个案管理模式在永久性结肠造口患者护理中的应用

The case management model in the application of nursing the permanent colostomy patients

目的探讨个案管理模式对提高永久性结肠造口患者的自我护理能力及知识掌握、改善患者带造口生活的主观感受及提高患者对护理服务满意度的效果。方法将78例患者按随机分组法分为观察组及对照组。观察组39例,对照组39例,观察组采用个案管理模式进行护理,对照组按照直肠癌术后常规护理流程进行护理、健康教育及康复指导。结果观察组患者在出院后的1周、1个月、3个月时对造口的自我护理状态、自我护理技能掌握方面均明显优于对照组(自我护理状态:χ~2=8.057,P=0.045;χ~2=18.831,P<0.001;χ~2=13.484,P=0.004;自我护理技能t=12.093,P=0.001;t=16.62,P<0.001;t=15.418,P<0.001);观察组患者在出院后3个月对带造口生活的主观感受方面综合评价及对护理服务满意度评价也高于对照组(t=5.198,P=0.007;t=4.514,P<0.001)。结论通过对永久性造口患者实施个案管理模式,可明显提高造口患者对造口自我护理技能、造口护理知识的掌握,改善造口患者的主观感受,同时提升患者对护理服务的满意度,改善护患关系。

Objective To explore the case management model for improving self-care ability of colostomy patients and mastering relevant knowledge,improving the subjective feeling of life for the colostomy patients,and improving the effect of the nursing service satisfaction.Methods Seventy-eight patients were divided into observation group and control group by random grouping method.Thirty-nine cases were in the observation group and39cases were in the control group.The observation group used the case management model to nurse the patients,the control group were nursing according to the postoperative rectal cancer routine nursing process,health education and rehabilitation guidance.Results Colostomy self-care status,self-care skills and mastering of colostomy nursing knowledge of the observation group after1week,1month,3months were better than that in control group(self-care status:χ2=8.057,P=0.045;χ2=18.831,P<0.001;χ2=13.484,P=0.004;self-care skills:t=12.093,P=0.001;t=16.62,P<0.001;t=15.418,P<0.001),the subjective feeling aspect of colostomy life of the observation group of patients in the hospital after three months also scored higher than the control group(t=5.198,P=0.007;t=4.514,P<0.001).Conclusion Through the case management model,the patients with permanent colostomy can obviously improve themselves with self-care skills,master the colostomy nursing knowledge,improve the subjective feeling of colostomy patients,improve patient satisfaction to nursing service at the same time and improve the relationship between nurses and patients.