基于结构-过程-结果三维质量评价理念的延续护理模式在尿道下裂患儿中的应用

Application of continuing nursing model based on the three-dimensional quality evaluation concept of Structure-Process-Outcome in children with hypospadias

目的探讨基于结构-过程-结果三维质量评价理念的延续护理模式在尿道下裂患儿中的应用效果。方法选取南京医科大学附属儿童医院2019年1月—2022年1月收治的132例尿道下裂患儿作为研究对象,采用随机数字表法分为对照组和观察组,每组66例。对照组患儿采用常规护理联合延续性护理干预,观察组患儿在对照组基础上采用基于结构-过程-结果三维质量评价理念的延续护理模式进行干预。比较2组患儿术后疼痛水平,干预前后心理状态、家属照顾能力以及家属护理满意度。结果2组患儿术后24 h、48 h、72 h的修订版面部表情疼痛评估量表(FPS-R)评分均逐渐降低,组间、时间及交互效应比较,差异均有统计学意义(F_(组间)、F_(时间)、F_(交互)=25.124、32.572、40.862,均P<0.001);观察组患儿术后各时间点FPS-R评分均低于对照组,差异均有统计学意义(P<0.05)。干预前,2组患儿Achen-bach儿童行为量表(CBCL)的社交退缩、躯体诉述、抑郁、分裂样、交往不良、强迫行为、多动、攻击行为、违纪行为9个因子评分比较,差异均无统计学意义(P>0.05);干预后,2组患儿CBCL量表9个因子评分均低于干预前,且观察组均低于对照组,差异均有统计学意义(P<0.05)。干预前,2组患儿家属FCTI量表的适应照顾角色、处理个人情绪、应变及提供协助、调整生活及满足照顾需求、评估家人与社区资源5个维度评分比较,差异均无统计学意义(P>0.05);干预后,2组患儿家属FCTI量表的5个维度评分均低于干预前,且观察组均低于对照组,差异均有统计学意义(P<0.05)。干预后,观察组患儿家属对阴茎伸直、阴茎头形态、尿道口外观及包皮外观的满意度评分均高于对照组,差异均有统计学意义(P<0.05)。结论在尿道下裂患儿中应用基于结构-过程-结果三维质量评价理念的延续护理模式,能有效减轻患儿术后疼痛程度,改善患儿心理状态,提高家属照顾能力和护理满意度。

Objective To explore the application effect of the continuing nursing model based on the three-dimensional quality evaluation concept of Structure-Process-Outcome in children with hypospadias.Methods A total of 132 children with hypospadias admitted to the Children's Hospital of Nanjing Medical University from January 2019 to January 2022 were selected as the research participants.They were randomly allocated to a control group and an observation group,with 66 cases in each group.The control group received routine nursing combined with continuing nursing intervention,while the observation group received intervention based on the continuing nursing model using the three-dimensional quality evaluation concept of Structure-Process-Outcome on the basis of the control group.The postoperative pain levels,pre-and post-intervention psychological status,family caregiving ability,and family member's degree of satisfaction with nurse were compared between the two groups.Results The revised Facial Pain Scale-Revised(FPS-R)scores of the two groups gradually decreased at 24 hours,48 hours,and 72 hours after surgery.The differences between the groups,time points,and interaction effects were statistically significant(F_(Between Groups),F_(Time),F_(Interaction)=25.124,32.572,40.862,all P<0.001).The FPS-R scores of the observation group at each time point after surgery were significantly lower than those of the control group(P<0.05).Before intervention,no statistically significant differences were observed in the scores of the nine factors of the Achenbach Child Behavior Checklist(CBCL)between the two groups,including social withdrawal,somatic complaints,depression,anxiety,social problems,aggressive behavior,attention problems,rule-breaking behavior(P>0.05).The scores of the nine factors of the CBCL in both groups showed a significant decrease after the intervention,and the scores in the observation group were significantly lower than those in the control group(P<0.05).Before the intervention,no statistically significant differences were found in the scores of the five dimensions of the Family Caregiving Transition Index(FCTI)between the two groups,including adapting caregiving roles,managing personal emotions,coping and providing assistance,adjusting life and meeting caregiving needs,and assessing family and community resources(P>0.05).The scores of the five dimensions of the FCTI in both groups were significantly decreased after the intervention,and the scores in the observa-tion group were significantly lower than those in the control group(P<0.05).After the intervention,the scores of family member's degree of satisfaction with nursing regarding penile straightening,penile glans morphology,urethral orifice ap-pearance,and foreskin appearance in the observation group were significantly higher than those of the control group(P<0.05).Conclusion The application of the continuing nursing model based on the three-dimensional quality evaluation con-cept of Structure-Process-Outcome in children with hypospadias can effectively reduce postoperative pain,strengthen psy-chological state,and promote family caregiving ability and degree of satisfaction with nursing.