【作者】 顾莺；

【导师】 王君俏； 张玉侠；

【作者基本信息】 复旦大学 ， 护理学， 2008， 硕士

【摘要】 目的通过研发并实施先心病患儿围术期“以家庭为中心”的护理模式,探讨该模式对缓解患儿术后疼痛、促进患儿心功能的恢复、以及缓解先心病患儿家长焦虑和提高家长对临床护理满意度的效果。方法采用非同期对照研究,以方便抽样的方法抽取07年10月至07年12月在复旦大学附属儿科医院心脏中心接受先天性心脏病外科手术治疗的患儿及其家长52例为对照组;08年2月至5月的患儿及其家长51例为干预组。对照组沿用目前儿科临床护理模式,干预组实施包括全程信息提供与心理支持、父母参与围术期照护、家庭互助支持平台搭建等“以家庭为中心”的护理措施。以基本资料问卷收集患儿及其家庭的人口统计学资料及疾病资料,用先心病患儿术后并发症的发生率、平均住院天数以及术后心功能恢复情况来评价患儿术后生理功能恢复程度,分别用疼痛行为评估量表(Face Legs Activity Cry Consolability,FLACC)、状态焦虑问卷(StateAnxiety Inventory,SAI)、照护过程评价量表(Measure of Processes of Care,MPOC-56)及顾客满意度量表(Client Satisfaction Questionnaire,CSQ-8)评价两组患儿的术后疼痛程度、父母围术期的焦虑水平和对临床护理服务的满意度。分别于入院后手术前、手术期间、CCU阶段、普通病房康复阶段和出院前应用相应的问卷和量表收集资料,并使用SPSS 15.0进行分析统计。结果两组在患儿及其家庭的基本资料构成上无差异。干预组患儿术后第1天FLACC疼痛评分与对照组患儿相比无明显差异(P＞0.05);术后第2天至第6天FLACC疼痛评分较对照组患儿明显降低,差异显著有统计学意义(P＜0.05);术后第7天及第8天FLACC疼痛评分差异无显著性(P＞0.05);干预组患儿其疼痛程度由重度向中度转变的中位天数较对照组患儿早0.4天,差异有统计学意义(P＜0.05);干预组患儿疼痛程度由中重度向轻度转变的中位天数较对照组患儿早1天,差异有统计学意义(P＜0.01)。干预组患儿心功能由Ⅲ～Ⅳ提高至Ⅱ级的中位天数较对照组患儿早0.95天,差异有统计学意义(P＜0.05);两组患儿术后并发症发生率、平均住院时间差异无统计学意义(P＞0.05)。对照组患儿父母在入院后手术前、手术期间等待过程、患儿CCU治疗监护期间以及术后病房康复治疗4个时期的SAI得分均高于国内常模,差异有统计学意义(P＜0.01);干预组患儿父母在入院后手术前、手术期间等待过程、患儿CCU治疗监护期间3个阶段的SAI均高于国内常模,差异有统计学意义(P＜0.05),术后病房阶段SAI得分与国内常模比较差异无统计学意义(P＞0.05);两组父母焦虑水平的变化趋势一样,即手术期间等待过程最为严重,其次为术前和术后CCU滞留期间,最低的是病房康复阶段(P＜0.05);干预组患儿父母在四个阶段的SAI得分均低于对照组,差异有统计学意义(P＜0.05)。干预组家庭的照护过程评价量表(MPOC-56)总得分以及在授权与合作(EP)、提供基本信息(PGI)、提供与患儿有关的特殊信息(PSI)、协调与全面的护理(CCC)、尊重与支持性护理(RSC)5个维度上的得分均显著高于对照组患儿父母(P＜0.01)。干预组家庭的顾客满意度量表(CSQ-8)得分显著高于对照组,差异有统计学意义(P＜0.01)。结论“以家庭为中心”的护理模式能为先心病围术期患儿乃至整个家庭提供医疗护理服务,满足先心患儿及其家庭在围术期的各种需求,能有效促进先心病术后早期心功能的恢复并减轻患儿术后疼痛;能有效减轻父母围术期焦虑程度以及提高父母对临床医疗服务的满意度。更多还原

【Abstract】 Objective By applying family-centered care to child with congenital heart disease (CHD)during their peri-operative period,so as to promote CHD patients’heart function recovery after surgery,alleviate patients’ pain,relief patient parents’ anxiety level and improve family’s satisfaction with clinical nursing care.Method Case control quasi experimental research design.52 CHD patients undergoing surgery in Children’s hospital Fudan University from October 8th,2007 to January 2008 were selected as control group through subjective sampling.51 patients were selected from Feburary 2008 to May 2008 as intervention group.The control group used the current mode of pediatric clinical care,while "family-centered care" model was carried out among the intervention group,including full implementation to provide information and psychological support,parental involvement in perioperative care,family to family support platform developing.General information questionnaire was used to collect basic information on children and their families demographic and disease data.The incidence of postoperative complications,the average days of hospitalization and heart function degree were used to evualate the patient’s recovery.State Anxiety Inventory(SAI) was used to evaluate the parents’ anxiety degree during the whole peri-operative period.Face Legs Activity Cry Consolability(FLACC) questionnaire was used to assess patients’ pain level and trend. Measure of Processes of Care(MPOC-56) and Client Satisfaction Questionnaire(CSQ-8) were used to evaluate the satisfaction of clinical care service from the CHD family.SPSS 15.0 was used to analysis the datas.Mean,Std deviation,percentage,one-sample T test,independent-sample T test,Chi-square test,Pearson relative analysis,Kaplan-Meier and Lon-rank test were used in different datas.Result There is no significant difference of the demographic data and disease data between two groups.There is no sighificant difference of the FLACC pain scale of the first day after surgery between the intervention group and the control group(P＞0.05);the FLACC scale of the intervention group was sighificantly lower than the control group from the second to sixth day after surgery(P＜0.05);there is also no sighificant difference of the FLACC pain scale of the seventh and eighth day after surgery between two groups (P＞0.05);the median day of intervention group children’s pain changing from sever to moderate was 0.4 day earlier than the control group patients(P＜0.05);the median day of intervention group children with their pain level changing from sever or moderate to mild was 1 dayearlier than the control group patients(P＜0.01). The median day of heart function from levelⅢ/Ⅳconvert to levelⅡin intervention group was 0.95 days earlier than the control group(P＜0.05);there is no significant difference of the incidence of postoperative complications and the average hospitalized days between two groups.The SAI scores of pre-operation,intraoperation,CCU admition and post-operation in control group were significantly higher than the national norm(P＜0.01);the SAI scores of pre-operation,intraoperation,CCU admition in intervention group were significantly higher than the national norm(P＜0.01),but there is no significant difference of the post-operation SAI score between the intervention group and the national norm(P＞0.05); parents of two groups have the same anxiety changing trend,that is intra-operation is the most serious period,followed by pre-operative period,CCU admition and post-operative time(P＜0.05);the SAI scores in 4 stages were signinificantly lower in intervention group than in control group(P＜0.05).The total score and 5 dimensions’scores(Enabling & Partnership,EP;Providing General Information,PGI;Providing Specific Information about the Child,PSI;Coordinated and Comprehensive,CCC;Respectful and Supportive care,RSC) of MPOC-56 were significantly higher in intervention group than in control group(P＜0.01);the total score of CSQ-8 was also significantly higher in intervention group than in control group (P＜0.01).Conclusion "Family centered care" could provide excellent health care to the CHD patients and their family during perioperative period,to meet with their different needs, could promote CHD patients’ heart function recovery after surgery,alleviate patients’ pain, relief parents’ anxiety and improve the family’s satisfaction during their hospitalization with clinical nursing care procedure.更多还原