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中国实用护理杂志
中国实用护理杂志

王国强

旬刊

1672-7088

huli@yizhe.net

0411-82490723

116013

辽宁省大连市西岗区南石道街丙寅巷3号

中国实用护理杂志/Journal Chinese Journal of Practical Nursing北大核心CSTPCD
查看更多>>中华人民共和国卫生部主管，中华医学会、大连理论医学研究所主办。本刊是国内外公开发行的，《中文核心期刊要目总览》临床医学/特种医学类核心期刊。被“万方数据库”收录。本刊宗旨是“突出实用，面向基层，传递护理学术信息，提高护理理论与技术水平，促进护理学科发展”。报道护理领域的科研成果和护理经验以及对临床护理有指导作用，且与临床护理密切结合的基础理论研究，体现科学性、实用性、新颖性、信息性的统一。主要读者对象为基层护理人员、管理人员及护理学院(系)教师、学生。
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    益肾健脾活血方穴位敷贴联合健身气功五禽戏改善透析患者衰弱的应用研究

    赵如琴刘胜凤薄祥敏殷玲...
    81-89页
    查看更多>>摘要：目的 观察益肾健脾活血方穴位敷贴联合健身气功五禽戏对改善透析治疗的衰弱患者机体的营养状况及衰弱程度的效果及影响，为透析患者衰弱的康复治疗提供依据。 方法 采用随机对照研究方法，便利抽样法选取南京中医药大学附属医院肾内科2020年4月至2021年12月住院规律透析治疗的衰弱患者80例，按照随机数字表法分为对照组与试验组各40例。对照组采用规律透析、基础治疗及饮食护理，试验组在此基础上采用健脾益肾活血方穴位敷贴联合健身气功五禽戏。比较2组患者干预前、干预12周后实验室检查结果、主观整体评估量表得分及中医症状得分；比较2组患者干预前及干预4、8、12周后不同时间点的Fried衰弱量表得分变化。 结果 对照组年龄（54.08 ± 11.34）岁，男23例，女17例。试验组年龄（57.38 ± 9.89）岁，男19例，女21例。干预4、8、12周后不同时间点试验组的Fried衰弱量表得分分别为2（2，2）、1（1，2）、1（0，1）分，低于对照组的3（2，4）、2（2，3）、2（2，3）分，其时间效应、组间效应及交互效应的比较，差异均有统计学意义（F=105.76、18.38、46.67，均P<0.01），组内进一步两两比较发现，干预后不同时间点2组Fried衰弱量表得分的比较，差异均有统计学意义（Z=-2.78、-4.01、-6.08，均P<0.01）。试验组干预12周后血红蛋白、血清白蛋白、血清前白蛋白检验结果分别为（107.88 ± 15.58）g/L、（39.10 ± 4.92）g/L、（289.36 ± 72.05）mg/L，高于对照组的（100.15 ± 17.62）g/L、（36.93 ± 4.72）g/L、（255.63 ± 75.35）mg/L，差异均有统计学意义（t=-2.08、-2.01、-2.05，均P<0.05）。干预12周后试验组主观整体评估量表A级（营养良好）及B级（轻中度营养不良）例数分别为36、4例，对照组分别为23、17例，2组比较差异有统计学意义（χ2=10.91，P<0.01）。干预12周后试验组中医症状得分为（4.68 ± 2.50）分，低于对照组的（9.58 ± 4.40）分，差异有统计学意义（t=6.13，P<0.01）。 结论 益肾健脾活血方穴位敷贴联合健身气功五禽戏可有效改善透析衰弱患者的营养状况，减轻患者的衰弱程度。 Objective To observe the effect of point application-invigorate the spleen and kidney, circulation of blood formula (PA) combined with five-animal exercise (FAE) on improving the nutritional status for asthenia of patients with dialysis, and provide evidence for the rehabilitation treatment of dialysis patients. Methods According to the random number table method, a total of 80 patients treated with regular dialysis at Department of Nephrology, the Affiliated Hospital of Nanjing University of Chinese Medicine from April 2020 to December 2021 were randomly divided into experimental group and control group, with 40 cases in each group. Participants in the control group received regular dialysis, basic treatment and diet nursing (RBD). Participants in the experimental group received RBD plus PA+FAE. Labaratory test results, Subjective Global Assessment scale score and Traditional Chinese medicine symptom score were measured at baseline and 12-weeks after the intervention. The Fried Frailty scale score was measured at baseline, 4, 8, and 12 weeks after the intervention. Results The control group aged (54.08 ± 11.34) years old, 23 males, 17 females the experimental group aged (57.38±9.89) years old, 19 males, 21 females. After 4, 8 and 12 weeks of intervention, the Fried Frailty Scale scores of the experimental group at different time points were 2 (2, 2), 1 (1, 2) and 1 (0, 1), respectively, lower than 3 (2, 4), 2 (2, 3) and 2 (2, 3) of the control group, and the differences in time effect, inter-group effect and interaction effect were statistically significant (F=105.76, 18.38, 46.67, all P<0.01). Further pairwise comparisons within groups indicated significant differences of Fried Frailty scale scores at different time points (Z=-2.78, -4.01, -6.08, all P<0.01). After 12-week of intervention, the results of hemoglobin, serum albumin and serum prealbumin were (107.88 ± 15.58) g/L, (39.10 ± 4.92) g/L, and (289.36 ± 72.05) mg/L in the experimental group, respectively, higher than (100.15 ± 17.62) g/L, (36.93 ± 4.72) g/L, (255.63 ± 75.35) mg/L in the control group (t=-2.08, -2.01, -2.05, all P<0.05). Subjective Overall Assessment scale was found a significant difference between the 2 groups (χ2=10.91, P<0.01): the number of grade A (good nutrition) and B (mild to moderate malnutrition) were 36 and 4 in the experimental group and 23 and 17 in the control group. Traditional Chinese medicine symptom score was (4.68 ± 2.50) in the experimental group, lower than (9.58 ± 4.40) in the control group (t=6.13, P<0.01). Conclusions Point application-invigorate the spleen and kidney and circulation of blood formula combined with five-animal exercise can effectively improve the nutritional status of dialysis patients and reduce the weakness of patients

    透析益肾健脾活血方穴位敷贴五禽戏衰弱

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    心血管疾病中高危人群发病风险感知与健康促进生活方式关系的Nomogram模型分析

    郭芝廷单燕敏张玉萍丁传琦...
    90-96页
    查看更多>>摘要：目的 了解心血管疾病（CVD）中高危人群发病风险感知与健康促进生活方式的关系，并构建列线图预测模型，以为临床早期筛查及靶向干预提供依据。 方法 采用横断面调查方法，便利选取2022年3—8月浙江大学医学院附属第二医院就诊的272例CVD中高危人群为调查对象，采用一般资料调查表、中文版心血管疾病风险态度和信念量表（ABCD-C）、健康促进生活方式量表-Ⅱ（HPLP-Ⅱ）进行调查，基于多因素回归分析构建CVD中高危人群健康促进生活方式的列线图模型。 结果 272例研究对象中，男150例，女122例，年龄（60.59 ± 10.64）岁。ABCD-C总分（56.57 ± 5.69）分，HPLP-Ⅱ总分为（111.92 ± 12.47）分，二者呈显著正相关（r=0.556，P<0.01）。以HPLP-Ⅱ总分中位数（111分）为界分为低水平健康促进生活方式（≤111分）和高水平健康促进生活方式（>111分）2类，并将其作为因变量，吸烟（OR=0.215，95%CI 0.104~0.446）是CVD中高危人群采取健康促进生活方式的障碍因素，已婚（OR=14.237，95%CI 1.963~103.238）、家庭人均月收入≥5 000元（OR=4.101，95%CI 1.369~12.288），心血管疾病预防知识（OR=1.660，95%CI 1.373~2.007）、感知到的益处和身体活动改变意图（OR=1.445，95%CI 1.255~1.663）、感知到的益处和健康饮食改变意图（OR=1.322，1.058~1.654）得分高为促进因素。 结论 CVD中高危人群健康促进生活方式处于中等偏上水平，受吸烟、婚姻和经济状态、心血管疾病预防知识风险态度和信念的影响，应用列线图模型开展早期筛查和重点人群靶向风险沟通，有助于提高其健康行为水平。 Objective To explore the relationship between risk perception and health promoting lifestyle profile in population with cardiovascular disease (CVD), and construct a prediction model for clinical screening and targeted intervention. Methods A cross-sectional survey method was used to select 272 people at moderate and high risk of CVD from the Second Affiliated Hospital of Zhejiang University School of Medicine from March to August 2022. The general information questionnaire, Chinese version of Attitude and Beliefs about Cardiovascular Disease Knowledge and Risk Questionnaire (ABCD-C), and Health Promoting Lifestyle Profile-II (HPLP Ⅱ) were used. Based on multiple regression analysis, a nomogram model for health promoting lifestyle in high-risk CVD population was constructed. Results Among 272 participants, male 150 cases, female 122 cases, aged (60.58 ± 10.64) years old. The total ABCD-C score was (56.57 ± 5.69), and the total HPLP Ⅱ score was (111.92 ± 12.47). ABCD-C score was significantly positively correlated with HPLP Ⅱ score (r=0.556, P<0.01). The median of HPLP Ⅱ total score (111 points) was used as the cut-off point for low level of health-promoting lifestyle (≤111 points) and high level of health-promoting lifestyle (>111 points), and used it as the dependent variable, smoking (OR=0.215, 95%CI 0.104-0.446) was a barrier factor for participants to adopt healthy lifestyle being married (OR=14.237, 95%CI 1.963-103.238), having a family average monthly income higher than 5 000 yuan (OR=4.101, 95%CI 1.369-12.288), higher score of CVD prevention knowledge (OR=1.660, 95%CI 1.373-2.007), perceived benefits and intention to change physical activity (OR=1.445, 95%CI 1.255-1.663), perceived benefits and intention to change healthy diet (OR=1.322, 95%CI 1.058-1.654) were promoting factors. Conclusions The health-promoting lifestyle of populations at risk for CVD is above-average, influenced by factors such as smoking, marital and economic status, risk attitudes, and beliefs. Utilizing the nomogram model for early screening and targeted risk communication among key populations may contribute to improving their health behavior.

    心血管疾病风险感知健康促进生活方式相关性预测模型

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    慢性心力衰竭再入院患者出院准备服务需求的质性研究

    吴迪王东梅王晓桐杨丽松...
    97-102页
    查看更多>>摘要：目的 探究慢性心力衰竭（CHF）再入院患者对出院前的准备服务需求，为制订出院准备服务计划提供可靠的证据支持。 方法 基于现象学研究方法，采用目的抽样法选取2023年2—4月黑龙江中医药大学附属第一医院的12例CHF再入院患者进行半结构式访谈，用Colaizzi 7步分析法对资料进行分析。 结果 12例患者中，男6例，女6例，年龄53~85岁。CHF再入院患者的出院准备服务需求可以归纳为生理、心理、社会3个大主题，包含6个小主题：提升自我管理技能的需求、康复锻炼的需求、改善负性情绪的需求、提升健康教育的需求、居家护理改善需求、卫生资源服务的需求。 结论 CHF再入院患者自我管理知识与技能、家庭照护需求、专业人员指导需求以及基层卫生资源转介服务信息需求较大，护理人员应重点评估患者此类需求，以制订个性化的CHF患者出院准备服务计划。 Objective The aim was to explore the needs of patients readmitted with chronic heart failure (CHF) for pre-discharge preparation services and to provide reliable evidence to support the development of a discharge preparation service plan. Methods The research was based on the phenomenology research method. Using a purposive sampling method, 12 readmitted patients with CHF from the First Hospital of Heilongjiang University of Traditional Chinese Medicine were selected and interviewed in a semi-structured manner between February and April 2023, and the data were analyzed using the Colaizzi seven-step analysis. Results Among 12 patients, 6 males, 6 females, aged 53 to 85 years old. The discharge preparation service needs of readmitted patients with CHF can be categorised into 3 major themes of physiological-psychological-social, containing 6 sub-themes: the need to improve self-management skills, the need for rehabilitation and exercise, the need for improvement of negative emotions, the need for improvement of health education, the need for improvement of home care, and the need for health resource services. Conclusions Patients readmitted with CHF have greater needs for self-management knowledge and skills, family care needs, professional guidance needs, and information on referral services from primary health resources, and nursing staff should focus on assessing such needs of patients in order to develop individualized plans for discharge preparation services for patients with CHF.

    病人再入院定性研究慢性心力衰竭出院准备需求延续护理

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    基于技术接受模型的山西省"136"兴医工程领军临床专科患者对智慧病房的认知与体验评价研究

    张绍果弓巧巧崔晓红李慧姣...
    103-109页
    查看更多>>摘要：目的 基于技术接受模型，探讨住院患者对智慧病房的认知与使用体验，为智慧病房的推广和优化建设提供决策信息和参考依据。 方法 基于技术接受模型，自制住院患者智慧病房认知与体验评价问卷，并评价其信度。采用横断面研究方法，便利选取2022年1—4月在山西省"136"兴医工程10个领军临床专科智慧病房住院的368例患者为研究对象，运用住院患者智慧病房认知与体验评价调查问卷进行调查研究。 结果 368例患者中，男148例，女220例，年龄18~70岁。该调查问卷总体Cronbach α系数为0.887，具有良好的信度。住院患者对智慧病房的认知及体验评价中，在感知有用性、感知易用性、感知安全性、使用态度和使用意愿5个维度得分分别为（4.76 ± 0.38）、（4.75 ± 0.46）、（4.72 ± 0.19）、（4.73 ± 0.55）、（4.77 ± 0.27）分；其中非常同意的比例最高达80.16%（295/368）。对智慧病房的总体满意度得分为（4.76 ± 0.35）分，很满意的比例最高达79.35%（292/368）。 结论 智慧病房系统应用于住院患者的护理工作中有助于优化患者就医服务体验，提高住院满意度。 Objective To explore the cognition and use experience of residents based on technical acceptance model, and provide decision-making information and reference for the promotion and optimization construction of the smart ward. Methods Based on the technical acceptance model, the research team made cognitive and experience evaluation questionnaire of hospitalization patients of the smart wards and evaluated its reliability. By adopting cross-sectional research methods, 368 patients who were hospitalized in the smart wards of the 10 leading clinical specialty in"136" Xingyi Project in Shanxi Province were selected as research objects from January to April 2022. The cognitive and experience evaluation questionnaire of hospitalization patients of the smart wards were used to conduct investigations and research. Results Among 368 patients, male 148 cases, female 220 cases, aged 18 to 70 years old. The overall Cronbach α coefficient of the questionnaire was 0.887, which had a good degree of reliability. In the cognition and experience evaluation of the smart wards, the five dimensions of perception of usefulness, perception of ease of use, perception safety, attitude and willingness to use were (4.76 ± 0.38),(4.75 ± 0.46), (4.75 ± 0.46), (4.72 ± 0.19), (4.73 ± 0.55), (4.77 ± 0.27) points respectively, the proportion of "very agreed" was 80.16% (295/368) the overall satisfaction of the smart wards scored (4.76 ± 0.35) points, the proportion of "very satisfied" was 79.35% (292/368). Conclusions The application of the smart ward in the nursing work of inpatients will help optimize the patients′ medical service experience and improve the satisfaction of hospitalization.

    认知病人满意度智慧病房体验

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    髋膝关节置换术患者围手术期加速康复护理的最佳证据总结

    王会玲李辉邵兵韩宁...
    110-117页
    查看更多>>摘要：目的 检索、评价并总结髋膝关节置换术患者围手术期加速康复护理的最佳证据总结，为临床围手术期护理实践提供参考。 方法 运用循证护理学方法，检索BMJ Best Practice、UpToDate、PubMed、CINAHL、中国知网等相关数据库。检索时限为2010年12月至2022年12月。由4名研究者对指南独立进行质量评价，2名研究者对专家共识和系统评价独立进行质量评价，最终对纳入文献进行总结归纳。 结果 共纳入文献12篇，其中3篇指南、5篇专家共识、4篇系统评价。从术前教育、术前优化、围手术期麻醉管理、围手术期血液管理、围手术期疼痛管理、围手术期液体管理、围手术期体温保护、预防感染、预防血栓、术后恶心呕吐、管路管理、功能锻炼、围手术期促进康复13个方面，总结形成35条髋膝关节置换术患者围手术期加速康复护理的最佳证据。 结论 本研究总结髋膝关节置换术患者围手术期加速康复护理的最佳证据，旨在为临床构建和规范髋膝关节置换术患者围手术期加速康复护理实践方案，以期为临床围手术期护理实践提供参考。 Objective To search, evaluate and summarize the best evidence summary of perioperative accelerated rehabilitation nursing for patients undergoing hip and knee arthroplasty, so as to provide reference for clinical perioperative nursing. Methods Evidence-based nursing methods were used to search for relevant databases such as BMJ Best Practice, UpToDate, PubMed, CINAHL, and CNKI, etc.. The search period was from December 2010 to December 2022. Four researchers independently evaluated the quality of the guidelines, and two researchers independently evaluated the quality of expert consensus and system evaluation. Finally, the included literature was summarized. Results A total of 12 pieces of literature, 3 guidelines, 5 expert consensus and 4 systematic reviews were included. From 13 aspects of preoperative education, preoperative optimization, anesthesia management, perioperative blood management, perioperative pain management, perioperative fluid management, perioperative temperature protection, infection prevention, thrombus prevention, postoperative nausea and vomiting, postoperative drainage, functional exercise, and perioperative rehabilitation promotion, 35 pieces of the best evidence for hip and knee replacement patients to accelerate rehabilitation nursing in the perioperative period was summarized. Conclusions This study summarizes the best evidence of accelerated rehabilitation nursing in the perioperative period of hip and knee arthroplasty, aiming to build and standardize the accelerated rehabilitation nursing scheme in the perioperative period of hip and knee arthroplasty, so as to provide reference for clinical perioperative nursing.

    关节成形术,置换,髋关节成形术,置换,膝围手术期护理加速康复护理证据总结循证护理

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    成人初显期强直性脊柱炎患者自我管理困境的质性研究

    朱迪赵志玲陈雁袁玲...
    117-122页
    查看更多>>摘要：目的 探索成人初显期强直性脊柱炎患者自我管理困境的体验，为构建成人初显期强直性脊柱炎患者自我管理干预方案提供参考依据。 方法 采用描述性现象学研究方法，于2022年8月至2023年3月对南京鼓楼医院风湿免疫科14例成人初显期强直性脊柱炎患者进行半结构式深度访谈，并运用Colaizzi 7步法对访谈资料进行分析。 结果 共14例患者完成访谈，男10例，女4例，年龄21~30岁。成人初显期强直性脊柱炎患者进行自我管理时，存在角色适应不良困境与疾病管理障碍困境，其中角色适应不良困境包括疾病管理角色适应不良以及社会角色适应不良；疾病管理障碍困境包括自我管理意识薄弱、自我管理信息支持不足、自我管理技能欠缺以及自我管理行为依从性差。 结论 成人初显期强直性脊柱炎患者角色适应能力及自我管理能力严重不足，亟需构建成人初显期强直性脊柱炎患者健康管理策略，帮助其提升角色适应与疾病管理水平。 Objective To explore the experience of self-management dilemma ofadults with emerging ankylosing spondylitis, and to provide reference for the construction of self-management intervention strategies for emerging adults with ankylosing spondylitis. Methods Descriptive phenomenology was used to conduct in-depth interviews with 14 adults with emerging ankylosing spondylitis in the Rheumatology and Immunology Department of Drum Tower Hospital Affiliated to Medical College of Nanjing University from August 2022 to March 2023. The interview data were analyzed by Colaizzi′s seven-step analysis method. Results A total of 14 patients completed the interview,10 males, 4 females, aged 21-30 years. In adults with emerging ankylosing spondylitis, there were dilemmas of role maladjustment and disease management disorder, including role maladjustment of disease management and social role maladjustment. Barriers to disease management included weak self-management awareness, insufficient support for self-management information, inadequate self-management skills, and poor compliance with self-management behaviors. Conclusions The role adaptation and self-management ability of adults with emerging ankylosing spondylitis are seriously inadequate. It is urgent to construct health management strategies for adults with emerging ankylosing spondylitis to help them improve the level of role adaptation and disease management.

    护理定性研究自我管理强直性脊柱炎成人初显期困境

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    慢性心力衰竭患者失志状况及影响因素分析

    高兴底瑞青李星丹杜文婷...
    123-129页
    查看更多>>摘要：目的 了解慢性心力衰竭（CHF）患者失志状况并分析其影响因素，为护理人员开展针对性心理干预提供依据。 方法 采用横断面调查方法，于2022年8月至2023年1月，采用便利抽样法，选取郑州大学第一附属医院心血管内科282例CHF患者作为调查对象，使用一般资料调查表、修订版中文失志量表、中文版简易疾病感知问卷（BIPQ）、简易恐惧疾病进展量表（FoP-Q-SF），采用单因素分析及多元线性回归分析CHF患者失志状况与影响因素。 结果 282例CHF患者中男172例，女110例，年龄（62.29 ± 10.05）岁。CHF患者修订版中文失志量表得分为（30.30 ± 10.37）分，处于高水平；BIPQ得分为（42.18 ± 13.94）分；FoP-Q-SF得分为（35.41 ± 7.29）分。多元线性回归分析结果显示，病程、纽约心脏病协会心功能分级、BIPQ得分、FoP-Q-SF得分是CHF患者失志状况的影响因素（t值为3.08~12.50，均P<0.05）。 结论 亟需关注CHF患者的失志现状，结合其病程、疾病分期、疾病感知、疾病进展恐惧状况，制订系统、科学有效的失志干预策略。 Objective To understand the current status and analyze the factors of demoralization of patients with chronic heart failure (CHF), providing references for targeted psychological interventions of nursing staff. Methods Using the cross-sectional survey method, from August 2022 to January 2023, 282 CHF patients who were followed up in the Cardiovascular Department of the First Affiliated Hospital of Zhengzhou University were selected as the study subjects. They were investigated using the General Information Questionnaire, Demoralization Scale Revised Mandarin Version, Brief Illness Perception Questionnaire (BIPQ), Fear of Progression Questionnaire-Short Form (FoP-Q-SF), and the factors influencing the demoralization of CHF patients were analyzed using univariate analysis and multiple linear regression. Results Among 282 cases, male 172 cases, female 110 cases, aged (62.29±10.05) years old. The Demoralization Scale Revised Mandarin Version′s score of CHF patients was (30.30 ± 10.37) points the score of BIPQ was (42.18 ± 13.94) points the score of FoP-Q-SF was (35.41 ± 7.29)points, which were at high level. The results of multiple linear regression analysis showed that patient disease duration, disease stages, New York heart association cardiac function classification, the score of BIPQ, and the score of FoP-Q-SF were factors influencing the demoralization of CHF patients (t values were 3.08 to 12.50, all P<0.05). Conclusions There is an urgent need to focus on the current status of the demoralization of CHF patients. It is necessary to develop a systematic and effective intervention strategy for demoralization, to take into account patient disease duration, disease stages, illness perception, and fear of progression in a comprehensive manner.

    心力衰竭横断面研究失志影响因素心理护理

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    多次体外受精-胚胎移植失败女性创伤后应激障碍轨迹及影响因素分析

    孙燕华赵静胡艳梅王霞...
    129-136页
    查看更多>>摘要：目的 探讨多次体外受精-胚胎移植（IVF-ET）失败女性创伤后应激障碍（PTSD）轨迹的潜在类别，分析不同人口学特征及心理因素对其PTSD轨迹潜在类别的影响。 方法 采用前瞻性观察研究，便利抽样法选取2021年5月至2022年10月上海市第一人民医院生殖科IVF-ET失败≥2次的女性为研究对象，分别于最近1次移植失败后3 d（T1）、10 d（T2）、20 d（T3）及下一移植周期前3 d（T4）采用创伤后应激障碍平民版量表进行4次随访，电话随访和线上随访相结合，获得4个时间点的PTSD水平，使用潜类别增长模型识别4个时间点PTSD得分轨迹的潜在类别，并采用无序多分类Logistic进行影响因素分析。 结果 最终纳入196例IVF-ET失败女性，年龄（29.42 ± 4.13）岁。本研究拟合出3条PTSD轨迹，分别为无PTSD组82例占42%、轻度PTSD组61例占31%及PTSD升高组53例占27%；Logistic回归分析显示，年龄、文化程度、生育压力、婚姻调适水平是多次IVF-ET失败女性PTSD轨迹的预测因素；以无PTSD组为参照，年龄≥35岁、初中及以下文化程度及婚姻调适水平越低的女性越易进入PTSD升高组（OR=4.570、8.540、0.949，均P<0.05），年龄≥35岁及生育压力越大的女性越易进入轻度PTSD组（OR=3.871、1.063，P<0.05）。 结论 多次IVF-ET失败女性在下一移植周期内PTSD的轨迹存在群体异质性，年龄大、文化程度低、生育压力大及婚姻调适差可预测PTSD的变化轨迹。生育压力及婚姻调适为可改变的变量，医护人员可通过进行健康教育、正念干预以缓解女性生育压力，促进良好的婚姻调适状态，尽可能降低PTSD对下一周期受孕的不良影响。 Objective To explore the potential categories of post-traumatic stress disorder (PTSD) trajectories in women with multiple in vitro fertilization-embryo transfer (IVF-ET) failures, and to analyze the effects of different demographic characteristics and psychological factors on the potential categories of PTSD trajectories. Methods This was a prospective empirical research, from May 2021 to October 2022, women with IVF-ET failure ≥ 2 times in the reproductive department of Shanghai First People′s Hospital from May 2021 to October 2022 were selected as the research objects. Post-traumatic stress disorder civilian version scale was used for 4 follow-ups at 3 d (T1), 10 d (T2), 20 d (T3) after the last transplantation failure and 3 d before the next transplantation cycle (T4). Telephone follow-up and online follow-up were combined to obtain the PTSD level at 4 time points. Potential categories of PTSD score trajectories at four time points were identified using a latent category growth model, and analyze influencing factors using unordered multi classification logistic analysis. Results Totally 196 IVF-ET women were admitted, aged (29.42 ± 4.13) years. Three PTSD trajectories were fitted in this study, including 82 cases (42%) in non-PTSD group, 61 cases (31%) in mild PTSD group and 53 cases (27%) in elevated PTSD group. Logistic regression analysis showed that age, education level, fertility pressure and marital adjustment level were the predictors of PTSD trajectory in women with multiple IVF-ET failures. Compared with the non-PTSD group, women aged ≥35 years, with lower education level and marital adjustment level were more likely to enter the elevated PTSD group (OR=4.570, 8.540, 0.949, all P<0.05). Women aged 35 years and with greater reproductive pressure were more likely to enter the mild PTSD group (OR=3.871, 1.063, both P<0.05). Conclusions There is group heterogeneity in the trajectories of PTSD in women with multiple IVF-ET failures in the next transplantation cycle. Old age, low education level, high fertility pressure and poor marital adjustment can predict the trajectories of PTSD. Fertility stress and marriage adjustment are changeable variables. Medical staff can relieve women′s fertility pressure through health education and mindfulness intervention, promote a good state of marriage adjustment, and minimize the adverse effects of PTSD on the next cycle of conception.

    体外受精-胚胎移植妊娠失败创伤后应激障碍轨迹潜在类别

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    网络认知行为疗法应用于改善冠心病患者负性情绪的SWOT分析

    王佳佳刘艳萍梁闪王琳琳...
    137-141页
    查看更多>>摘要：目的 借助SWOT（S：内部优势，W：内部劣势，O：外部机遇，T：外部威胁）分析，探讨网络认知行为疗法应用于改善冠心病患者负性情绪的各种内部条件和外部条件，并提出发展策略。 方法 运用SWOT分析法，分析、梳理网络认知行为疗法改善冠心病患者负性情绪的内部优势与劣势、外部机遇与威胁。 结果 网络认知行为疗法改善冠心病患者负性情绪的内部优势有治疗效果显著，治疗可操作性强，成本效益高。内部劣势有过度依赖患者治疗积极性，护士缺乏心理学相关培训。外部机遇包括技术支持、需求支持、理论支持。外部威胁为缺乏大样本实证研究，存在患者个人信息泄露风险。 结论 网络认知行为疗法在改善冠心病患者负性情绪临床应用中优势与劣势并存，机遇与威胁同在。应利用机遇克服劣势，提高患者治疗中的自主性与积极性，加强医护人员心理学相关培训，以期促进网络认知行为疗法在改善冠心病患者负性情绪的临床应用中进一步推广。 Objective With the help of SWOT(S: internal strengths, W: internal weaknesses, O: external opportunities, T: external threats)analysis, to explore the internal and external conditions of internet-based cognitive behavioral therapy applied to improve the negative emotions of patients with coronary heart disease, and to propose development strategies. Methods SWOT analysis was used to analyze and sort out the internal strengths and internal weaknesses, external opportunities and external threats of internet-based cognitive behavioral therapy in improving the negative emotions of patients with coronary heart disease. Results The internal strengths of internet-based cognitive behavioral therapy in improving the negative emotions of patients with coronary heart disease were significant therapeutic effect, strong operability and high cost-effectiveness. The internal weaknesses included excessive dependence on patients′ treatment enthusiasm, and a lack of psychological training among nurses. The external opportunities included demand support, technical support, and theoretical support. The external threats were the lack of large-scale empirical research and the risk of patient personal information leakage. Conclusions In the clinical application of internet-based cognitive behavioral therapy to improve the negative emotions of patients with coronary heart disease, both strengths and weaknesses coexist, and opportunities and threats coexist. Only by taking strengths of opportunities to overcome weaknesses, improve the autonomy and enthusiasm of patients in treatment, and increase the psychological training of medical staff, can internet-based cognitive behavioral therapy be further promoted in the clinical application of improving the negative emotions of patients with coronary heart disease.

    冠心病负性情绪网络认知行为疗法SWOT分析

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    医养结合视域下专科护士帮扶模式对护理院护士经外周静脉置入中心静脉导管维护能力的影响

    李丹柴春燕杨雪芳王敏...
    142-148页
    查看更多>>摘要：目的 评价医养结合视域下静疗专科护士帮扶对护理院护士PICC导管维护能力的影响，为开展基层医院专科护理帮扶工作提供参考。 方法 采用类实验研究方法，根据Miller金字塔理论构建以专科技术为核心的专科护士帮扶模式，2021年1—12月对苏州市3家护理院进行帮扶。采用便利抽样法，调查帮扶前后护理院护士的PICC导管维护能力、PICC导管维护缺陷发生率、PICC导管并发症及非计划拔管的发生率、医生及患者满意度。 结果 共纳入86名护士，年龄（33.17 ± 2.31）岁。帮扶后，护理院护士理论、操作技能成绩分别为（89.77 ± 2.11）、（92.75 ± 1.62）分，均显著高于帮扶前的（60.84 ± 2.71）、（79.81 ± 1.68）分，差异均有统计学意义（t=-84.96、-52.12，均P<0.05）。帮扶后护理院PICC导管维护缺陷中的标识不全、贴膜卷边、渗血渗液、导管打折、贴膜固定不规范、延续护理信息不全发生率分别为9.95%（21/211）、8.53%（18/211）、2.84%（6/211）、6.16%（13/211）、4.74%（10/211）、2.37%（5/211），均低于帮扶前的50.57%（89/176）、43.18%（76/176）、14.20%（25/176）、25.57%（45/176）、18.18%（32/176）、11.93%（21/176），差异均有统计学意义（χ2值为14.00~77.81，均P<0.05）。帮扶后医用黏胶相关性皮肤损伤和导管阻塞并发症、非计划拔管发生率分别为4.44%（4/90）、3.33%（3/90）、2.22%（2/90），均低于帮扶前的20.51%（16/78）、15.38%（12/78）、11.54%（9/78），差异均有统计学意义（χ2=8.81、6.06、4.50，均P<0.05）。帮扶后医生对护士满意度、患者对护理工作满意度分别为96.43%（27/28）、93.75%（45/48），均高于帮扶前的71.43%(20/28)、72.73%(32/44)，差异均有统计学意义（χ2=4.77、5.97，均P<0.05）。 结论 医养结合视域下静疗专科护士团队对护理院PICC导管维护帮扶能有效降低PICC导管并发症及非计划拔管的发生率，提高护理院护士PICC导管维护能力，有助于提高护理院的护理质量。 Objective To evaluate the effect of nursing specialist nurses′ assistance on the ability of nursing home nurses to maintain venous catheter under the vision of combination of medical care and nursing care, providing reference for carrying out specialized nursing assistance work in grassroots hospitals. Methods This study was an experimental study. According to Miller′s pyramid theory, a model of specialist nurse assistance was established with specialized technology as the core. From January to December 2021, three nursing hospitals in Suzhou were assisted. Convenience sampling method was used to investigate the ability of intravenous catheter maintenance, the incidence of central venous catheter maintenance defects, the incidence of central venous catheter complications and unplanned extubation, and the satisfaction of doctors and patients before and after help. Results Totally 86 nurses were included, aged (33.17 ± 2.31) years old. After the help, the theoretical and operational skill scores of nurses in the nursing home were (89.77 ± 2.11) and (92.75 ± 1.62) points, respectively, which were significantly higher than those before the help (60.84 ± 2.71) and (79.81 ± 1.68) points, and the differences were statistically significant (t=-84.96, -52.12, both P<0.05). Among the maintenance defects of central venous catheter in nursing homes, incomplete labeling, film wrapping, blood seepage, catheter discounting, non-standard film fixing, and incomplete information of extended care were 9.95% (21/211), 8.53% (18/211), 2.84% (6/211), 6.16% (13/211), 4.74% (10/211), 2.37% (5/211) after help, all lower than 50.57% (89/176), 43.18% (76/176), 14.20% (25/176), 25.57% (45/176), 18.18% (32/176), 11.93% (21/176) before help. The differences were statistically significant (χ2 values were 14.00 to 77.81, all P<0.05). The incidence of medical adhesive related skin injury, catheter obstruction complications and unplanned extubation were 4.44% (4/90), 3.33% (3/90) and 2.22% (2/90), respectively, which were lower than 20.51% (16/78), 15.38% (12/78) and 11.54% (9/78) before help. The differences were statistically significant (χ2=8.81, 6.06, 4.50, all P<0.05). Doctors′ satisfaction with nurses and patients′ satisfaction with nursing work were 96.43%(27/28) and 93.75%(45/48), respectively, both higher than 71.43%(20/28) and 72.73%(32/44) before help, and the differences were statistically significant respectively (χ2=4.77, 5.97, both P<0.05). Conclusions From the perspective of combination of medical care and nursing care, the maintenance and assistance of intravenous catheters by the team of intravenous therapy nurses in nursing hospitals can effectively reduce the incidence of central venous catheter complications and unplanned extubation, improve the maintenance ability of intravenous catheters of nurses in nursing hospitals, and help to improve the quality of nursing care in nursing hospitals.

    导管插入术,中心静脉专科护士护理院医养结合帮扶PICC导管维护

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