【作者】 邓敏；

【导师】 沈军；

【作者基本信息】 重庆医科大学 ， 护理学， 2014， 硕士

【摘要】 背景：慢性非传染性疾病是指以恶性肿瘤、心脑血管疾病、慢性阻塞性肺部疾病、糖尿病等为代表的一组疾病，《中国慢性病防治工作规划（2012-2015年）》指出我国慢性病发病人数快速上升，现有确诊患者2.6亿人，导致的死亡已经占到我国总死亡的85%，疾病负担已占总疾病负担的70%，若不及时有效控制，将带来严重的社会经济问题。根据流行病学调查，老年人慢性病的患病率为76-89%，明显高于中青年的23.7%，有研究显示，老年慢性病的病程长且无法治愈，导致老年患者活动受限，照顾需求增多，医疗费用支出加大，是影响老年人健康、自理和预期寿命的最重要因素，中国护理事业发展规划纲要提出“十二五”期间的主要目标以推进医院实施优质护理服务和推进老年、慢性病、临终关怀等长期医疗护理服务为抓手，不断提升护理服务能力和专业水平，因此，在不同场所为慢性病老年人提供切实有效的护理服务是护理事业发展的方向之一。目前，整体护理程序多采用1973年北美护理诊断协会制定评估、诊断、计划、实施、评价五个步骤，而老年人由于机体老化，免疫功能下降，器官功能衰退等原因而致多种慢性病共存且症状和体征不典型，在老年慢性病患者护理实践中出现护理问题杂陈，原因不清，重点不明等现象，从而不能对老年慢性病患者进行有效的护理干预，因此，建立规范化的模式促进老年慢性病患者护理的发展迫在眉睫。奥马哈系统是美国标准化语言分类系统的一种，包括问题分类系统、干预分类系统和效果评价系统三部分，主要用于社区护理，为社区护士及其他服务人员全面评估患者，及时针对患者问题采取干预措施提供了指引和评价方法，通过应用该系统，可以全面的评估出患者存在的问题，针对性的制定干预计划，并评估干预前后患者问题改善的程度，为及时调整护理计划提供依据，同时，标准化语言的应用确保了信息记录的准确性，因此，分析奥马哈系统在医护养中心的老年慢性病患者中应用的可行性、制定护理程序，针对老年慢性病患者存在的护理问题进行整理和分析，采取护理干预，并进行效果评价，验证奥马哈系统应用于医护养中心老年慢性病患者的效果。目的：探索奥马哈系统应用于医护养中心老年慢性病的可行性及前景，研究奥马哈系统应用于医护养中心老年慢性病患者的效果。方法：采取立意抽样法选择2013年5月至2013年8月入住重庆青杠老年医护养中心的老年慢性病患者护理记录107份，对描述症状体征、干预措施及护理结局的语句按照奥马哈系统框架进行内容分析，再通过方便抽样法选择医护养中心48例老年慢性病患者，应用奥马哈系统评估护理问题、实施护理干预，并在干预前后评分，数据录入SPSS13.0统计软件进行统计学分析。结果：1.采用内容分析法对从医护养中心老年慢性病患者护理记录中提取描述症状体征、干预措施及护理结局的分析单元4530个进行分析，与奥马哈系统概念完全吻合2227条，占总数的49.16%，同时，护理问题集中在生理领域（68.92%），护理措施集中在安全（8.79%）、服用药物（8.09%）的教育、指导和咨询，以及护理照顾（8.04%）的治疗和程序。2.采用奥马哈系统对医护养中心老年慢性病患者进行研究发现，共存在护理问题29个，占问题总数（42个）的69.05%，频次为1337，其中生理领域问题14个（885，66.19%），健康相关行为领域6个（291，21.77%），心理社会领域问题8个（157，11.74%），环境领域问题为1个（4，0.30%）。48例患者总共采用703个干预方案，平均14.65个/例，4个干预类别均有采用，其中教育、指导和咨询424次（60.31%）、治疗及程序109次（15.50%）、个案管理92次（13.09%）和监测78次（11.10%），干预导向69个，占总数（76个）的90.79%。干预前后，统计≥10人的问题结局评分，干预后患者认知、行为及状态的均分3.85、3.92、4.05分较干预前3.07、3.16、3.61分有明显改善（t=-14.291、-14.368、-9.807，均P<0.000），干预类别以教育、指导和咨询为主（424，60.31%）。结论：1.本研究证实奥马哈系统概念与医护养中心老年慢性病护理记录有较好的吻合率，四个干预类别均在医护养中心老年慢性病患者护理中得到体现，因此具备在医护养中心应用的可行性。2.本研究证实奥马哈系统可以概括医护养中心老年慢性病患者的护理问题，使评估更加系统和全面，干预方案体现了多学科团队参与的特点，能够提高医护养中心老年慢性病患者认知、行为、状态的水平，培养患者的自护意识和能力。更多还原

【Abstract】 Background: noninfectious chronic disease（NCD） Is a group ofdiseases including cancer, cardiovascular and cerebrovascular diseases,chronic obstructive pulmonary disease（COPD）, diabetes and so on.Chinese chronic disease prevention planning (2012-2015) pointed out thatNCD rises quickly, So far260000000patients suffer from NCD, and the85%of total deaths and the70%of burden of disease in China was causedby NCD, To continue, will bring the serious social and economic problems.According to the epidemiological survey, the prevalence rate of theNCD of the elderly was76-89%, is higher than young people (23.7%),Previous studies have shown that NCD of the elderly had the long courseand can not be cured, that limited activities of elderly patients, and lead tocare needs increased, and the medical expenditure increased, As well as Itis the most important factor to influence the health of the elderly, self-careand life expectancy, Chinese nursing development plan outline pointedout to promote the implementation of high quality nursing service and the elderly, chronic disease, hospice care, long-term care service is theimportant task of the period in“12th Five Year Plan", Therefore, indifferent places to provide effective nursing services for NCD of the elderlycan promote the nursing career development.At present, So far, China still used the holistic nursing programformulated by North American Nursing Diagnosis Association（NANDA）in1973,include assessment, diagnosis, planning, implementation,evaluation, but not applicable for the NCD of elderly, because with theaging，immune function and organ function decreased, various symptomsand signs coexist and are not typical, and caused the nursing problemsConfusion, reason is not clear, thus nursing intervention cannot beeffectively, therefore, to establish standardized model for elderly patientswith NCD is imminent.Omaha system is a classification system of standardized language inUSA, including question classification system, nursing intervention systemand evaluation system, mainly used for community care, providesguidelines for community nurses and other service personnel to assesspatients correctly And taking intervention measures in time, through theapplication of the system, the nursing problems of patients can bedistinguish effectively, targeted of interventions was pertinence, and assessthe improvement degree of patients before and after intervention, adjust thenursing care plan timely, at the same time, standard nursing language ensures nursing record accuracy, therefore, to analysis thefeasibility of application of Omaha system to elderly with NCD in nursinghome, and apply Omaha system and evaluate the effect.Objective: To explore the feasibility and Prospect of theOmaha System Applied in Senior Care Center in elderly patients withchronic disease. To explore the effects of Omaha system that is applied toseniors with chronic disease in medical nursing home.Methods: Choose nursing records of107elderly patients with chronicdiseases in Chongqing Qinggang Senior Care Center by Judgmentsampling methods, applied the content analysis methods to analysis thedescriptions of symptoms and signs, interventions and nursing outcomesaccording to Omaha framework. Choose48seniors with chronic diseasesin medical nursing home through convenience sampling methods, apply theOmaha System to Assess nursing problem, carry out nursing intervention,score outcome before and after the intervention, entry data to SPSS13.0statistical software for statistical analysis.Results:1.Extract4530analysis unit of symptoms andsigns, intervention and nursing outcome from nursing records of elderlypatients with chronic diseases in senior care center, And2227of it is fullyconsistent with the Omaha system concepts, accounting for49.16%of thetotal, At the same time, the nursing problems focused on physiological field(68.92%), the nursing measures focused onsafety (8.79%), medication (8.09%) of teaching, guidance and counseling,and nursing care (8.04%) of treatments and procedures.2. Seniors withchronic care issues focused on physical fields (885,66.19%)，such as nerve-muscle-skeletal and others, intervention category focused on education,guidance and counseling (424,60.31%), K-B-S score was statisticallysignificant (P <0.05).Conclusions：1.Omaha system question classification and interventionprogram covers most of the contents of nursing records of the elderlychronic diseases in senior care center, can be used to guide clinical nursingpractice and research.2. The application of Omaha system can improvethe lever of cognition and behavior and state of seniors with chronicdisease in medical nursing home.更多还原