标准化SBAR沟通模式联合多元化护理在血小板减少性紫癜患儿中的应用效果

Application effect of Standardized SBAR communication model combined with diversified nursing in children with thrombocytopenic purpura

目的评估标准化“现状-背景-评估-建议”(SBAR)沟通模式联合多元化护理在血小板减少性紫癜患儿中的应用效果。方法回顾性分析2020年8月至2022年8月郑州大学附属儿童医院收治的88例血小板减少性紫癜患儿的资料,依照护理方式不同将其分为两组。对照组44例,患儿男26例,女18例,年龄(9.59±1.04)岁,体质量指数(22.21±0.34)kg/m^(2);家属男15名,女29名,年龄(34.21±1.25)岁,受教育年限(10.08±1.05)年,采取常规护理。观察组44例,患儿男25例,女19例,年龄(9.56±1.02)岁,体质量指数(22.19±0.32)kg/m^(2);家属男12名,女32名,年龄(34.19±1.23)岁,受教育年限(10.05±1.03)年,实施SBAR沟通模式联合多元化护理。两组均持续护理至患儿出院,并随访观察1个月。比较两组遵医依从性、凝血功能、家属对健康知识的掌握情况、不良事件发生率、生活质量和家属满意度。采用t检验、χ^(2)检验。结果观察组遵医依从率为95.45%(42/44),高于对照组的79.55%(35/44),差异有统计学意义(χ^(2)=5.091,P=0.024);观察组护理后血小板计数为(224.87±21.46)×10^(9)/L、平均血小板体积为(9.19±0.53)fl、血红蛋白为(152.29±5.42)g/L,均高于对照组[(179.95±21.42)×10^(9)/L、(7.04±0.42)fl、(134.67±5.39)g/L],差异均有统计学意义(t=9.827、21.089、15.290,均P<0.05);观察组护理后家属健康知识掌握中病情监测评分为(12.25±1.05)分、饮食指导评分为(12.33±1.14)分、并发症预防评分为(12.47±1.09)分、用药指导评分为(12.28±1.18)分、保健知识评分为(12.27±1.05)分、总分为(62.35±3.16)分,均高于对照组[(8.98±1.02)分、(9.02±1.08)分、(8.76±1.06)分、(9.92±1.15)分、(8.99±1.02)分、(42.79±3.12)分],差异均有统计学意义(t=14.817、13.982、16.186、9.501、14.863、29.217,均P<0.05);观察组不良事件发生率为6.82%(3/44),低于对照组的22.73%(10/44)(χ^(2)=4.423,P=0.035);观察组护理后诺丁汉健康调查问卷(NHP)中睡眠评分为(23.37±2.46)分、精力评分为(18.69±2.63)分、孤独感评分为(21.14±2.09)分、身体活动评分为(14.35±1.10)分、情绪评分为(22.38±2.14)分,均低于对照组[(28.68±2.50)分、(26.37±2.69)分、(26.67±2.15)分、(17.63±1.16)分、(27.24±2.19)分](t=10.043、13.541、12.234、13.610、10.528,均P<0.05);观察组家属满意度为95.45%(42/44),高于对照组的81.82%(36/44),差异有统计学意义(χ^(2)=4.062,P=0.044)。结论SBAR沟通模式联合多元化护理能够提高血小板减少性紫癜患儿遵医依从性,改善患儿凝血功能,提升家属对健康知识的掌握,降低不良事件发生率,促进生活质量提升,从而获得更高的家属满意度。

Objective To evaluate the application effect of standardized SBAR(situation,background,assessment,and recommendation)communication model combined with diversified nursing in children with thrombocytopenic purpura(ITP).Methods The data of 88 children with ITP admitted to Children's Hospital Affiliated to Zhengzhou University from August 2020 to August 2022 were retrospectively analyzed.They were divided into two groups according to different nursing methods.In the control group,there were 26 boys and 18 girls,aged(9.59±1.04)years,with a body mass index of(22.21±0.34)kg/m^(2);there were 15 males and 29 females of the family members,aged(34.21±1.25)years,with years of education of(10.08±1.05)years.In the observation group,there were 25 boys and 19 girls,aged(9.56±1.02)years,with a body mass index of(22.19±0.32)kg/m^(2);there were 12 males and 32 females of the family members,aged(34.19±1.23)years,with years of education of(10.05±1.03)years.The control group took routine nursing,while the observation group implemented SBAR communication model combined with diversified nursing.Both groups received continuous nursing until the children were discharged,and the children were followed up for 1 month.The two groups were compared in terms of medical compliance,coagulation function,family members'mastery condition of health knowledge,incidence of adverse events,quality of life,and family satisfaction degree.t test andχ^(2) test were used.Results The medical compliance rate of the observation group was 95.45%(42/44),which was higher than that of the control group[79.55%(35/44)],with a statistically significant difference(χ^(2)=5.091,P=0.024).After nursing,the platelet count in the observation group was(224.87±21.46)×10^(9)/L,the mean platelet volume was(9.19±0.53)fl,and the hemoglobin was(152.29±5.42)g/L,which were higher than those in the control group[(179.95±21.42)×10^(9)/L,(7.04±0.42)fl,and(134.67±5.39)g/L],with statistically significant differences(t=9.827,21.089,and 15.290;all P<0.05).After nursing,the scores of disease monitoring,diet guidance,complication prevention,medication guidance,and health care knowledge of family members'mastery condition of health knowledge in the observation group were(12.25±1.05),(12.33±1.14),(12.47±1.09),(12.28±1.18),and(12.27±1.05)points,respectively,and the total score was(62.35±3.16)points,which were higher than those in the control group[(8.98±1.02),(9.02±1.08),(8.76±1.06),(9.92±1.15),(8.99±1.02),and(42.79±3.12)points],with statistically significant differences(t=14.817,13.982,16.186,9.501,14.863,and 29.217;all P<0.05).The incidence of adverse events in the observation group was 6.82%,lower than 22.73%in the control group(χ^(2)=4.423,P=0.035).After nursing,the scores of sleep[(23.37±2.46)points],energy[(18.69±2.63)points],loneliness[(21.14±2.09)points],physical activity[(14.35±1.10)points],and mood[(22.38±2.14)points]of the Nottingham Health Profile(NHP)in the observation group were all lower than those in the control group[(28.68±2.50),(26.37±2.69),(26.67±2.15),(17.63±1.16),and(27.24±2.19)points](t=10.043,13.541,12.234,13.610,and 10.528;all P<0.05).The satisfaction rate of family members in the observation group was 95.45%(42/44),which was higher than that in the control group[81.82%(36/44)],with a statistically significant difference(χ^(2)=4.062,P=0.044).Conclusion SBAR communication model combined with diversified nursing can improve the medical compliance of ITP children,improve the children's blood coagulation function,enhance the family members'health knowledge mastery,reduce the occurrence rate of adverse events,promote the improvement of quality of life,and thus obtain higher family satisfaction degree.