老年共病住院患者出院后延续性护理需求分析及应对策略

Analysis of Continuing Nursing Needs and Coping Strategies of Elderly Patients with Comorbidities After Discharge

目的调查北京市某三级医院综合科老年共病住院患者出院后延续性护理需求的内容,分析其特点,为制定患者回转至社区的护理方案提供理论依据,以协助家庭医生对患者实现连续性健康管理。方法采用横断面研究,选择首都医科大学附属复兴医院综合科2019年1月1日~12月31日收治的≥60岁的符合共病诊断标准的181例患者作为研究对象,根据入院第一诊断统计其住院原因;依据其出院诊断统计所患慢性病情况;依据其出院带药统计其用药情况;依据患者临床情况统计其出院后延续性护理需求。结果患者住院原因依次为明确感染(48.62%)、心血管疾病加重(24.86%)、脑血管疾病加重(18.78%)、其他慢性病急性加重(4.97%)、待查类疾病(2.76%);患者慢性病情况:高血压(72.37%)、高脂血症(67.40%)、冠心病(48.07%)、脑血管疾病(43.65%)、糖尿病(25.97%)、慢性阻塞性肺疾病(20.99%)、慢性心力衰竭(18.78%)、精神-心理疾病(20.44%)、胃食管返流(17.68%)、慢性贫血(16.02%)、慢性肾脏病(13.26%);用药方面,96.68%的患者存在多重用药;患者护理需要主要包括监测血压、血糖、定期采血、防压疮护理、预防深静脉血栓护理等。结论老年共病出院患者住院原因多样,患者慢性病较多,且普遍存在多重用药情况,延续性护理需求量大,护理要求存在一定难度。三级医院护士需要向患者及其照护人员充分宣教,制定详实可行的医疗照护方案,定期随访以利于与社区医护人员协同做好患者的连续性健康管理。

Objective To investigate the content of continuity nursing needs of inpatients with comorbidities in the general department of a tertiary hospital in Beijing after discharge,and analyze its characteristics.It provides a theoretical basis for formulating nursing plans for patients to return to the community to assist family doctors in realizing continuous health management of patients.Methods A cross-sectional study was used to select 181 patients≥60 years old who met the diagnostic criteria for comorbidities who were admitted to the General Department of Fuxing 1950 Hospital,from January 1 st to December 31 st,2019.Statistics of the reason for hospitalization based on the first diagnosis of admission;statistics of chronic diseases based on the diagnosis of discharge;statistics of the use of drugs based on the discharge of drugs;statistics of the need for continuous care after discharge based on the clinical conditions of patients.Results The reasons for the patients’hospitalization were as follows:clear infection(48.62%),exacerbation of cardiovascular disease(24.86%),exacerbation of cerebrovascular disease(18.78%),acute exacerbation of other chronic diseases(4.97%),and disease to be investigated(2.76%);chronic diseases:hypertension(72.37%),hyperlipidemia(67.40%),coronary heart disease(48.07%),cerebrovascular disease(43.65%),diabetes(25.97%),chronic obstructive pulmonary disease(20.99%),chronic heart failure(18.78%),mental-psychological diseases(20.44%),gastroesophageal reflux(17.68%),chronic anemia(16.02%),chronic kidney disease(13.26%);In terms of medication,96.68%of patients had multiple medications;Patient care needs mainly include monitoring blood pressure,blood sugar,regular blood sampling,nursing care for pressure ulcers,and nursing care for the prevention of deep vein thrombosis.Conclusion Elderly discharged patients with comorbidities are hospitalized for various reasons,more chronic diseases,and multiple medications are common.There is a large demand for continuous care,and there are certain difficulties in nursing requirements.Nurses in tertiary hospitals need to fully educate patients and their caregivers,formulate detailed and feasible medical care plans,and follow up regularly to facilitate continuous health management of patients in collaboration with community medical staff.