腹腔镜手术护理中断原因分析及其对手术结局影响的研究

Cause Analysis of Nursing Interruption in Laparoscopic Surgery and Its Impact on Surgical Outcomes

目的探讨腹腔镜手术护理中断事件的来源、类型及中断事件结局,分析腹腔镜手术护理中断事件对手术结局的影响。方法收集本院2014年4月-2017年4月实施的腹腔镜手术例,记录发生护理中断的事件,包括患者护理中断事件来源、护理中断事件类型、对事件结局或并发症的影响,分析发生护理中断事件的原因,采用Logistic回归分析法分析发生护理中断事件和未发生护理中断事件的影响因素。结果130例腹腔镜手术共记录80例护理中断事件,护理中断事件来源依次为手术环境、手术医生、麻醉医生、护士同事、护士自身、患者、其他人员;护理中断事件类型主要以侵扰型为主(55.00%),分心型、矛盾型次之(11.25%、23.75%),毁损型最少(10.00%);80例护理中断事件导致3例中转为开腹手术,2例护理险失事件;经Logistic回归分析法分析后显示,护士年资低、手术时间长是导致护理中断事件的影响因素。结论腹腔镜手术护理中断事件主要来源为手术环境和手术医生,以侵扰型为主;积极有效改善手术室环境,加强对低年资护士的培训,对于预防手术护理中断事件的发生具有积极意义。

Objective To explore sources,types,and outcomes of nursing interruption events in laparoscopic surgery,and analyze impact of nursing interruption events in laparoscopic surgery on surgical outcomes.Methods The paper collected cases of laparoscopic surgery in our hospital from April 2014 to April 2017,recorded nursing interruption events,including source of patient nursing interruption events,types of nursing interruption events,impact on event outcomes or complications,analyzed couse of nursing interruption events,influencing factors of nursing interruption events and non nursing interruption events with logistic regression analysis.Results There were 80 nursing interruption events recorded among 130 laparoscopic surgeries.Sources of nursing interruption events included:surgical environment,surgeon,anesthesiologist,nurse colleagues,nurse themselves,patients,and other staff.Main types of nursing interruption events included intrusive type(55.00%),followed by divided heart and contradictory(11.25%,23.75%),and destructive type,which was the least,(10.00%).Among 80 nursing interruption events,3 cases were changed to open surgery and 2 cases of nursing risk loss events.Logistic regression analysis,it was found that low seniority of nurses and long surgical time was influencing factors for nursing interruption events.Conclusion Main sources of nursing interruption events during laparoscopic surgery include surgical environment and surgeons,main with invasive type.It is of positive significance to improve operating room environment and strengthen training of junior nurses actively and effectively in preventing surgical nursing interruptions.