舒适护理模式在乳腺癌患者围手术期护理中的应用

提供个性化舒适护理管理,营造良好的住院环境,可以使乳腺癌患者生理和心理方面得到改善,消除了不良情绪,减少了并发症的发生,有利于降低住院日,提高患者的满意度。     

手术室实施舒适护理的效果观察

目的：探讨舒适护理应用于手术室护理中的临床效果及应用价值。方法选择外科手术患者140例,采用数字表法随机分成观察组与对照组,各70例。对照组实施手术室常规护理,观察组在此基础上于术前、术中及术后实施心理、生理及体位的舒适护理。比较两组焦虑评分、手术配合度、舒适度及患者满意度。结果观察组SAS评分明显低于对照组;而其患者无焦虑与轻度焦虑、手术主动配合率、患者满意率、舒适度明显高于对照组,差异均有统计学意义（ P＜0.05）。结论舒适护理有助于缓解患者的焦虑情绪,使其积极配合手术治疗,提高了患者的舒适度和满意度。     

舒适护理在肾病性高度水肿中的应用研究

目的探讨舒适护理在肾病性高度水肿中的应用效果。方法将2011年11月～2012年11月本科收治的肾病综合征合并高度水肿患者60例,随机分为两组,对照组给予常规基础护理,观察组在对照组护理基础上,增加舒适护理;比较两组患者水肿消退情况、皮肤感染、住院时间、对护理工作满意度。结果观察组水肿完全消退27例（90％）,显著优于对照组21例（70％）;皮肤感染发生率为3．33％,显著低于对照组的16．66％;平均住院时间显著低于对照组,差异均有统计学意义（P〈0．05）。在患者的满意度调查中,观察组也远远高于对照组（P〈0．05）,患者对护理工作的满意度提高,效果满意。结论舒适护理在肾性水肿中的应用,可以有效降低皮肤感染的发生率、缩短住院时间,增加患者的满意度。同时,对改善肾病性水肿的预后减少并发症具有重要作用。     

Cycling-off modes during pressure support ventilation: Effects on breathing pattern,patient effort,and comfort

Purpose

Expiratory asynchrony during pressure support ventilation (PSV) has been recognized as a cause of patient discomfort, increased workload, and impaired weaning process. We evaluated breathing pattern, patient comfort, and patient effort during PSV comparing 2 flow termination criteria: fixed at 5% of peak inspiratory flow vs automatic, real-time, breath-by-breath adjustment within the range of 5% to 55%.

Materials and methods

Randomized crossover clinical trial. Sixteen awake patients, in the process of weaning, under PSV for more than 24 hours were subjected to 3 phases of PSV, each lasting 1 hour and using 1 of the 2 aforementioned termination criteria.

Results

Effective pressure support during automatic adjustment (AA) was 12.5 ± 3.2 cm H₂O vs 12.5 ± 3.9 cm H₂O (P = .9) with the fixed termination criterion, and external positive end-expiratory pressure was 6.2 ± 1.8 vs 6.8 ± 2 (P < .05). The effective termination criterion was higher during AA (31% [23-39] vs 12% [6-23]; P < .01), but without producing premature breath terminations. Pressure overshoots and alternative cycling-off were also decreased. Throughout the AA period, we observed a higher respiratory rate (24 ± 8 breaths/min vs 19 ± 6 breaths/min; P < .001), lower tidal volume (484 ± 88 mL vs 518 ± 102 mL; P < .001), and shorter inspiratory times (1.0 ± 0.3 seconds vs 1.3 ± 0.3 seconds; P < .001). Automatic adjustment was associated with lower airway occlusion pressure after 0.1 second (P0.1) (1.8 ± 0.9 cm H₂O vs 2.4 ± 1 cm H₂O; P < .01), lower pressure-time product to trigger the ventilator, and lower subjective discomfort (visual analog scale, 3.7 ± 1.3 vs 4.5 ± 1.2; P < .001).

Conclusions

When compared with a fixed termination criterion, the use of a variable, real-time–adjusted termination criterion improved some indices of patient-ventilator synchrony, producing better breathing pattern, less discomfort, and slightly lower patient effort during PSV.     

人口学特征对阴道灌洗患者舒适度的影响分析

目的了解阴道灌洗患者舒适状况,探讨人口学因素对其的影响.方法选择129例在妇科手术前遵医嘱接受阴道灌洗的患者,运用自行设计的阴道灌洗患者舒适状况及相关因素调查表对患者进行调查,分析阴道灌洗患者舒适状况及影响患者舒适的相关人口学因素.结果患者舒适度评分为1~8(3.70±1.34)分; Pearson相关分析显示,年龄与患者舒适度评分呈负相关(P<0.01),文化程度与患者舒适度评分呈显著正相关(P<0.01);Logistic多元线性回归分析显示,只有年龄对舒适度评分的影响有统计学意义(P<0.01).结论妇科患者在手术前阴道灌洗时存在不舒适状况,患者年龄与阴道灌洗舒适度评分负相关,即年龄越小舒适程度越差,年龄越大舒适程度越好.     

舒适护理在外科无陪病房的应用

目的通过在外科无陪病房开展舒适护理，达到提高护理质量，促进患者早日康复。方法以人为本，提供温馨舒适的环境，护士热情接待。对一般患者、手术患者每天评估，针对性地对每位患者制订计划并予以实施。出院患者电话联系，了解患者住院期间的满意度，对患者存在的问题及功能锻炼继续指导。体现对患者的关爱和重视，使患者得到生理、心理、社会、精神的舒适。结果在外科无陪病房开展舒适护理，患者的平均住院日、住院费用显著低于开展前（P〈0．01），而综合满意度显著高于开展前（P〈0．01）。结论开展无陪病房舒适护理，缩短了患者平均住院日，降低了住院费用，提高了患者满意度，深化了整体护理的内涵，创造了良好的社会效益。     

The Therapeutic Aspects of Acceptance

problem : What does acceptance mean to hospitalized adolescents? methods : Using a phenomenological research approach, the authors asked hospitalized adolescents (N = 6) on a psychiatric unit to describe how acceptance from psychiatric-mental health nurses was experienced by them. findings : Three essential themes emerged: (a) the nurse who shows acceptance is seen as a friend, (b) acceptance generates a sense of well-being, and (c) acceptance produces feelings of comfort with the nurse. conclusions : In acceptance, adolescents experience nurses as unique individuals who provide comfort and nurturing. This relationship connection helps adolescent clients to use their inner strength to gain a sense of well-being.     

Use of the Vector scaling unit in supportive periodontal therapy: a subjective patient evaluation

BACKGROUND: Patient discomfort is one reason for poor compliance with supportive periodontal therapy (SPT). The aim of this study was to compare the levels of discomfort during SPT, using the Vector system and treatment with a conventional ultrasonic scaler. METHODS: Forty-six patients with an SPT programme were debrided using both the Vector system and a conventional piezo-electric scaler (Sirona) in a split mouth design. A visual analogue scale was used to evaluate of pain scores upon completion of treatment. A verbal response scale(VRS) was used to assess discomfort, vibration and noise associated with the scaling system, as well as the volume and taste of the coolant used by these systems. RESULTS: Patients instrumented with the Vector system experienced approximately half the amount of pain compared with the conventional ultrasonic scaling system. The VRS showed that the Vector system caused less discomfort than the conventional ultrasonic scaling system when assessed for pain, vibration, noise and volume of coolant. These findings were all statistically significant. There was, however, no statistically significant difference between the two systems when assessed for taste. CONCLUSION: During SPT the Vector system caused reduced discomforting sensations compared with conventional methods and may be useful in improving compliance with SPT programmes.     

预防性护理对全麻下留置导尿管患者苏醒时舒适度的影响

目的探讨预防性护理对全麻下留置导尿管患者苏醒时舒适度的影响。方法选择2008年1月～2009年6月拟择期行食道癌根治术的90例男性老年患者为对照组,2009年7月～2010年12月拟择期行食道癌根治术的90例男性老年患者为实验组。对照组全麻下采用常规方法留置导尿管,实验组在留置导尿管的过程中实施预防性护理,减少导尿管对尿道的刺激及损伤,比较两组患者苏醒时舒适度的差异。结果两组患者苏醒时及术后2d的尿道刺激反应比较,均P<0.001,差异具有统计学意义,实验组患者尿道刺激反应轻于对照组。结论对全麻下留置尿管的患者实施预防性护理,能减少导尿管对尿道的刺激及损伤,提高患者苏醒时的舒适度,有利于加强对患者的人性化护理。