危机管理模式结合传统外伤急救护理对急诊颅脑外伤患者的应用效果
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摘要
目的探究危机管理模式与传统外伤急救护理相结合对急诊颅脑损伤患者的应用效果。方法选择2017年2月—2018年9月绍兴市人民医院收治的90例急诊颅脑外伤患者,按照随机数字表法将其分为观察组和对照组各45例。对照组患者应用传统外伤急救护理,观察组患者在对照组的基础上结合危机管理模式。比较2组患者并发症发生率、护理期间不良事件发生率、神经功能(脑卒中量表,NIHSS评分)及昏迷程度(格拉斯哥昏迷指数,GCS评分)。结果 2组患者均无严重并发症(脑疝)的发生,观察组患者并发症包括肢体功能障碍、吞咽功能障碍、肺部感染及电解质紊乱的总发生率为4.4%(2/45),低于对照组患者的17.8%(8/45),差异有统计学意义(P<0.05);观察组患者护理期间不良事件发生率为8.9%,低于对照组患者的24.4%(P<0.05);护理干预前,2组患者NIHSS评分及GCS评分比较差异无统计学意义(P>0.05),护理后,观察组患者NIHSS评分明显低于对照组,且观察组患者GCS评分高于对照组(P<0.05)。结论危机管理模式结合传统外伤急救护理有利于提高急诊颅脑损伤患者急救效率,减少患者并发症的发生,且提高患者神经功能,减少护理期间不良事件的发生率。
Objective To explore the application effect of crisis management mode combined with traditional trauma emergency care on patients with emergency craniocerebral injury. Methods Ninety patients with emergency craniocerebral trauma admitted from February 2017 to September 2018 were randomly divided into observation group and control group, with 45 cases in each group. The patients in the control group were treated with traditional trauma emergency care, and the patients in the observation group were combined with the crisis management model based on the control group. Complication rate, incidence of adverse events during nursing, neurological function(stroke scale, NIHSS score) and coma degree(Glasgow coma index, GCS score) were compared between the two groups. Results There were no serious complications(cerebral hernia) in both groups. The total incidence of complications including limb dysfunction, swallowing dysfunction, pulmonary infection and electrolyte disturbance in the observation group was 4.4%(2/45), which was lower than that in the control group(17.8%, 8/45), P<0.05. The incidence of crisis events in the observation group was 8.9% lower than that in the control group(24.4%, P<0.05); there was no significant difference in NIHSS score and GCS score between the two groups before nursing intervention(P>0.05). After nursing, the NIHSS score of the patients in the observation group was significantly lower than that of the control group, and the GCS score of the patients in the observation group was higher than that of the control group(P<0.05). Conclusion Crisis management mode combined with traditional trauma first aid nursing is conducive to improving the first aid efficiency of emergency patients with craniocerebral injury, reducing the occurrence of complications, and improving patients' nervous function, and reducing the incidence of adverse events during nursing, which is worthy of clinical application.
Objective To explore the application effect of crisis management mode combined with traditional trauma emergency care on patients with emergency craniocerebral injury. Methods Ninety patients with emergency craniocerebral trauma admitted from February 2017 to September 2018 were randomly divided into observation group and control group, with 45 cases in each group. The patients in the control group were treated with traditional trauma emergency care, and the patients in the observation group were combined with the crisis management model based on the control group. Complication rate, incidence of adverse events during nursing, neurological function(stroke scale, NIHSS score) and coma degree(Glasgow coma index, GCS score) were compared between the two groups. Results There were no serious complications(cerebral hernia) in both groups. The total incidence of complications including limb dysfunction, swallowing dysfunction, pulmonary infection and electrolyte disturbance in the observation group was 4.4%(2/45), which was lower than that in the control group(17.8%, 8/45), P<0.05. The incidence of crisis events in the observation group was 8.9% lower than that in the control group(24.4%, P<0.05); there was no significant difference in NIHSS score and GCS score between the two groups before nursing intervention(P>0.05). After nursing, the NIHSS score of the patients in the observation group was significantly lower than that of the control group, and the GCS score of the patients in the observation group was higher than that of the control group(P<0.05). Conclusion Crisis management mode combined with traditional trauma first aid nursing is conducive to improving the first aid efficiency of emergency patients with craniocerebral injury, reducing the occurrence of complications, and improving patients' nervous function, and reducing the incidence of adverse events during nursing, which is worthy of clinical application.
引文
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[14] 苏川川.危机管理在急诊外科护理过程中的应用价值分析[J].社区医学杂志,2016,14(4):29-30.
[15] 朱蓓妮.危机管理在急诊外科护理工作中的应用效果分析[J].当代医药论丛,2014,12(21):115-117.
[2] 顾怡兰.无缝衔接一体化急救护理新模式在严重创伤患者救治中的应用[J].中国医药科学,2016,6(15):126-128.
[3] NGO S,SHAHSAHEBI M,SCHREIBER S,et al.Evaluatingthe effectiveness of community and hospital medicalrecord integration on management of behavioral health in the emergency department[J].J BehavHealth Serv Res,2017,44(11):1-8.
[4] ANTONACOPOULOU E P,SHEAFFER Z.Learning in crisis:rethinking the relationship between organizational learning and crisis management[J].J Manage,2014,23(1):5-21.
[5] LESTER N A,THOMPSON L R,HERGET K,et al.CALM interventions:behavioral health crisis assessment,linkage,and management improve patient care[J].Am J Med Qual,2018,33(1):65-71.
[6] 格林伯格.神经外科手册[M].7版.南京:江苏科学技术出版社,2013:34-35.
[7] 张小佳,商赫兰,汪立刚.系统护理干预对急性重症脑外伤患者术后康复日常生活能力的影响[J].中国医药导报,2017,14(25):155-158.
[8] 谭震森.危机管理结合一体化创伤急救模式在急诊外伤患者中的应用效果分析[J].现代诊断与医疗,2015,26(12):2852-2853.
[9] 易冰霞,余天鹏,谭壮丽.危机管理模式在降低急诊科危机事件发生率及患者满意度中的应用[J].中国当代医药,2017,24(26):166-168.
[10] 邹丽芳,钱凤萍,张金玲,等.危机管理模式结合传统外伤急救护理模式的应用研究[J].临床医药实践,2018,27(11):872-874.
[11] 许庆超,范萍,王昌俊.危机管理在急诊护理管理中的策略探讨[J].中国保健营养,2018,28(36):217.
[12] 牛茜.无缝衔接一体化急救护理模式在严重创伤病人中的应用[J].世界最新医学信息文摘,2015,15(68):199-200.
[13] 刘娟妹,周娟,陈春花.危机管理配合无缝隙一体化创伤急救护理模式在外伤急诊急救中的应用[J].护理实践与研究,2017,14(20):151-153.
[14] 苏川川.危机管理在急诊外科护理过程中的应用价值分析[J].社区医学杂志,2016,14(4):29-30.
[15] 朱蓓妮.危机管理在急诊外科护理工作中的应用效果分析[J].当代医药论丛,2014,12(21):115-117.