【作者】 李爽；

【导师】 黄志红； 陈月华；

【作者基本信息】 河南大学 ， 护理硕士（专业学位）， 2022， 硕士

【摘要】 目的构建重症胰腺炎患者ICU过渡期护理干预方案,并探讨该方案对患者家属的迁移应激水平、照顾能力、满意度及患者的炎症反应,不良事件发生率、转出ICU后住院天数及总住院天数的影响。方法本研究包括两部分:第一部分:制定干预方案。检索国内外数据库,查找关于ICU过渡期护理干预方案的相关文献,并进行最佳证据总结。在此基础上经专家会议法修改干预方案,结合预试验进一步完善并确定最终干预方案。第二部分:ICU过渡期护理干预方案临床应用效果评价。本研究为病例对照研究,选取2020年9月-2021年12月在开封市某三甲医院重症医学科病区收集计划从ICU转入普通病房的重症胰腺患者及家属,根据患者的病案号的末尾号进行分组,单数为对照组,双数为干预组,直到饱和。最终纳入对照组33例,干预组34例。对照组实施常规转科护理,干预组在其基础上实施ICU过渡期护理干预方案。比较两组患者家属的迁移应激水平、照顾能力、满意度以及患者转出ICU后住院天数、总住院天数以及ICU重返率的改善效果。采用EXCEL和SPSS 22.0统计软件分析数据,使用统计描述、卡方检验(χ~2)、独立样本t检验,p<0.05有统计学差异。结果1.最佳证据共纳入20篇文章,其中包括8篇随机对照试验(RCT)、4篇系统评价和8篇指南共识。从安全、支持、合作3个角度出发,对不同阶段(转出前、转出中、转出后)的措施归纳总结,形成了27条最佳证据。2.本研究共纳入67例患者,其中对照组33例,干预组34例。两组患者一般人口学资料及病因、入住ICU时长均无统计学差异(p>0.05);患者家属的一般人口学资料及照顾经历无统计学差异(p>0.05)。3.干预前两组ICU患者家属迁移应激得分差异无统计学意义(p>0.05),干预组患者家属的迁移应激水平得分差异有统计学意义(p<0.05)。尤其在分离焦虑、转科的安全性这2个维度的改善效果明显优于对照组。4.干预前两组患者的照顾能力无统计学差异(p>0.05),干预后干预组患者家属照顾能力总分及各维度得分差异有统计学意义(p<0.05)。5.对两组患者家属的满意度进行分析,结果表明干预后患者家属的满意度高于干预前,差异有统计学意义(p<0.05),采用χ~2检验比较两组患者家属的满意度,结果显示,ICU过渡期护理模式患者家属的满意度得分显著高于对照组,差异具有显著性(p<0.05)。6.干预前两组患者的ICU住院时长差异无统计学意义(p>0.05),干预后干预组转出ICU后住院天数及总住院日有统计学意义(p<0.05)。7.两组患者ICU重返率差异无统计学意义(p>0.05)。8.两组患者护理不良事件发生率差异无统计学意义(p>0.05)。结论临床应用发现ICU过渡期护理方案可显著缓解ICU重症胰腺炎病人家属的迁移应激、提高患者家属的照顾能力和满意度;减少患者转出ICU后住院天数以及总住院天数。更多还原

【Abstract】 ObjectiveTo construct an ICU transitional nursing model intervention plan for patients with severe pancreatitis,and to verify whether the transitional nursing model intervention can reduce the migration stress level of the patient’s family members,improve the patient’s family member’s caring ability and satisfaction,reduce the patient’s inflammatory symptoms,and reduce ward hospitalization days and total hospital stays.MethodsThis study consists of two parts:Part Ⅰ: Develop an intervention plan.Based on evidence-based methods,the relevant literature on ICU transitional care models at home and abroad was obtained and analyzed,and the best evidence was summarized.On this basis,the intervention plan was revised and improved by two rounds of expert meetings,and the final intervention plan was further improved and determined in combination with the pre-trial.Part Ⅱ: Clinical application of ICU transitional nursing model.This study is a case-control study.From September 2020 to December 2021,patients with severe pancreas and their families who were planned to be transferred from the ICU to the general ward in the intensive care unit of a tertiary hospital in Kaifeng were selected.According to the end of the patient’s medical record number Numbers are used for grouping,the odd number is the control group,and the even number is the intervention group,until saturation.Finally,33 cases in the control group and 34 cases in the intervention group were included.The control group was given routine transfer nursing care,and the intervention group was given ICU transitional care based on it.The migration stress level,caring ability,satisfaction of the family members of the patients in the two groups,and the ward hospitalization days and total hospitalization days were observed.EXCEL and SPSS 22.0 statistical software were used to analyze data,using statistical description,chi-square test(χ2),independent sample t test,p<0.05 was statistically significant.Result1.The best evidence included 20 articles,including 8 randomized controlled trials(RCTs),4systematic reviews,and 8 guideline consensuses.From the perspectives of safety,support,and cooperation,the measures at different stages(before,during,and after the transfer)were summarized,and 27 pieces of the best evidence were formed.2.A total of 67 patients were included in this study,including 33 in the control group and 34 in the intervention group.There were no significant differences in the general demographic data,etiology,and length of stay in the ICU between the two groups(p >0.05);there was no statistical difference in the general demographic data and care experience of the patient’s family members(p >0.05).3.Before the intervention,there was no significant difference in the migration stress scores of the family members of the ICU patients between the two groups(p >0.05).In particular,the improvement effect in the two dimensions of separation anxiety and the safety of transferring to another department was significantly better than that of the control group.4.Before the intervention,there was no statistical difference in the nursing ability between the two groups(P>0.05),and after the intervention,there were significant differences in the scores of each dimension and the total score of the nursing ability in the intervention group(P<0.05).5.The analysis of the satisfaction of the family members of the two groups of patients showed that the satisfaction of the family members of the patients after the intervention was higher than that before the intervention,and the difference was statistically significant(p >0.05),he satisfaction score of family members of patients with the ICU transitional nursing model was significantly higher than that of the control group,and the difference was significant(p <0.05).6.There was no significant difference in the length of ICU stay between the two groups before the intervention(p >0.05),and after the intervention,there was a statistically significant difference in the length of stay in the ward and the total length of stay in the intervention group(p <0.05).7.There was no significant difference in ICU return rate between 2 groups(P>0.05).8.There was no significant difference in the incidence of nursing adverse events between the two groups before and after intervention(P>0.05).ConclusionThe clinical application found that the ICU transitional nursing model significantly relieved the migration pressure and caring ability of the family members of the ICU patients with severe pancreatitis,improved the satisfaction of the family members of the critically ill patients;reduced the patients’ total hospital days.更多还原