新型冠状病毒肺炎疫情期间肠造口门诊管理实践

Management of the out-patient clinic for enterostomy during the epidemic of CO⁃VID-19

目的分析2020年新型冠状病毒肺炎疫情期间某时段的造口门诊管理实践效果。方法我院造口门诊于2020年2月5日至2020年3月18日实施弹性动态管理模式——“6及时”管理,细化造口门诊管理工作,分析此期间患者资料及来诊者就诊满意度,并记录“6及时”管理模式实施前后出诊专科护士的焦虑情绪评分(HAMA评分)。同时,整理2019年6月1日至2019年12月31日患者资料以作基线参考。结果2020年所选研究时段就诊患者实际人数24人,年龄42~85岁,共401人次(造口患者本人有前来就诊50人次,其余为陪人或家属),其中肠造口换药36人次。与2019年所选择研究时段的患者资料相比,2020年所选研究时段本市郊区、外省市、外院手术、回肠造口、袢式造口患者占比有所上升,无并发症患者占比也有所上升,来诊者评价诊疗服务为“非常满意”者占比从初期的约70%上升至后期的90%以上。出诊护士人数为5人,每次均安排3人同时出诊协调工作。实施弹性动态管理模式前,护士5人的HAMA评分分别为15、18、22、23、17分,实施弹性动态管理模式后相应分别为3、4、4、8、2分。结论实施弹性动态“6及时”管理模式,注重新型冠状病毒肺炎疫情防控工作中造口门诊护理工作的细节管理,在保护关爱造口患者群体及出诊专科护士方面取得了良好的效果。

Objectives To analyze the quality of the management of the out-patient clinic for enterostomy during the epidemic of COVID-19.Methods Between February 5 and March 18,2020,our hospital initiated a flexible and dynamic management model,namely the‘six-timely management’,to refine the management of the out-patient clinic for enterostomy.We analyzed patients’characteristics,patient-visits’satisfaction and the anxiety level of the clinical nurse specialist by using the Hamilton Anxiety Scale,before and after the initiation of the model.Patients who attended the clinic between June 12019,and December 312019 were used as the reference group.Results Twenty-four patients attended the clinic during the period in 2020.Their age ranged from 42 to 85 years.We recorded 401 patient-visits,including 50 visits with the patients themselves and the remain⁃ing was accompanying persons or family members.There were 36 dressing changes.Compared with the reference group,the pro⁃portions of patients living in the suburban area,patients from other provinces,patients who received surgery in other hospitals,patients with ileostomy,patients with loop stomy,and patients with no complications increased in 2020.The proportion of pa⁃tients who rated the service as“very satisfied”increased from about 70%at the begining to over 90%at the end.Five clinical nurse specialists worked in the clinic,and three nurses attended the clinic for each consultation.The Hamilton Anxiety Scales scores of these five nurses before the initiation were 15,18,22,23,and 17,respectively,and the corresponding scores after the initiation were 3,4,4,8,and 2,respectively.Conclusion Our flexible and dynamic management model meets the needs to re⁃fine the management of the out-patient clinic for enterostomy during the epidemic of COVID-19.It provides care to the patients as well as the nurses.