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1、 人性化護(hù)理干預(yù)對(duì)手術(shù)患者焦慮抑郁狀況的影響 楊麗 儲(chǔ)成美Summary 目的 探討人性化護(hù)理干預(yù)對(duì)手術(shù)患者焦慮抑郁狀況的影響。 方法 選擇2016年1月2017年1月在海安縣人民醫(yī)院行手術(shù)治療的148例患者為研究對(duì)象,按照隨機(jī)數(shù)字表法分為常規(guī)組和觀察組,每組各74例。常規(guī)組給予基礎(chǔ)護(hù)理措施,觀察組在常規(guī)組基礎(chǔ)上給予人性化護(hù)理干預(yù)。比較手術(shù)前后兩組患者的心理狀態(tài)變化情況、術(shù)后各項(xiàng)生命體征及護(hù)理滿意度。 結(jié)果 術(shù)后觀察組焦慮、抑郁自評(píng)量表評(píng)分低于常規(guī)組,差異有統(tǒng)計(jì)學(xué)意義(P 0.05)。觀察組呼吸、心率、舒張壓及收縮壓均低于常規(guī)組,差異有統(tǒng)計(jì)學(xué)意義(P 0.05)。觀察組護(hù)理總滿意高于常規(guī)組,差

2、異有統(tǒng)計(jì)學(xué)意義(P 0.05)。 結(jié)論 手術(shù)患者進(jìn)行人性化護(hù)理干預(yù),有利于減輕焦慮抑郁程度,減少應(yīng)激反應(yīng),提高手術(shù)耐受力,提高護(hù)理滿意度。Key 手術(shù);人性化護(hù)理干預(yù);焦慮;抑郁 R472.3 A 1673-7210(2018)02(a)-0164-05Effects of humanized nursing intervention on anxiety and depression in patients underwent surgeryYANG Li1 CHU Chengmei21.Department of Surgery, Peoples Hospital of Haian Cou

3、nty, Jiangsu Province, Haian 226600, China2 Department of Gynecology, Peoples Hospital of Haian County, Jiangsu Province, Haian 226600, ChinaAbstract Objective To explore the effects of humanized nursing intervention on anxiety and depression in patients underwent surgery. Methods From January 2016

4、to January 2017, 148 patients underwent surgical treatment in Peoples Hospital of Haian County were selected as research objects and divided into the routine group and the observation group by random number table, with 74 cases in each group. The routine group was given basic care intervention and t

5、he observation group was given humanized nursing intervention on the bases of routine group. The changes of mental status were observed before and after operation, and the vital signs and nursing satisfaction were observed. The psychological status before and after operation was compared, the vital

6、signs and the nursing satisfaction after the operation were compared between the two groups. Results After operation, the scores of self-rating anxiety scale and self-rating depression scale in the observation group were lower than those of routine group, with statistically significant differences (

7、P 0.05). The respiration, heart rate, diastolic blood pressure and systolic blood pressure in the observation group were all lower than those of routine group, with statistically significant differences (P 0.05). The total nursing satisfaction rate was higher than that of routine group, with statist

8、ically significant difference (P 0.05),有可比性。見表1。1.2 方法常規(guī)組患者采用常規(guī)護(hù)理模式:術(shù)前由病房護(hù)士完成常規(guī)術(shù)前準(zhǔn)備,手術(shù)當(dāng)日由巡回護(hù)士提前30 min 將患者送入手術(shù)室,按常規(guī)手術(shù)護(hù)理操作程序給予術(shù)前健康宣教、病情觀察與準(zhǔn)備,術(shù)中給予常規(guī)性鼓勵(lì)、術(shù)后并發(fā)癥預(yù)防等。觀察組在常規(guī)組基礎(chǔ)上深入開展人性化護(hù)理干預(yù),具體措施如下:由護(hù)理部主任擬定詳細(xì)的培訓(xùn)和實(shí)施方案,護(hù)理團(tuán)隊(duì)人員(主要由1名科主任、1名主治醫(yī)師、2名護(hù)士、1名營養(yǎng)師、2名患者直系親屬等成員組成)進(jìn)行人性化護(hù)理培訓(xùn),由責(zé)任護(hù)士評(píng)估患者的病情,由護(hù)士長監(jiān)督實(shí)施和檢查護(hù)理措施的執(zhí)行質(zhì)量,團(tuán)隊(duì)

9、在科主任帶領(lǐng)下實(shí)施互動(dòng)、動(dòng)態(tài)管理,為患者實(shí)施人性化護(hù)理干預(yù)模式。具體內(nèi)容如下:1.2.1 術(shù)前人性化護(hù)理 術(shù)前訪視。術(shù)前1 d由專職巡回護(hù)士對(duì)患者探訪,當(dāng)面閱讀患者病理資料,對(duì)患者病史、手術(shù)史、職業(yè)、既往史、文化背景等信息進(jìn)行全面評(píng)估。同時(shí),做自我介紹,說明來意,增進(jìn)醫(yī)護(hù)態(tài)度,交流中注意語言和氣及技巧,充分得到患者的信任。此時(shí),向患者介紹患者病情,及對(duì)其采用的手術(shù)方法,講述手術(shù)流程,手術(shù)環(huán)境及何時(shí)進(jìn)入手術(shù)室開展手術(shù)5。最后,告知患者有專門護(hù)士協(xié)助進(jìn)入手術(shù)室,并對(duì)各個(gè)環(huán)節(jié)給予專業(yè)護(hù)理,護(hù)士也會(huì)全程協(xié)助醫(yī)生處理手術(shù)過程中可能出現(xiàn)的問題,使手術(shù)達(dá)到預(yù)期效果。對(duì)于不同文化程度與接收能力的患者,可通過播

10、放手術(shù)錄像、發(fā)放宣傳冊(cè)等方式,為患者宣教疾病及治療等知識(shí),并用通俗易懂語言解答其問題。介紹手術(shù)成功病例,闡明手術(shù)的可靠性,幫助其樹立治療信心6-7。同時(shí),聽取患者對(duì)手術(shù)的感覺運(yùn)動(dòng)、意識(shí)狀態(tài)及認(rèn)知感知情況,為其講解手術(shù)重要性及必要性,消除其顧慮、擔(dān)憂,若患者存在較大疑慮,護(hù)理人員要耐心、細(xì)致地解答,并給予心理疏導(dǎo),給予患者鼓勵(lì)性、撫慰性的引導(dǎo),使其積極面對(duì)手術(shù),穩(wěn)定手術(shù)前的心理狀態(tài)。飲食護(hù)理。給予患者高熱量、高蛋白、富含維生素、易消化飲食,加強(qiáng)抵抗力,協(xié)助患者完成術(shù)前檢查8。1.2.2 術(shù)中人性化護(hù)理 患者進(jìn)行手術(shù)前,將室內(nèi)溫濕度調(diào)整好,取舒適體位,保障患者有一個(gè)舒適的手術(shù)環(huán)境;采用積極語言及手

11、勢(shì)鼓勵(lì)患者勇敢面對(duì)手術(shù),緩解患者緊張情緒,建立良好的信任關(guān)系;操作中動(dòng)作輕柔,在不影響操作下盡量減少患者暴露時(shí)間9。同時(shí)隨時(shí)觀察患者的生命體征和情緒狀態(tài)變化,對(duì)局麻的清醒患者,要隨時(shí)眼神交流和語言鼓勵(lì)。在進(jìn)行各項(xiàng)操作時(shí),動(dòng)作應(yīng)輕柔,使患者感覺舒適。1.2.3 術(shù)后人性化護(hù)理 術(shù)后將患者護(hù)送至病房,主動(dòng)與患者家屬溝通,加強(qiáng)巡視,妥善放置各種引流管;給予術(shù)后疼痛患者徒手按摩,指導(dǎo)其進(jìn)行放松訓(xùn)練,如音樂放松法、四肢放松法等,轉(zhuǎn)移疼痛注意力10;注意保暖,蓋好被單;針對(duì)患者病情給予正壓吸痰、霧化吸入、拍背等措施,以保障呼吸道通暢;把患者送回病房后,詢問患者主觀感受,并解答其疑問,操作時(shí)對(duì)患者四肢動(dòng)作及

12、面部表情進(jìn)行觀察,積極預(yù)防并發(fā)癥,并囑咐患者與家屬術(shù)后康復(fù)的注意事項(xiàng)。1.3 觀察指標(biāo)心理狀態(tài)。采用抑郁自評(píng)量表(SDS)、焦慮自評(píng)量表(SAS)對(duì)患者主觀感受進(jìn)行評(píng)估,每個(gè)量表均包含20個(gè)條目,分值越高,負(fù)性情緒越嚴(yán)重11-12。生命體征。術(shù)后10 min對(duì)患者血壓(收縮壓、舒張壓)、呼吸、心率進(jìn)行記錄13。護(hù)理滿意度。在Reference14基礎(chǔ)上自行制訂調(diào)查問卷,對(duì)患者的護(hù)理滿意度進(jìn)行調(diào)查,內(nèi)容包括操作、宣教、手術(shù)結(jié)果、護(hù)理態(tài)度、環(huán)境5個(gè)方面,共100分,85100分為非常滿意,6085分為滿意,60分為不滿意。滿意度=(非常滿意+滿意)例數(shù)/總例數(shù)100%。1.4 統(tǒng)計(jì)學(xué)方法采用SPS

13、S 21.0對(duì)所得數(shù)據(jù)進(jìn)行統(tǒng)計(jì)學(xué)分析,計(jì)量資料采用均數(shù)標(biāo)準(zhǔn)差(xs)表示,組間比較采用t檢驗(yàn),計(jì)數(shù)資料采用百分率表示,組間比較采用2檢驗(yàn)。以P 0.05);術(shù)后兩組SAS、SDS評(píng)分均低于術(shù)前,觀察組降低更加顯著,差異均有統(tǒng)計(jì)學(xué)意義(P 0.05)。見表2。2.2 兩組術(shù)后生命體征比較術(shù)后觀察組呼吸、心率、舒張壓及收縮壓均低于常規(guī)組,差異均有統(tǒng)計(jì)學(xué)意義(P 0.05)。見表3。2.3 兩組護(hù)理滿意度比較觀察組護(hù)理滿意度高于常規(guī)組,差異有統(tǒng)計(jì)學(xué)意義(P 0.05)。見表4。3 討論近年來,患者自我保護(hù)權(quán)益觀念及醫(yī)療安全意識(shí)的逐漸增強(qiáng),關(guān)于醫(yī)療糾紛事件的報(bào)道屢見不鮮15-16,護(hù)理人員的言行舉止直

14、接影響患者對(duì)護(hù)理質(zhì)量的感知及治療效果的臆斷,故擯棄陳舊被動(dòng)、機(jī)械配合手術(shù)操作的觀念,在圍術(shù)期給予舒適有效的護(hù)理模式,提高臨床護(hù)理質(zhì)量、減少醫(yī)療糾紛、減輕患者負(fù)面心理作用是目前亟待探討的課題17-18。隨著現(xiàn)代醫(yī)療的日益完善及生活水平的提高,人們對(duì)護(hù)理工作的要求也不斷提高,患者關(guān)心的不再局限于自身疾病治療,對(duì)護(hù)理服務(wù)質(zhì)量也有較高的需要,同時(shí)臨床研究發(fā)現(xiàn),完善的護(hù)理干預(yù)機(jī)制有助于患者快速康復(fù)19。人性化護(hù)理是一種科學(xué)的護(hù)理模式,具有有效性、整體性及創(chuàng)造性等特點(diǎn),其將“以患者為中心”轉(zhuǎn)變?yōu)椤耙匀说慕】禐橹行摹保粌H強(qiáng)調(diào)高效及規(guī)范護(hù)理,還重視患者的社會(huì)、身心健康、經(jīng)濟(jì)及家庭等方面的協(xié)調(diào),將關(guān)懷滲透至每

15、個(gè)護(hù)理環(huán)節(jié)中20-21。該模式既能滿足患者合理的心理需求,又能滿足其對(duì)疾病情況改善的訴求,保障其各方面均處于舒適狀態(tài)22。由于患者對(duì)相關(guān)手術(shù)缺乏了解以及圍術(shù)期對(duì)麻醉、手術(shù)醫(yī)生技術(shù)的不信任,擔(dān)心手術(shù)成功與否、術(shù)時(shí)疼痛、器械碰撞聲音、意外等因素影響手術(shù)結(jié)果,常伴有緊張、焦慮等心理反應(yīng),易造成生理紊亂及血流動(dòng)力學(xué)改變,增加術(shù)后并發(fā)癥發(fā)生風(fēng)險(xiǎn)23。故為了更好地實(shí)施手術(shù)與保障手術(shù)效果,臨床護(hù)理人員應(yīng)對(duì)患者講解術(shù)前準(zhǔn)備、手術(shù)流程及術(shù)后康復(fù)等內(nèi)容,實(shí)施針對(duì)性的生理、心理護(hù)理措施。此外,護(hù)理人員術(shù)前還應(yīng)擴(kuò)大知識(shí)學(xué)習(xí)范圍、增強(qiáng)操作技能水平,以便更好地配合醫(yī)生展開治療。焦慮、抑郁是個(gè)體面臨潛在性威脅而出現(xiàn)的一種負(fù)

16、面、復(fù)雜的心理學(xué)應(yīng)激反應(yīng),屬于常見的不良心理反應(yīng),可增加個(gè)體痛苦體驗(yàn)24。本研究結(jié)果顯示,給予人性化護(hù)理干預(yù)患者的SDS、SAS評(píng)分均低于常規(guī)護(hù)理干預(yù)的患者,提示人性化護(hù)理干預(yù)有利于消除或減輕手術(shù)患者焦慮、抑郁等心理障礙,提高其治療依從性及信心,有利于手術(shù)順利進(jìn)行,進(jìn)而增強(qiáng)手術(shù)效果。手術(shù)作為一種強(qiáng)烈的應(yīng)激事件,存在心理障礙的患者會(huì)出現(xiàn)生命體征明顯波動(dòng)現(xiàn)象,降低機(jī)體適應(yīng)能力及調(diào)節(jié)功能,影響麻醉、手術(shù)等醫(yī)療活動(dòng)的進(jìn)度25-26。本研究結(jié)果顯示,給予人性化護(hù)理干預(yù)的患者術(shù)后呼吸、心率、舒張壓及收縮壓低于常規(guī)護(hù)理干預(yù)的患者,提示給予手術(shù)患者人性化護(hù)理可穩(wěn)定其生命體征,減少波動(dòng),促使患者精神松弛,提高對(duì)

17、手術(shù)耐受力。同時(shí),采用人性化護(hù)理措施干預(yù)后,患者對(duì)操作、宣教、手術(shù)結(jié)果、護(hù)理態(tài)度、環(huán)境等方面的滿意度高達(dá)98.65%,可見我院實(shí)施人性化護(hù)理模式受到廣大患者的青睞與認(rèn)可。綜上所述,給予手術(shù)患者人性化護(hù)理干預(yù)有利于減輕患者的焦慮抑郁程度,充分調(diào)動(dòng)其治療積極性,降低應(yīng)激反應(yīng),提高手術(shù)耐受力,改善護(hù)理體驗(yàn)。Reference1 劉梅,滕敬華.圍手術(shù)期護(hù)理干預(yù)對(duì)乳腺癌改良根治術(shù)患者情緒及疼痛影響J.現(xiàn)代中西醫(yī)結(jié)合雜志,2017,26(2):223-225.2 Kohler N, Friedrich M, Gansera L,et al. Psychological distress and adjus

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