医护和患方共同参与护理计划制订对围术期患者护理效果的影响

Effect of doctors,nurses and patients involved in nursing plan formulation in perioperative patients nursing

目的探讨医护人员和患方(患者及患者家属)共同参与护理计划制订对普外腹部外科围术期患者护理效果的影响。方法选择2015-07至2016-06在福建医科大学附属泉州第一医院普通外科住院择期手术的110例患者为研究对象,采用便利抽样法选取部分患者由责任医师、责任护士、患方共同参与拟定护理计划(观察组,n=50),部分患者采用常规护理方法(对照组,n=60)。对比分析两组术前心理反应、术后并发症发生率及对护理工作的满意度。结果(1)术前心理反应中,观察组对担心手术失败(χ~2=6.93,P=0.01)、担心被误诊误治(χ~2=4.72,P=0.03)、惧怕麻醉与手术(χ~2=6.34,P=0.01)和担心疼痛(χ~2=13.37,P<0.001)的比例均显著低于对照组,差异有统计学意义。(2)观察组术后8%(4/50)患者出现并发症,显著低于对照组的28%(17/60),两组间差异有统计学意义(χ~2=7.30,P=0.01);且观察组感染(χ~2=4.50,P=0.03)、出血(P=0.50)、发热(χ~2=6.39,P=0.01)及电解质紊乱(χ~2=5.38,P=0.02)的发生率均低于对照组,差异均有统计学意义。(3)观察组术后对护理的满意度高于对照组,差异有统计学意义(Z=-3.69,P<0.001)。结论在常规护理的前提下,责任护士、责任医师和患方共同参与护理计划制定,能减少普外腹部外科围术期患者术前的心理反应、减少术后并发症发生,提升其满意度,具有现实指导意义。

Objective The objective of this study was to investigate the effect of doctors,nurses and patients together making nursing plan in nursing of perioperative general abdominal surgery patients.Methods A total of110patients hospitalized in department of general surgery,Quanzhou First Hospital Affiliated to Fujian Medical University from July2015to June2016were selected in this study.The patients were divided into the observation group(n=50)and the control group(n=60)using convenience sampling method.The observation group was given the comprehensive nursing involving doctors,nurses and patients,and the control group was given routine nursing.The psychological reaction before the treatment,incidence of complications and satisfaction towards nursing work after the treatment was compared and analyzed between the two groups.Results(1)The percentage of fear of mismanagement(χ2=4.72,P=0.03)&surgical failure(χ2=6.93,P=0.01)&anesthesia and surgery(χ2=6.34,P=0.01)&pain(χ2=13.37,P<0.001)in the observation group were significantly lower than those in the control group,and the differences were statistically significant.(2)There were8%(4/50)patients in the observation group developing complications,while the control group was28%(17/60),and the difference was statistically significant(χ2=7.30,P=0.01).And the incidence of infection(χ2=4.50,P=0.03)&hemorrhage(P=0.50)&fever(χ2=6.39,P=0.01)&electrolyte disturbance(χ2=5.38,P=0.02)in observation group was lower than that of the control group,and the differences were statistically significant.(3)Satisfaction towards nursing work in the observation group was higher than that of the control group after the operation,and the difference was statistically significant(Z=-3.69,P<0.001).Conclusions Comprehensive nursing involving primary nurses,physicians(anesthesiologists)and patients besides the regular nursing can reduce preoperative psychological reaction and incidence of postoperative complications,and improve patient satisfaction.