【作者】 吴飞；

【导师】 王超虹；

【作者基本信息】 吉林大学 ， 护理学， 2015， 硕士

【摘要】 目的：本研究以网络通信为手段告知家属患者手术的进展情况，探讨该干预措施对家属心理以及生理的影响，旨在为完善手术室的护理服务，贯彻落实“以健康为中心”的整体护理理念。方法：本研究分两步进行，第一步通过德尔菲法确定手术进程信息内容标准；第二步以手术进程信息内容标准为依据对手术患者家属进行干预，干预分为术前访视、术中沟通和术后随访三个阶段。本研究选择2013年9月—2014年8月在吉林大学第一医院小儿外科住院患者的家属100例作为研究对象，随机分为试验组和对照组各50例。本着知情同意的原则，首先要告知家属本研究的目的及意义，并签署知情同意书。两组研究对象均要在术日前1天术前访视时和术日手术开始时两个时间点，由专门的护理人员采用状态焦虑量表（S-AI）评估家属当时的心理状况，同时用血压计、便携式血痒指套、计时器测定两组家属当时的脉搏、呼吸频率和血压三项生理指标。在干预措施上，对照组只接受术前访视和术后随访，不与其进行术中网络沟通；而试验组家属除了接受术前访视和术后随访之外，在术中由巡回护士通过网络通信平台（微信、QQ）与家属之间进行适当的网络沟通，实时告知患者的手术进展情况。本研究全部数据采用Excel软件进行统计，然后用SPSS17.0进行统计学分析，计量资料使用t检验分析，计数资料采用χ2检验分析，P>0.05为差异没有统计学意义，P<0.05为差异有统计学意义，P<0.01为差异有显著性。结果：1.德尔菲法确定手术进程信息内容标准，包括3个一级条目；8个二级条目；23个三级条目。2.两组家属一般资料比较结果显示：两组患者的病种和医保类型进行比较，结果两组患者不具有差异性，两个方面均无统计学意义（P>0.05），从而保证两组患者的家属具有可比性。两组家属在与患者关系、年龄、学历、患者是否独生、是否增加家庭经济负担、是否影响工作和生活、对孩子病情的了解程度和对手术的了解程度8个方面差异无统计学意义（P>0.05），具有可比性。3.两组家属状态焦虑量表（S-AI）评测结果显示：两组家属术前状态焦虑评分差异无显著性（P﹥0.05）；两组术中焦虑评分差异具有显著性（P﹤0.01）；试验组和对照组各自的术前、术中焦虑评分差异也具有显著性（P﹤0.01）。4.两组家属生命体征测量结果显示：两组家属术前呼吸频率、脉搏次数、收缩压以及舒张压数值差异均无显著性（P﹥0.05）；两组术中呼吸频率、脉搏次数、收缩压以及舒张压数值差异均具有显著性（P﹤0.01）；试验组和对照组各自的术前、术中呼吸频率、脉搏次数、收缩压以及舒张压数值差异也具有显著性（P﹤0.01）。5.改善医院管理，提高家属满意度：发布手术进程信息后，患者家属不必在等候区焦急的等待，可以在病房静候信息发布。家属对手术室护理服务的满意度也由74%提高到96%，受到患者家属的高度评价。结论：1.手术进程信息网络发布能减轻家属患者手术期间的心理负担；2.手术进程信息网络发布能缓解了家属患者手术期间生命体征的波动；3.能够为手术室完善护理服务，贯彻“以健康为中心”的整体护理理念提供科学的依据；4.提高了家属对手术室护理服务的满意度，有助于改善护患关系，一定程度上降低了医疗纠纷的发生率。更多还原

【Abstract】 Objective:This research based on network communication means to inform theprogress of the families of pediatric surgery, to explore the interventionmeasures impact on family psychology and physiology, designed toimprove the operating room nursing services, to carry out the holisticnursing concept of "health centered" provides the basis of the facts.Methods:This study is divided into two steps, the first step by Delphi methodto determine the operation process information content standard;Thesecond step was based on operation process information content standardto intervene the surgical patients family members, intervention is dividedinto preoperative visit, intraoperative and postoperative follow-up ofthree phases communication.This study choose in September2013to August2014in the firsthospital of Jilin university, pediatric surgery residents with the families ofthe100cases as the research object, were randomly divided intoexperimental group and control group50cases each.Based on theprinciple of informed consent, the first thing to tell family members the purpose of this study and significance, and sign the informedconsent.Both groups are to1day prior to the surgery preoperative visitand, at the beginning of the procedure for two time points, and by thespecialized nursing staff using state anxiety inventory (S-AI) assessfamily psychological condition at that time, at the same time with itchydevice, portable blood refers to, timer, a measure of the pulse of thefamilies of the two groups were three physiological indexes, breathingrate and blood pressure.On the intervention, the control group onlyreceived preoperative visit and postoperative follow-up, not withintraoperative communication;And family members of the experimentalgroup except accept preoperative visit and postoperative follow-up bycircuit in intraoperative nurses through the network communicationplatform (micro letter, QQ) with the appropriate network communicationbetween family members, real-time informed patient operationprogress.All of this research for statistical data using the Excel software,and then use SPSS17.0statistical analysis, measurement data using t testanalysis of count data using χ2test analysis,P>0.05for the difference wasnot statistically significant,P<0.05for the difference was statisticallysignificant,P<0.01for the difference is significanResults:1.The Delphi method to determine the operation process informationcontent standards, including three level of entry;Eight secondaryentry;23level3items.2.The comparison results of two groups of family members of thegeneral data shows: two groups of families in the relationship withpatients, age, educational background, whether children only, whether toincrease family economic burden, whether to affect the work and life, tothe child the illness degree of knowledge and understanding of theoperation of eight aspects there was no statistically significant difference(P>0.05),comparable.3.Two groups of family members of the state anxiety inventory(S-AI)evaluation results showed that two groups of family members ofthe preoperative state anxiety score there was no significant difference (P﹥0.05);Two groups of intraoperative anxiety score difference issignificant (P﹤0.01);Experimental group and control group in theirpreoperative and intraoperative anxiety score differences are significant(P﹤0.01).4.Two groups of families of vital signs measurement results showthat two groups of families of preoperative respiratory frequency, pulserate, systolic blood pressure and diastolic blood pressure there was nosignificant difference were observed in the numerical (P﹥0.05);Twogroups of intraoperative breathing frequency, pulse rate, systolic bloodpressure and diastolic blood pressure values have significant difference(P﹤0.01);Experimental group and control group in their preoperative and intraoperative breathing frequency, pulse rate, systolic blood pressureand diastolic blood pressure numerical differences are significant (P﹤0.01).5.Improve the hospital management, improve the family satisfaction:after release information about the operation process, children withfamilies don’t have to be in the waiting area anxious waiting, can wait forinformation release in the ward.Family members of the operating roomnursing service satisfaction also increased from74%to96%, spokehighly of by the children with their families.Conclusion:1. The information network communication to inform operationprocess can reduce the psychological burden of family children during theoperation;2. Process information network communication to inform surgerycan reduce the volatility of families with vital signs during the operation.3. Be able to perfect the operating room nursing services, to carryout the holistic nursing concept of "health centered" provides thescientificbasis;4. Improve the families of the operating room nursing servicesatisfaction, help to improve the relationship between nurses and patients,to some extent reduced the incidence of medical disputes.更多还原