以问题为导向的管理模式在血液透析患者护理中的应用

目的：探讨以问题为导向的管理模式在血液透析患者护理中的应用效果。方法将2012年9月-2013年4月收治的92例血液透析患者按照1∶1比例随机分为两组，每组46例，对照组给予常规护理，观察组给予以问题为导向的管理模式运用1个月。采用抑郁自评量表（ SDS）、焦虑自评量表（SAS）及简明健康测量量表（SF-36）对进行评价。结果干预前两组患者SAS、SDS、SF-36各维度评分比较差异均无统计学意义（P＞0．05）；干预后，观察组患者SAS、SDS评分分别为（36．67±6．11），（40．69±6．76）分，均低于对照组（45．02±6．24），（45．96±6．87）分，差异有统计学意义（t 值分别为5．462，6．211；P＜0．05）；观察组患者SF-36各维度评分优于对照组和干预前，差异均有统计学意义（ P＜0．05）；观察组患者并发症发生率为10．87％，低于对照组的32．61％，差异有统计学意义（χ2＝3．619，P＝0．024）。结论通过以问题为导向的护理管理模式，可显著提高血液透析患者临床疗效，改善患者预后，提高其生活质量，值得临床广泛推广和应用。

Application of problem-based management model in the nursing of hemodialysis patients

Objective To explore the application effect of problem -based management model in the nursing of hemodialysis patients .Methods Ninety-two hemodialysis patients from September 2012 to April 2013 were chosen and randomly divided into the control group and the observation group , each with 46 cases.The control group received the routine nursing , and the observation group received problem-based management model for one month.The self-rating anxiety scale （SAS）, the self-rating depression scale （SDS） and the short form-36 health survey （SF-36） were used in two groups.Results No differences were found in the scores of SAS , SDS and SF-36 before intervention between two groups （ P 〉0.05 ）.The scores of SAS and SDS were respectively （36.67 ±6.11）, （40.69 ±6.76） in the observation group after intervention , and were lower than （45.02 ±6.24）, （45.96 ±6.87） in the control group, and the differences were statistically significant （ t=5.462, 6.211, respectively;P〈0.05）.The scores of every dimension in SF-36 in the observation group after intervention were better than those in the control group and those before intervention , and the differences were statistically significant （P〈0.05）.The incidence rate of complication in the observation group was 10.87%, and was lower than 32.61%in the control group, and the difference was statistically significant （χ2 =3.619, P=0.024）.Conclusions The problem-based management model in the nursing of hemodialysis patients can significant increase their clinical efficacy , and improve their prognosis , and improve the quality of life , and is worthy of promotion and application in clinic .