奥马哈系统延续护理对肿瘤患者PICC结局的影响
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摘要
目的探索基于奥马哈系统延续护理对肿瘤患者经外周静脉置入中心静脉导管(PICC)护理结局的影响。方法选择2017年2月—12月46例置入PICC导管的肿瘤患者为对照组,实施常规护理模式,实验组50例,实施基于奥马哈系统延续护理,分别在置入PICC当天、第一次化疗、第二次化疗、第三次化疗结束时对患者护理问题的认知、行为、状况进行评价,比较两组护理结局改善情况。结果两组患者环境、心理社会、生理、健康相关行为领域17个护理问题的认知、行为、状况均随着评价时间变化维度得分呈增长趋势,时间效应之间差别均有统计学意义(P <0. 05)。实验组患者社区资源、社交、精神健康、疏忽、认知、疼痛、皮肤、神经肌肉、循环、传染、个人照顾、健康照顾监督、遵医行为问题的认知、行为、状况以及收入、卫生问题的认知和角色改变、身体活动问题的认知、行为维度得分均高于对照组,组间效应之间差别均有统计学意义(P <0. 05);而收入、卫生问题的行为、状况和角色改变、身体活动问题的状况维度得分虽高于对照组,但组间效应之间差别无统计学意义(P>0. 05)。结论基于奥马哈系统的延续护理能够提高肿瘤患者PICC环境、心理社会、生理、健康相关行为领域问题的认知、行为、状况,全面改善护理结局,取得较好的护理成效。
Objective To explore the inflence of continuous care based on the Omaha system on PICC care outcomes in tumor patients. Methods From February to December 2017,46 patients with PICC catheters were selected as the control group and adopted the routine nursing model. Fifty patients were selected as experimental group and carried out the continuation of nursing based on the Omaha system. The cognition,behavior,and status of patients' nursing problems were evaluated,and the improvement of nursing outcomes in the two groups was compared at the first time the catheters placed in,the first time of chemotherapy,second chemotherapy and the third of chemotherapy. Results Seventeen nursing issues of two groups of patients in the cognition,behavior,status in the field of environmental,psychosocial,physiological,health-related behavioral are growing with the evaluation time and time effect between the difference had statistical significance( P < 0. 05) Patients in the experimental group have higher scores than that in the control group in the area of cognition,behavior,status in the fields of community resources,social,mental health,neglect,cognition,pain,skin,neuromuscular,circulation,infection,personal care,health care supervision,compliance issues and Income,health problem cognition,role change,physical activity problem cognition,behavioral dimension. There was a statistically significant difference between the groups( P< 0. 05). However,the scores of income,health problems,status,role changes and physical activity problems were higher than those in the control group,but the difference between the groups was not statistically significant( P > 0. 05). Conclusion The continuing nursing based on Omaha system can improve the cognition,behavior and status of PICC environment,psychosocial,physiological and healthrelated behaviors of tumor patients,improve nursing outcomes comprehensively,and achieve better nursing results.
Objective To explore the inflence of continuous care based on the Omaha system on PICC care outcomes in tumor patients. Methods From February to December 2017,46 patients with PICC catheters were selected as the control group and adopted the routine nursing model. Fifty patients were selected as experimental group and carried out the continuation of nursing based on the Omaha system. The cognition,behavior,and status of patients' nursing problems were evaluated,and the improvement of nursing outcomes in the two groups was compared at the first time the catheters placed in,the first time of chemotherapy,second chemotherapy and the third of chemotherapy. Results Seventeen nursing issues of two groups of patients in the cognition,behavior,status in the field of environmental,psychosocial,physiological,health-related behavioral are growing with the evaluation time and time effect between the difference had statistical significance( P < 0. 05) Patients in the experimental group have higher scores than that in the control group in the area of cognition,behavior,status in the fields of community resources,social,mental health,neglect,cognition,pain,skin,neuromuscular,circulation,infection,personal care,health care supervision,compliance issues and Income,health problem cognition,role change,physical activity problem cognition,behavioral dimension. There was a statistically significant difference between the groups( P< 0. 05). However,the scores of income,health problems,status,role changes and physical activity problems were higher than those in the control group,but the difference between the groups was not statistically significant( P > 0. 05). Conclusion The continuing nursing based on Omaha system can improve the cognition,behavior and status of PICC environment,psychosocial,physiological and healthrelated behaviors of tumor patients,improve nursing outcomes comprehensively,and achieve better nursing results.
引文
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[2]刘春丽,颜美琼,陆箴琦,等.肿瘤患者PICC自我管理能力及影响因素调查[J].中华护理教育,2011,8(7):294-297.
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[4]周燕,汤晓敏,程晓微,等. PICC导管维护标准流程降低导管相关性感染的效果[J].解放军护理杂志,2012,29(4):51-53.
[5]Martin K S,Monsen K A,Bowles K H. The Omaha system and meaningful use:applications for practice,eduction,and research[J].Comput Inform Nurs,2011,29(1):52-58.
[6]黄金月,王少玲,周家仪,等.奥马哈系统在社区护理和延续护理中的应用[J].中华护理杂志,2010,45(4):320-323.
[7]Anttila S K,Huhtala H S,Pekurinen M J,et al. Cost-effectiveness of an innovative four-year post-discharge programme for elderly patients-prospective follow-up of hospital and nursing home use in project elderly and randomized controls[J]. Scand J Public Health,2008,28(1):41-46.
[8]陈飞,张咏梅,韦秀碧,等.奥马哈系统应用于肠造口患者的可行性研究[J].护理管理杂志,2015,15(11):815-817.
[9]苏晓萍,张丽萍,李毅宁,等.奥马哈系统在泌尿造口患者延续护理中的应用和效果评价[J].中华护理杂志,2016,51(4):389-394.
[10]Martin K S,Norris J. Leak GK. Psychometric analysis of the problem rating scale for outcomes[J]. Outcomes Manag Nurs Pract,1999,3(1):20-25.
[11]张明,高伟,孙媛媛,等.肿瘤患者PICC带管期间自我护理能力与心理一致感及社会支持的相关性研究[J].护理学杂志,2014,29(8):78-80.
[12]闻曲,成芳,鲍爱琴,等.多维度关怀措施在肿瘤患者PICC置管中的实践与体会[J].护理管理杂志,2015,15(2):120-122.
[13]郭丽明,上官志毅,纪红梅,等. 1770例肿瘤患者PICC置管术后并发症的分析[J].护理管理杂志,2010,10(6):436-437.
[14]蒋国琴. 59例放化疗患者PICC置管的护理问题及对策[J].齐齐哈尔医学院学报,2012,33(8):1085-1086.
[15]陆松琴. PICC穿刺置管中存在问题的原因分析及对策[J].中国实用护理杂志,2011,27(12):54-55.
[16]刘远玲,潘玉琴,张秋荣.癌症患者PICC带管出院后并发症的原因分析及对策[J].护理学报,2008,15(10):80-82.
[2]刘春丽,颜美琼,陆箴琦,等.肿瘤患者PICC自我管理能力及影响因素调查[J].中华护理教育,2011,8(7):294-297.
[3]Turner J,Zapart S,Pedersen K,et al. Clinical practice guidelines for the psychosocial care of adults withcancer[J]. Psychooncology,2005,14(3):159-173.
[4]周燕,汤晓敏,程晓微,等. PICC导管维护标准流程降低导管相关性感染的效果[J].解放军护理杂志,2012,29(4):51-53.
[5]Martin K S,Monsen K A,Bowles K H. The Omaha system and meaningful use:applications for practice,eduction,and research[J].Comput Inform Nurs,2011,29(1):52-58.
[6]黄金月,王少玲,周家仪,等.奥马哈系统在社区护理和延续护理中的应用[J].中华护理杂志,2010,45(4):320-323.
[7]Anttila S K,Huhtala H S,Pekurinen M J,et al. Cost-effectiveness of an innovative four-year post-discharge programme for elderly patients-prospective follow-up of hospital and nursing home use in project elderly and randomized controls[J]. Scand J Public Health,2008,28(1):41-46.
[8]陈飞,张咏梅,韦秀碧,等.奥马哈系统应用于肠造口患者的可行性研究[J].护理管理杂志,2015,15(11):815-817.
[9]苏晓萍,张丽萍,李毅宁,等.奥马哈系统在泌尿造口患者延续护理中的应用和效果评价[J].中华护理杂志,2016,51(4):389-394.
[10]Martin K S,Norris J. Leak GK. Psychometric analysis of the problem rating scale for outcomes[J]. Outcomes Manag Nurs Pract,1999,3(1):20-25.
[11]张明,高伟,孙媛媛,等.肿瘤患者PICC带管期间自我护理能力与心理一致感及社会支持的相关性研究[J].护理学杂志,2014,29(8):78-80.
[12]闻曲,成芳,鲍爱琴,等.多维度关怀措施在肿瘤患者PICC置管中的实践与体会[J].护理管理杂志,2015,15(2):120-122.
[13]郭丽明,上官志毅,纪红梅,等. 1770例肿瘤患者PICC置管术后并发症的分析[J].护理管理杂志,2010,10(6):436-437.
[14]蒋国琴. 59例放化疗患者PICC置管的护理问题及对策[J].齐齐哈尔医学院学报,2012,33(8):1085-1086.
[15]陆松琴. PICC穿刺置管中存在问题的原因分析及对策[J].中国实用护理杂志,2011,27(12):54-55.
[16]刘远玲,潘玉琴,张秋荣.癌症患者PICC带管出院后并发症的原因分析及对策[J].护理学报,2008,15(10):80-82.