摘要
目的 深入了解显微外科护士在识别皮瓣移植手术患者血管危象与对已发生血管危象患者护理过程中的真实体验以提高护士对皮瓣移植手术患者的专科护理能力.方法 采用现象学研究方法,于2022年1-5月运用目的抽样法,选取湖南省某三甲医院15名显微外科护士进行半结构式深入访谈,并采用Colaizzi 7步分析法分析访谈资料,提炼主题.结果 显微外科护士对皮瓣移植手术患者血管危象识别与护理体验可归纳为4个主题及15个亚主题:多重情感体验(紧张感、无助感、自责感、职业认同感和成就感)、核心能力特征要素(责任心与观察能力、理论知识与实践操作能力、工具运用与创新思考能力、亲和力与沟通能力)、血管危象识别与护理阻力因素(工作难度增大、内在支持系统不足、缺乏理解)、寻求组织支持(接受相关教育和培训、改善现有皮瓣血管危象处理流程及记录工具、制定皮瓣情况交接规范、增强皮瓣血管危象早期识别技术支持).结论 在识别与护理皮瓣血管危象患者过程中,需要重视显微外科护士心理健康,强化护士针对皮瓣血管危象的相关专科护理能力,加强医护协作及患者参与,发展皮瓣血循环监测技术并进行持续质量改进,优化皮瓣移植手术围术期管理.
Abstract
Objective To gain insight into the real-life experiences of microsurgical nurses in identifying vascular crises in patients undergoing flap graft surgery versus caring for patients who have developed vascular crises,so as to improve nurses'ability of specialized nursing for patients undergoing skin flap transplantation.Methods A phenome-nological research method was used to select 15 microsurgical nurses from a tertiary hospital in Hunan Province for semi-structured in-depth interviews using purposive sampling from January to May 2022,and the Colaizzi 7-step a-nalysis method was used to analyze the interview data and refine the themes.Results Microsurgical nurses'experi-ences of vascular crisis recognition and care for patients undergoing flap grafting can be summarized into 4 themes and 15 sub-themes:Multiple emotional experiences(feelings of nervousness,helplessness,self-blame,professional identity,and sense of achievement),core competencies(responsibility and observation,theoretical knowledge and practical skills,use of tools and creative thinking,rapport and communication),resistance to recognition and care(increased work difficulty,insufficient internal support system,lack of understanding),seeking organisational sup-port(receiving relevant education and training,improving the existing flap vascular crisis handling process and re-cording tools,developing flap situation handover specifications,and enhancing technical support for the early identi-fication of flap vascular crises).Conclusion In the process of identifying and caring for patients with flap vascular cri-sis,it is necessary to pay attention to the psychological health of microsurgical nurses,strengthen the nurses'ability to provide specialised care for patients with flap vascular crisis,intensify the collaboration between doctors and nur-ses as well as the participation of patients,and develop the technique of monitoring the flap's blood circulation and continue to improve the quality of the technique in order to optimise the management of flap transplantation during the perioperative period.
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