访调查,比较2组患者对治疗的依从性.结果 实验组电话随访后治疗依从性提高,与对照组比...     

基于一对一访谈模式的治疗性沟通在老年脑卒中病人护理干预中的应用

[目的]观察基于一对一访谈模式的治疗性沟通在老年脑卒中病人护理干预中的应用效果。[方法]将94例老年脑卒中病人采用随机数字表法分为观察组和对照组各47例,对照组给予神经内科常规护理,观察组在常规护理的基础上采用基于一对一访谈模式的治疗性沟通护理干预,采用希望水平量表(HHI)和特质应对方式问卷(TCSQ)进行心理评估,比较两组病人的治疗效果。[结果]干预后观察组病人对现实和未来的态度、采取积极的行动的态度、与他人保持亲密关系评分均明显高于对照组(P0.05),积极应对评分明显高于对照组、消极应对评分明显低于对照组(P0.05),总有效率明显高于对照组(P0.05)。[结论]基于一对一访谈模式的治疗性沟通护理干预有助于改善老年脑卒中病人希望水平,优化应对方式,提高治疗效果。     

腹膜透析置管术后出院患者电话跟踪访问效果

目的：探讨腹膜透析置管术后患者出院电话访问管理的效果。方法将67例腹膜透析置管术后患者,按随机数字表法随机分为干预组34例和对照组33例。对照组出院时给予常规健康教育,干预组在出院后给予电话跟踪访问,共5次,采用腹膜透析知识测评问卷、健康相关生活质量问卷、患者满意度调查表对两组患者进行调查,评价电话访问的效果。结果干预组知识掌握程度为优52．9％,良38．2％,差8．8％,对照组分别为24．2％,30．3％,45．5％,两组比较差异有统计学意义（ Z＝-3．252, P＝0．001）;干预组患者睡眠、躯体活动、精力、疼痛、情绪反应、社会孤独感得分分别为（10．6±6．3）,（8.9±5．2）,（22．3±0．5）,（18．6±7．3）,（13．6±9．3）,（15．7±7．6）分,均低于对照组,差异有统计学意义（t值分别为5．436,6．532,7．674,8．213,6．567,7．324;P＜0．01）;干预组患者对科主任、、主诊医师、普通护士满意度均高于对照组,差异有统计学意义（P＜0．05）。结论对腹膜透析患者出院后进行电话跟踪访问和指导,可以提升患者腹膜透析相关知识和技能,对患者的生活质量和医护人员的满意度均起到积极作用。     

出诊医师参与电话指导目击者实施心肺复苏

目的 评估出诊医生参与电话指导目击者实施心肺复苏(CPR)的可行性和有效性,并探讨电话指导的方法及影响电话指导的相关因素.方法 回顾分析2008-01～2009-04 32例院前心脏骤停(CA)患者的救治方法,没有电话指导或指导不成功18例,目击者未实施CPR;出诊医生采用预先制定的电话指导方案成功给予了电话指导14例,目击者实施了CPR.比较两组的复苏结果,并计算通过电话指导方案正确识别CA的比率,目击者对出诊医师电话指导CPR的接受率及CPR正确率等.结果 电话指导目击者25例,接受指导19例(19/25,76%),不接受6例.经指导成功完成CPR 14例(14/19,73.7%),未完成5例.指导人员采用电话指导方案正确识别CA 17例(17/19,89.5%),目击者正确实施CPR 5例(5/14,35.7%).目击者行CPR 14例中院前成活5例(35.7%),目击者未行CPR 18例中院前成活1例(5.6%).院前成活率两组比较有统计学意义(P＜0.01).结论 出诊医生依据简化的电话指导CPR方案参与电话指导目击者实施CPR能提高CA院前复苏结果.但值得注意的是电话指导受诸多因素影响.