胎动不安中西医结合临床护理路径的研究
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摘要
研究目的：制定出适合胎动不安患者的中西医结合临床护理路径。评价其临床应用效果,以规范护理行为,减少护理差错；减轻患者的焦虑抑郁症状,提高保胎成功率和患者满意度；为创建具有中医特色且符合我国国情发展和医疗卫生政策改革要求的新型护理模式提供参考依据。
研究方法：研究过程分两个阶段进行,采用类实验研究设计。第一阶段采用数据分析、循证和专家咨询法,设计并生成胎动不安中西医结合临床护理路径表格和实施流程。第二阶段采用便利抽样的方法,于2010年5月-2011年2月选取黑龙江中医药大学附属第一医院妇科研究病房住院120例胎动不安患者作为研究对象,将120例患者随机分为试验组和对照组,每组各60例。对照组实施妇科常规护理模式,试验组根据事先制定好的中西医结合临床护理路径表格(护理人员版和患者版)对患者进行护理。选用住院天数、住院费用、自我护理能力、焦虑得分、抑郁得分、住院患者对临床护理工作满意度、临床疗效七项指标作为评价工具,将试验所得数据全部输入SPSS17.0软件进行分析,采用频数分布、均数、标准差等描述性统计分析方法以及t检验、秩和检验、Krusal-wallisH检验、单因素方差分析等推断性的统计分析方法对数据进行处理。
研究结果：1.制定出胎动不安中西医结合临床护理路径表格和实施流程,路径表包括护理人员版和患者版；
2.临床应用效果分析
2.1试验前两组患者焦虑、抑郁及自我护理能力得分比较差异无统计学意义(P>0.05)：焦虑得分均集中在60-69分,处于中等水平；抑郁指数均集中在0.6-0.69之间,处于中等水平；自我护理水平以中下等为主；
2.2试验前两组患者焦虑、抑郁得分与国内常模比较差异有统计学意义(P<0.01),得分均明显高于常模值；
2.3试验后两组患者焦虑、抑郁得分均较试验前明显降低,自身比较差异有统计学意义(P<0.01)；试验后两组患者焦虑得分均集中在50-59分,以无焦虑及轻度焦虑为主；抑郁指数均集中在0.5-0.59之间,以无抑郁及轻度抑郁为主,试验组焦虑、抑郁得分均低于对照组,两组之间比较差异有统计学意义(P<0.05)；
2.4试验后两组患者的自我护理能力均有提高,处于中高等水平；试验组得分高于对照组,两组之间比较差异有统计学意义(P<0.01);
2.5试验后两组患者的焦虑得分均高于常模值(P<0.01)；抑郁得分对照组仍高于常模值(p<0.01),试验组与常模值没有差异(P>0.05)；
2.6试验组患者对临床护理工作满意度得分高于对照组,两组之间比较差异有统计学意义(P<0.01);
2.7试验组患者的住院天数、住院费用低于对照组,两组之间比较差异有统计学意义(P<0.01)；
2.8试验组临床有效率为90%,对照组为85%,两者之间比较差异无统计学意义(P>0.05)；
2.9焦虑、抑郁、患者满意度、自我护理能力得分在临床疗效上单因素分析,差异有统计学意义(P<0.05)；住院天数及住院费则无统计学意义(P>0.05)。
研究结论：制定出胎动不安病人的中西医结合临床护理路径,与医院内常规护理模式相比,中西医结合临床护理路径模式可以有效的提高患者对护理工作的满意度,减轻患者焦虑、抑郁不良情绪,增强自我护理能力,缩减医疗费用,并有助于提高保胎成功率。
Objective:Develop appropriate fetal movement disturbed the patient's clinical care in the Western path to regulate the care and behavior, to reduce nursing errors, improve clinical quality of care; reduce the symptoms of anxiety and depression in patients and improve the success rate of miscarriage and patient satisfaction; to create a Chinese characteristics and conditions in line with my policy of reform and development and new health care model to provide a scientific reference.
Methods:This study used a quasi-experimental design, research process in two stages. The first stage is using the data analysis, evidence and expert consultation, design and creation of disturbed fetal movement path of Integrated Traditional and Western forms and the implementation of clinical care processes. The second phase of convenience sampling method, in May 2010-2011 selected in February of Heilongjiang University of Chinese Medicine, First Affiliated Hospital inpatient gynecology ward of 120 cases of fetal movement disturbed patients as research subjects,120 patients were randomly divided into test group and control group,60 patients in each group. The implementation of the control group routine gynecological care model, the experimental group laid down in advance in accordance with Chinese and Western forms of clinical care path (nursing staff and patients edition version) on the patients care. Choose length of stay, hospital costs, self-care ability, anxiety scores, depression scores, length of stay of patients in clinical nursing job satisfaction, clinical evaluation of seven indicators as a tool to test all of the data input SPSS17.0 software analysis, the use of frequency distribution, mean, standard deviation, descriptive statistical methods, as well as t test, rank sum test, Krusal-wallis H test, ANOVA and other inferential statistical methods for data processing.
Results:1. To develop a fetal irritability of Traditional Chinese Medicine and implementation of nursing process forms the path, the path version of the table, including nurses and patient version;
2. Analysis of clinical effect
2.1 Test the first two groups of patients with anxiety, depression and self-care ability score difference was not statistically significant (P> 0.05); anxiety scores were concentrated in 60-69 minutes, in the middle level; depression index were concentrated in the 0.6-0.69, in the middle level; self-care level to lower-middle-based;
2.2 Two groups of patients before the test anxiety and depression scores compared with the national norm difference was statistically significant (P <0.01), scores were significantly higher than the norm value;
2.3 Test the two groups were anxiety, depression scores significantly lower than before the test, there was significant difference between their own (P <0.01); test anxiety score of two groups are concentrated in 50-59 minutes, to no anxiety and mild anxiety based; depression between the index are concentrated in the 0.5-0.59, with no depression and minor depression based; tests of anxiety and depression scores were lower than the control group there was significant difference between the (P<0.05);
2.4 Tests the two groups of patients were improved self-care ability, at the higher level; the experimental group scored higher, the difference between the two groups was statistically significant (P<0.01);
2.5 Test anxiety in both groups scored higher than the norm values (P <0.01); depression score of the control group was still higher than normal value (P<0.01), and the norm value of the test group did not differ (P> 0.05);
2.6 Clinical trial group patients scored higher in satisfaction with care, the difference between the two groups was statistically significant (P<0.01);
2.7 Test group of patients with length of stay, hospital costs were lower than the control group, the difference between the two groups was statistically significant (P<0.01);
2.8 The clinical trial was 90% effective,85% of the control group between the two was no significant difference (P> 0.05);
2.9 Anxiety, depression, patient satisfaction, self-care ability scores on the clinical efficacy of single-factor analysis, the difference was significant (P <0.05); hospital stay and hospital expenses, there was no statistical significance (P> 0.05);
Conclusions:The development of the fetal movement disturbed the patient-'s clinical care in the Western path, with the hospital compared to usual care model, combined with clinical care in the Western path model can effectiv-ely improve patient care and job satisfaction, reduce anxiety, depression and poor Emotions, and strengthen self-care capacity, reduce health care costs and help increase the success rate of miscarriage.
研究方法：研究过程分两个阶段进行,采用类实验研究设计。第一阶段采用数据分析、循证和专家咨询法,设计并生成胎动不安中西医结合临床护理路径表格和实施流程。第二阶段采用便利抽样的方法,于2010年5月-2011年2月选取黑龙江中医药大学附属第一医院妇科研究病房住院120例胎动不安患者作为研究对象,将120例患者随机分为试验组和对照组,每组各60例。对照组实施妇科常规护理模式,试验组根据事先制定好的中西医结合临床护理路径表格(护理人员版和患者版)对患者进行护理。选用住院天数、住院费用、自我护理能力、焦虑得分、抑郁得分、住院患者对临床护理工作满意度、临床疗效七项指标作为评价工具,将试验所得数据全部输入SPSS17.0软件进行分析,采用频数分布、均数、标准差等描述性统计分析方法以及t检验、秩和检验、Krusal-wallisH检验、单因素方差分析等推断性的统计分析方法对数据进行处理。
研究结果：1.制定出胎动不安中西医结合临床护理路径表格和实施流程,路径表包括护理人员版和患者版；
2.临床应用效果分析
2.1试验前两组患者焦虑、抑郁及自我护理能力得分比较差异无统计学意义(P>0.05)：焦虑得分均集中在60-69分,处于中等水平；抑郁指数均集中在0.6-0.69之间,处于中等水平；自我护理水平以中下等为主；
2.2试验前两组患者焦虑、抑郁得分与国内常模比较差异有统计学意义(P<0.01),得分均明显高于常模值；
2.3试验后两组患者焦虑、抑郁得分均较试验前明显降低,自身比较差异有统计学意义(P<0.01)；试验后两组患者焦虑得分均集中在50-59分,以无焦虑及轻度焦虑为主；抑郁指数均集中在0.5-0.59之间,以无抑郁及轻度抑郁为主,试验组焦虑、抑郁得分均低于对照组,两组之间比较差异有统计学意义(P<0.05)；
2.4试验后两组患者的自我护理能力均有提高,处于中高等水平；试验组得分高于对照组,两组之间比较差异有统计学意义(P<0.01);
2.5试验后两组患者的焦虑得分均高于常模值(P<0.01)；抑郁得分对照组仍高于常模值(p<0.01),试验组与常模值没有差异(P>0.05)；
2.6试验组患者对临床护理工作满意度得分高于对照组,两组之间比较差异有统计学意义(P<0.01);
2.7试验组患者的住院天数、住院费用低于对照组,两组之间比较差异有统计学意义(P<0.01)；
2.8试验组临床有效率为90%,对照组为85%,两者之间比较差异无统计学意义(P>0.05)；
2.9焦虑、抑郁、患者满意度、自我护理能力得分在临床疗效上单因素分析,差异有统计学意义(P<0.05)；住院天数及住院费则无统计学意义(P>0.05)。
研究结论：制定出胎动不安病人的中西医结合临床护理路径,与医院内常规护理模式相比,中西医结合临床护理路径模式可以有效的提高患者对护理工作的满意度,减轻患者焦虑、抑郁不良情绪,增强自我护理能力,缩减医疗费用,并有助于提高保胎成功率。
Objective:Develop appropriate fetal movement disturbed the patient's clinical care in the Western path to regulate the care and behavior, to reduce nursing errors, improve clinical quality of care; reduce the symptoms of anxiety and depression in patients and improve the success rate of miscarriage and patient satisfaction; to create a Chinese characteristics and conditions in line with my policy of reform and development and new health care model to provide a scientific reference.
Methods:This study used a quasi-experimental design, research process in two stages. The first stage is using the data analysis, evidence and expert consultation, design and creation of disturbed fetal movement path of Integrated Traditional and Western forms and the implementation of clinical care processes. The second phase of convenience sampling method, in May 2010-2011 selected in February of Heilongjiang University of Chinese Medicine, First Affiliated Hospital inpatient gynecology ward of 120 cases of fetal movement disturbed patients as research subjects,120 patients were randomly divided into test group and control group,60 patients in each group. The implementation of the control group routine gynecological care model, the experimental group laid down in advance in accordance with Chinese and Western forms of clinical care path (nursing staff and patients edition version) on the patients care. Choose length of stay, hospital costs, self-care ability, anxiety scores, depression scores, length of stay of patients in clinical nursing job satisfaction, clinical evaluation of seven indicators as a tool to test all of the data input SPSS17.0 software analysis, the use of frequency distribution, mean, standard deviation, descriptive statistical methods, as well as t test, rank sum test, Krusal-wallis H test, ANOVA and other inferential statistical methods for data processing.
Results:1. To develop a fetal irritability of Traditional Chinese Medicine and implementation of nursing process forms the path, the path version of the table, including nurses and patient version;
2. Analysis of clinical effect
2.1 Test the first two groups of patients with anxiety, depression and self-care ability score difference was not statistically significant (P> 0.05); anxiety scores were concentrated in 60-69 minutes, in the middle level; depression index were concentrated in the 0.6-0.69, in the middle level; self-care level to lower-middle-based;
2.2 Two groups of patients before the test anxiety and depression scores compared with the national norm difference was statistically significant (P <0.01), scores were significantly higher than the norm value;
2.3 Test the two groups were anxiety, depression scores significantly lower than before the test, there was significant difference between their own (P <0.01); test anxiety score of two groups are concentrated in 50-59 minutes, to no anxiety and mild anxiety based; depression between the index are concentrated in the 0.5-0.59, with no depression and minor depression based; tests of anxiety and depression scores were lower than the control group there was significant difference between the (P<0.05);
2.4 Tests the two groups of patients were improved self-care ability, at the higher level; the experimental group scored higher, the difference between the two groups was statistically significant (P<0.01);
2.5 Test anxiety in both groups scored higher than the norm values (P <0.01); depression score of the control group was still higher than normal value (P<0.01), and the norm value of the test group did not differ (P> 0.05);
2.6 Clinical trial group patients scored higher in satisfaction with care, the difference between the two groups was statistically significant (P<0.01);
2.7 Test group of patients with length of stay, hospital costs were lower than the control group, the difference between the two groups was statistically significant (P<0.01);
2.8 The clinical trial was 90% effective,85% of the control group between the two was no significant difference (P> 0.05);
2.9 Anxiety, depression, patient satisfaction, self-care ability scores on the clinical efficacy of single-factor analysis, the difference was significant (P <0.05); hospital stay and hospital expenses, there was no statistical significance (P> 0.05);
Conclusions:The development of the fetal movement disturbed the patient-'s clinical care in the Western path, with the hospital compared to usual care model, combined with clinical care in the Western path model can effectiv-ely improve patient care and job satisfaction, reduce anxiety, depression and poor Emotions, and strengthen self-care capacity, reduce health care costs and help increase the success rate of miscarriage.
引文
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