“三位一体”护理管理模式在维持性血液透析患者中的应用

Application of ＂three-in-one＂ nursing management model on patients with maintained hemodialysis

目的探讨“三位一体”护理管理模式在维持性血液透析患者护理中的应用价值。方法采用便利抽样法，选择2015年7月-2017年8月在浙江省立同德医院治疗的维持性血液透析患者102例，随机分成对照组与观察组，各51例。对照组沿用传统护理管理模式，观察组实施医院-社区-家庭“三位一体”护理管理模式，于人院后建立个人档案，并在出院前1周选择患者居住地附近的社区卫生服务所，将护理工作与社区护士交接，给予家庭康复指导。比较两组干预前后的血压、口渴程度、味觉敏感度以及唾液静息流率改变情况，采用自我管理量表、生活质量量表（SF．36）比较两组自我管理行为和生活质量。结果干预3个月后，观察组收缩压为（132．67±12．54）mmHg，对照组（141．57±12．09）mmHg，差异有统计学意义（t=-3．370，P〈0．05）；观察组味觉敏感度评分为（78．23±8．72）分，对照组（66．31±9．65）分，差异有统计学意（t=6．545，P〈0．05）。干预后观察组自我管理行为（70．52±10．05）分，总体健康评分（87．65±6．92）分，均高于对照组，差异有统计学意义（t值分别为4．656、2．660；P〈0．05）。结论对维持性血液透析患者采用“三位一体”护理管理，有利于提升味觉敏感度，改善患者自我管理行为与生活质量，值得在临床推广。

Objective To explore the effects of the ＂three-in-one＂ nursing management model when applied in the patients with maintained hemodialysis. Methods Totally 102 patients with maintained hemodialysis who were treated in Tongde Hospital of Zhejiang Province from July 2015 to August 2017 were selected by convenient sampling, and equally and randomly divided into a control group and an observation group. Patients in the control group received routine nursing and management, while patients in the observation group received the ＂three-in-one＂ nursing and management of hospitals, communities and families. Their personal information was filed when they were admitted into hospital, and the nursing work was transferred to the nurses in the community health service center in the vicinity of the patients＇residence which was chosen one week before the patients were discharged from hospital. These nurses provided family rehabilitation guidance to the patients. The changes in blood pressure, degree of thirst, taste acuity and the resting salivary flow rate were compared between the patients in the two groups before and after the intervention. The Self-Management Scale and the MOS Item Short Form Health Survey （SF-36） were used to compare the sell-management behavior and quality of life between the patients in the two groups. Results After three months＇ intervention, the systolic pressure of the patients in the observation group and the patients in the control group was （132.67 ± 12.54）mmHg and （141.57 ± 12.09） mmHg respectively （t=3.370, P〈0.05）; the taste acuity score of the patients in the observation group and the patients in the control group was （78.23 ± 8.72） and （66.31 ± 9.65）, respectively （t=6.545, P 〈 0.05） ; the scores for self-management behavior and overall health of the patients in the observation were （70.52 ＋ 10.05） and （87.65 ± 6.92）, both higher than those of the patients in the control group （t=4.656, 2.660; P 〈 0.05）. Conclusions The ＂three-in-one＂ nursing and management model applied in the patients with maintained hemodialysis can help to improve taste acuity, self-management behavior and quality of life in these patients, thus worthy of clinical application.