医养结合视域下专科护士帮扶模式对护理院护士经外周静脉置入中心静脉导管维护能力的影响

The influence of specialized nurses′assistance mode on the maintenance ability of PICC catheter in nursing hospital from the perspective of combination of medical care and nursing care

目的评价医养结合视域下静疗专科护士帮扶对护理院护士PICC导管维护能力的影响,为开展基层医院专科护理帮扶工作提供参考。方法采用类实验研究方法,根据Miller金字塔理论构建以专科技术为核心的专科护士帮扶模式,2021年1—12月对苏州市3家护理院进行帮扶。采用便利抽样法,调查帮扶前后护理院护士的PICC导管维护能力、PICC导管维护缺陷发生率、PICC导管并发症及非计划拔管的发生率、医生及患者满意度。结果共纳入86名护士,年龄(33.17±2.31)岁。帮扶后,护理院护士理论、操作技能成绩分别为(89.77±2.11)、(92.75±1.62)分,均显著高于帮扶前的(60.84±2.71)、(79.81±1.68)分,差异均有统计学意义(t=-84.96、-52.12,均P<0.05)。帮扶后护理院PICC导管维护缺陷中的标识不全、贴膜卷边、渗血渗液、导管打折、贴膜固定不规范、延续护理信息不全发生率分别为9.95%(21/211)、8.53%(18/211)、2.84%(6/211)、6.16%(13/211)、4.74%(10/211)、2.37%(5/211),均低于帮扶前的50.57%(89/176)、43.18%(76/176)、14.20%(25/176)、25.57%(45/176)、18.18%(32/176)、11.93%(21/176),差异均有统计学意义(χ^(2)值为14.00~77.81,均P<0.05)。帮扶后医用黏胶相关性皮肤损伤和导管阻塞并发症、非计划拔管发生率分别为4.44%(4/90)、3.33%(3/90)、2.22%(2/90),均低于帮扶前的20.51%(16/78)、15.38%(12/78)、11.54%(9/78),差异均有统计学意义(χ^(2)=8.81、6.06、4.50,均P<0.05)。帮扶后医生对护士满意度、患者对护理工作满意度分别为96.43%(27/28)、93.75%(45/48),均高于帮扶前的71.43%(20/28)、72.73%(32/44),差异均有统计学意义(χ^(2)=4.77、5.97,均P<0.05)。结论医养结合视域下静疗专科护士团队对护理院PICC导管维护帮扶能有效降低PICC导管并发症及非计划拔管的发生率,提高护理院护士PICC导管维护能力,有助于提高护理院的护理质量。

Objective To evaluate the effect of nursing specialist nurses′assistance on the ability of nursing home nurses to maintain venous catheter under the vision of combination of medical care and nursing care,providing reference for carrying out specialized nursing assistance work in grassroots hospitals.Methods This study was an experimental study.According to Miller′s pyramid theory,a model of specialist nurse assistance was established with specialized technology as the core.From January to December 2021,three nursing hospitals in Suzhou were assisted.Convenience sampling method was used to investigate the ability of intravenous catheter maintenance,the incidence of central venous catheter maintenance defects,the incidence of central venous catheter complications and unplanned extubation,and the satisfaction of doctors and patients before and after help.Results Totally 86 nurses were included,aged(33.17±2.31)years old.After the help,the theoretical and operational skill scores of nurses in the nursing home were(89.77±2.11)and(92.75±1.62)points,respectively,which were significantly higher than those before the help(60.84±2.71)and(79.81±1.68)points,and the differences were statistically significant(t=-84.96,-52.12,both P<0.05).Among the maintenance defects of central venous catheter in nursing homes,incomplete labeling,film wrapping,blood seepage,catheter discounting,non-standard film fixing,and incomplete information of extended care were 9.95%(21/211),8.53%(18/211),2.84%(6/211),6.16%(13/211),4.74%(10/211),2.37%(5/211)after help,all lower than 50.57%(89/176),43.18%(76/176),14.20%(25/176),25.57%(45/176),18.18%(32/176),11.93%(21/176)before help.The differences were statistically significant(χ^(2) values were 14.00 to 77.81,all P<0.05).The incidence of medical adhesive related skin injury,catheter obstruction complications and unplanned extubation were 4.44%(4/90),3.33%(3/90)and 2.22%(2/90),respectively,which were lower than 20.51%(16/78),15.38%(12/78)and 11.54%(9/78)before help.The differences were statistically significant(χ^(2)=8.81,6.06,4.50,all P<0.05).Doctors′satisfaction with nurses and patients′satisfaction with nursing work were 96.43%(27/28)and 93.75%(45/48),respectively,both higher than 71.43%(20/28)and 72.73%(32/44)before help,and the differences were statistically significant respectively(χ^(2)=4.77,5.97,both P<0.05).Conclusions From the perspective of combination of medical care and nursing care,the maintenance and assistance of intravenous catheters by the team of intravenous therapy nurses in nursing hospitals can effectively reduce the incidence of central venous catheter complications and unplanned extubation,improve the maintenance ability of intravenous catheters of nurses in nursing hospitals,and help to improve the quality of nursing care in nursing hospitals.