老年患者脑卒中康复过程中的疏漏问题的观察与分析

Observation and analysis of nursing omissions in the rehabilitation process of elderly patients undergoing with stroke after cranial drilling

目的调查和分析老年脑卒中患者康复期延续治疗和护理过程中的遗漏或错失。方法本研究采用前瞻性方法,选择需要卧床的老年住院患者8例、出院患者14例作为研究对象,根据护理程序不同将患者分为专业护理(住院期间接受的护理,n=8),社区护理(出院患者接受的门诊社区护理,n=7例)以及自助护理(家庭护理,n=7),观察时间10天。观察和记录康复过程中的治疗与护理遗漏,并发症发生。结果在设定的10天观察期间,专业组、社区组和家庭组共记录到护理项目1926、1601和1346个,专业组共发现护理差错86人次(4.4%),包括遗漏和护理延迟43人次(2.2%)和43人次(2.2%);社区组发现护理差错183人次(11.5%),分别遗漏102人次(6.4%)和护理延迟81人次(5.1%);家庭组发现护理差错251人次(18.7%),遗漏130人次(9.7%)和护理延迟121人次(9.0%),三组比较,差异有统计学意义(P<0.05)。专业组共发生重要护理疏漏15项,社区组有80项重要护理遗漏,家庭组中133项疏漏。结论缺乏常规训练的家庭护理发生遗漏的比例很高,患者发生不良事件比例增加,针对发生频度较高的护理项目进行监控和及时纠正有利于降低患者并发症发生及康复。

Objective To investigate and analyze omissions or misses in the continued treatment and nursing process of elderly patients during the rehabilitation period. Methods This study adopts a prospective approach,8 elderly inpatients and 14 discharged patients who need to be bedridden were selected as the research objects. According to the different nursing procedures,the patients are divided into professional nursing(nursing during hospitalization,n=8)and community nursing(Outpatient and community care for discharged patients,n=7 cases)and self-care(home care,n=7),observation time was 10 days.The treatment and nursing errors and omissions were observed and recorded during the rehabilitation process. Results During the set 10-day observation period,the professional group,the community group and the family group recorded a total of 1926,1601,and 1346 nursing items. The professional group found a total of 86 nursing errors(4.4%),including 43 cases of omissions and nursing delays(2.2%)and 43(2.2%);community group found 183 nursing errors(11.5%),missing 102(6.4%)and nursing delay81(5.1%);family group found 251 nursing errors(18.7%),130(9.7%)missed and 121(9.0%)nursing delay were missed. The difference between the three groups was statistically significant(P < 0.05).There were 15 important nursing omissions in the professional group,80 important nursing omissions in the community group,and 133 omissions in the family group. Conclusion Home care lacking routine training has a high rate of omissions and an increase in the proportion of patients with adverse events.Monitoring and timely correction of nursing items with a higher frequency will help reduce the incidence of complications and recovery of patients.