基于专科护士观察的术后早期患者更换肠造口产品流程规范性分析

Standardization of procedures to replace stoma care products in patients in early postoperative stage:an analysis based on clinical nurse specialists’observation

目的分析肠造口患者术后早期(≤6个月)更换造口产品流程规范性及其影响因素,为预防患者发生因产品使用不当引起的造口并发症提供参考。方法选取2019年8月至2019年12月于南方医科大学南方医院伤口造口门诊就诊的122名肠造口患者作为研究对象,研究人员成立造口专科护理评估小组,结合问卷调查的方法获取患者的一般人口学资料、肠造口相关资料,分析术后早期肠造口患者更换肠造口产品流程的规范性及其影响因素。结果在122名术后早期肠造口患者中,更换肠造口产品流程具有规范性的占比为41.8%,流程中规范性较弱的环节是“剪裁造口底盘”和“检查造口异常表现”。文化程度、是否与子女同住、造口护理健康教育形式、延续性护理模式对肠造口患者术后早期更换造口产品流程规范性有影响(均P<0.05);年龄、性别、职业类型、婚姻状况、家庭人均月收入、造口接受程度则对其无影响(均P>0.05)。患者与子女同住、使用回授法对患者进行健康教育、利用网络进行延续性护理对患者行为的规范性是有利的(均P<0.05)。结论采用回授法指导术后早期肠造口患者使用造口产品,并加强剪裁造口底盘、识别造口异常表现的教育对规范患者更换造口产品行为有重要意义,护士应给予未与子女同住的患者更多关注,积极开展网络延续性护理,帮助患者管理肠造口。

Objectives To analyze the levels of and factors affecting standardization of procedures to replace stoma care prod⁃uct in patients in early postoperative stage(within 6 months),and provide insights into the prevention of complications due to product misue.Methods One hundred and twenty-two patients with intestinal stoma attended the out-patient clinic of enterosto⁃my at the Nan Fang Hospital of Southern Medical University between August and December 2019 were recruited.Clinical nurse specialists formed an assessment team.Questionnaires were designed to obtain patients’demographics and information related to the stoma.We analyzed the levels of and factors affecting standardization of procedures to replace stoma care products.Results Of the 122 patients,only 41.8%performed the standardized procedure.The most difficult steps were tailoring chassis in stoma care product and checking the abnormality of the stoma.The factors affecting the patients’performing of the standardized proce⁃dure included education level,whether living with children or not,types of stoma education,and continuous nursing education(P<0.05).Age,sex,profession,marital status,household monthly income per person,and stoma acceptance did not affect whether the standardized procedure will be performed(P>0.05).Living with children,feedback,and continuous nursing via the internet were beneficial for patients to perform standardized procedure(P<0.05).Conclusion In order to perform the standardized proce⁃dure to replace stoma care product,it was important to use feedback and emphasize on tailoring chassis in stoma care product and checking the abnormality of the stoma.Nurses should pay more attention to patients who do not live with children and pro⁃vide continuous nursing to patients via the internet.