人性化护理在腹壁结肠永久性造口中的应用

摘要:目的探讨人性化护理在腹壁结肠永久性造口中的应用效果。方法纳入2013年4月~2014年3月于我院进行腹壁结肠永久性造口治疗的76例患者,随机分为两组后,比较观察组(行人性化护理)和对照组(采取常规护理)的护理满意度、生活质量及心理状况。结果经上述护理后,观察组患者的护理满意度评分、生活质量评分分别为(92.09±5.18)分和(76.35±3.09)分,明显高于对照组水平;且观察组的抑郁量表评分低于对照组水平,指标的组间差异均有统计学意义(P<0.05)。结论人性化护理应用于腹壁结肠永久性造口中,能够明显提高患者术后生活质量,改善心理状况,有利于良好护患关系的构建。 腹壁结肠永久性造口术是治疗恶性肠道疾病的常用术式,是通过在腹壁处行人为手术切口,随后将病灶肠管拉出、翻转后缝合于腹壁处,形成肠道造口,从而达到替代肛门功能的治疗目的[1]。患者在手术前由于缺乏相关知识,容易产生恐惧心理而拒绝治疗,且在术后由于排便部位的变化,会给患者带来极大的心理压力,给生活质量造成极不利影响。本组研究对人性化护理在腹壁结肠永久性造口中的应用效果进行分析,结果显示观察组在接受人性化护理后,取得满意效果,现报道如下。 1 资料与方法 1.1一般资料选取2013年4月~2014年3月于我院接受腹壁结肠永久性造口手术治疗的76例患者为研究对象。将其随机分为观察组和对照组患者各38例,观察组中男性患者20例,女性18例,患者年龄41~68岁,平均年龄(5 2.79±4.51)岁,病症类型:大肠癌14例,大肠破裂24例;对照组患者中男性17例,女性21例,年龄42~70岁,平均年龄(5 3.41±5.18)岁,病症类型:大肠癌15例,大肠破裂23例。两组患者在年龄、性别、病因等一般资料对比上均无显著性差异(P>0.05),具有可比性。 1.2方法对照组给予常规护理,包括术前口头对患者进行心理安慰,帮助其了解手术预期疗效,消除不安心理;术后常规遵医嘱给药等。 观察组采取人性化护理:①手术前护理:确定手术 方案 气瓶 现场处置方案 .pdf气瓶 现场处置方案 .doc见习基地管理方案.doc关于群访事件的化解方案建筑工地扬尘治理专项方案下载 后积极与患者进行交流沟通,使患者正确认识永久性结肠造口术,并对预期治疗效果有初步了解,缓解患者的消极情绪,使患者保持平稳心态接受治疗;②术前造口护理:确定患者处于合适体位(平卧位,双手置入枕后),指导患者在放松情绪下观察腹部皮肤,选择平整、无褶皱或骨骼突出的部位,随后判定腹直肌位置,在腹直肌上标识造口位,随后协助患者变动体位,并对造口标识进行调整,以造口部位足够平坦、且患者可看清造口部位为原则;标识结束后嘱患者勿擦拭标识记号; ③手术过程中积极配合手术医师,并注意保护患者的隐私;④手术后应积极与患者进行沟通交流,帮助患者树立生活信心和正确、健康的生活观念;护理人员在日常护理中也应对患者表示尊重和理解,忌私下讨论患者病情或嘲笑患者;同时在手术后还应定期更换造口袋,并严格遵从无菌操作进行更换;同时还应与患者家属进行交流沟通,指导家属进行造口袋更换及造口保护等,并尽量进食清淡、易消化食物,避免剧烈运动;⑤患者痊愈出院后对其进行随访, 记录 混凝土 养护记录下载土方回填监理旁站记录免费下载集备记录下载集备记录下载集备记录下载 造口在日常使用中出现的问题并及时予以解决。 1.3观察指标[2] 自制护理满意度调查量表(共设置20个项目,每一项目下设"满意"、"一般"、"不满意"3个选项,分别对应5分、3分和1分,执行百分制),评价其护理满意度。使用CQOL-74生活质量量表评价术后患者的生活质量,分数越高表明生活质量越良好;同时使用SDS量表评价患者的心理状况,分数越高,表明抑郁症状越严重。 1.4统计学方法采取统计学软件SPSS19.0对相关数据进行分析和处理,计量资料采取(x±s)表示,组间对比进行t检验;对比以P<0.05为有显著性差异和统计学意义。 2 结果 经上述护理后,观察组患者的护理满意度评分及生活质量量表评分均高于对照组水平,且SDS量表评分低于对照组,各项指标的组间比较结果均有统计学意义(P<0.05),见表1。 3 讨论 3.1人性化护理应用于腹壁结肠永久性造口的效果结肠造口是对大肠破裂或肠道功能障碍患者进行治疗的主要方式,能够有效避免排泄物对腹腔的污染,避免严重后果[3]。但腹壁结肠永久性造口术后患者极易由于生理变化而导致不同程度的心理问题,不利于其术后恢复。因此,对腹壁结肠永久性造口术患者进行良好护理很有必要。人性化护理始终将"以人为本"作为最基本的护理理念,将其应用于腹壁结肠永久性造口中能够为患者提供更舒适的护理,为术后心理状况的改善及病情恢复创造有利条件。本组研究结果显示,观察组患者在接受人性化护理后,其生活质量评分高于对照组,抑郁量表评分则低于对照组,且观察组的护理满意度高于对照组水平,提示人性化护理不仅有利于患者身心健康的恢复,还能为良好护患关系的形成奠定基础。 3.2人性化护理的注意事项虽说人性化护理可在一定程度上促进患者的术后恢复,但在进行人性化护理干预时仍需注意以下事项:①护理人员在对患者进行术前心理疏导时,应站在患者立场上思考问题,始终保持耐心、亲切的态度,解答患者的疑惑与问题,帮助患者提高对永久性造口术的认识,提高依从性;②在手术后护理时,应确保病房内的温湿度适宜,并根据患者的术后表征制定合理的饮食计划,例如排泄不畅患者应增加高维生素、高纤维素食物[4],肠道过敏者则需遵医嘱给予药物治疗;③应根据季节变化做好相应护理工作,冬季需加强保暖,夏季等潮湿季节则应密切关注造口处皮肤的变化情况,并适当缩短造口袋更换时间[5],以免发生造口感染,给患者带来不必要的痛苦;④患者出院时应加强出院指导,告知患者及家属在日常生活中的注意事项,并对永久性造口患者加强电话随访或上门随访,帮助患者在出院后树立良好的生活心态,并及时更换造口袋。 综上所述,人性化护理有利于腹壁结肠永久性造口手术后患者的病情恢复和生活质量的提高,值得推广使用。 Abstract: objective to explore the humanistic nursing in the abdominal wall colon permanent made the application effect of the mouth. Methods included in April 2013 to March 2014 in our hospital for abdominal colic permanent colostomy treatment of 76 patients, randomly divided into two groups, comparative observation group (line humanized nursing) and control group (conventional nursing) nursing satisfaction, quality of life and psychological status. Results after the nursing, the observation group of patients with nursing satisfaction score, quality of life score, respectively (92.09-5.18) and (76.35-3.09), significantly higher than the control group; Depression rating scale and the observation group than controls, indicators of the differences between groups were statistically significant (P < 0.05). Conclusions humanized nursing applied to the abdominal wall permanent mouth, colon can obviously increase the postoperative patients quality of life, improve the psychological condition, is conducive to the construction of a good relationship between nurses and patients. Abdominal colic permanent colostomy is commonly used for the treatment of malignant bowel disease operation,www.gzjjgyw.com is pedestrian for incision through the abdominal wall, then pull the lesions insufflate, reverse suture in the abdominal wall place, after the formation of intestinal colostomy, so as to achieve the aim of treatment for replace the anus function [1]. Patients preoperatively because of the lack of related knowledge and prone to fear and to refuse treatment, and due to the changes of defecation areas, after surgery can bring great psychological pressure to patients, extremely adverse effects to the quality of life. This research of humanized nursing in abdominal colic permanent mouth of application effect is analyzed, results show that the observation group after accepting the humanized nursing, satisfactory effect, now report as follows. 1 data and methods 1.1 general data selection in April 2013 to March 2014 in our hospital abdominal colic permanent colostomy surgery treatment of 76 patients as the research object. Its all the 38 cases were randomly divided into observation group and control group patients, male patients in the observation group 20 cases, 18 cases, women patients aged 41 to 68, average age (5 2.79 + 4.51), disease types: 14 cases of colorectal cancer and 24 cases of large intestine rupture. Male 17 cases in the control group patients, 21 cases of women, aged 42 to 70, average age (5 3.41 + 5.18), and disease types: colorectal cancer 15 cases, 23 cases of large intestine rupture. Two groups of patients in comparison with the data such as age, gender, cause of general were no significant differences (P > 0.05), comparable. 1.2 method in the control group given routine nursing care, including preoperative psychological comfort for patients with oral and help them understand the operation expected curative effect, eliminate nervous psychology; Postoperative routine prescribed medication, etc. Preoperative nursing observation group adopt humanized nursing: (1) : determine positive for communication with the patient after surgery, the correct understanding of permanent colostomy patients, and has a preliminary understanding to the expected effect, alleviate the negative emotion of patients, making patients maintained steady mentality for treatment; (2) the preoperative colostomy care: to determine the patients are in the right position (after the hypothesis, both hands is put pillow), guiding patients with abdominal skin is looked at under a relaxed mood, choose level off, without folds or bones prominent place, then determine the rectus locations, logo on the rectus incision, then assist patients change positions, and to adjust colostomy logo, with colostomy parts enough flat, and patients can see colostomy parts for the principle; After the logo told patients do not wipe the sign; (3) surgery in the process of actively cooperate with the doctor, and pay attention to protect the patient's privacy; (4) after the operation, should actively communicate with patients, help patients set up confidence and the right of life, healthy life concept; Patients with nursing staff in daily care should also show respect and understanding,www.hgmse.net www.gpsdvd.cn avoid is privately to discuss patients or patients with ridicule; At the same time also made pocket should be replaced periodically after the surgery, and strictly comply with aseptic operation be replaced; At the same time should also communicate with patients' families, the family guidance for pocket change and colostomy protection, and try to eat light, easy to digest food, avoid strenuous exercise; 5 patients recovered to follow-up after discharge, records colostomy problem in daily use and resolved in a timely manner. 1.3 observation index [2] homemade nursing satisfaction scale (20 items were set up, each project, there are "happy", "general", "not satisfied" three options, respectively corresponding to the five points, three points and 1 minute, execution 0) and evaluate its nursing satisfaction. Use CQOL - 74 evaluation of the quality of life of patients with postoperative quality of life scale, higher scores show that the better quality of life; At the same time using SDS scale to evaluate the psychological status of patients, the higher the score, suggests that the more serious the depressive symptoms. SPSS19.0 1.4 statistical methods adopt statistical software for data analysis and processing, measurement data (x + s) said, t test comparison between groups; The significant differences compared with P < 0.05 and statistical significance. 2 the results After the nursing, the observation group of patients with nursing satisfaction score and quality of life scale score were higher than the control group, and SDS scale score lower than the control group, each index of the comparison results between groups have statistical significance (P < 0.05), see table 1. 3 discuss 3.1 humanized nursing applied to the effect of abdominal colic permanent colostomy Is underwent colostomy in patients with large intestine rupture or bowel dysfunction is the main treatment, can effectively avoid waste pollution of the abdominal cavity, [3] to avoid serious consequences. But permanent colostomy patients with postoperative abdominal colic due to physiological changes extremely easily lead to different degrees of psychological problems, is not conducive to the postoperative recovery. Therefore, patients with permanent colostomy colon of abdominal surgery with good care is necessary. Humanized nursing always will be "people-oriented" as the most basic care concept, applied to the abdominal wall colon permanent building mouth can provide a more comfortable nursing to patients, for the recovery of the improvement of the psychological status and condition to create favorable conditions. This study, according to the results of observation group of patients after accepting the humanized nursing, the quality of life score higher than control group, depression rating scale were lower than the control group, higher than the control group and observation group nursing satisfaction level, prompt the humanized nursing is not only beneficial to the recovery of patients' physical and mental health, but also for laying a foundation for the formation of good relationship between nurses and patients. 3.2 humanized nursing considerations Though the humanized nursing can to a certain extent, promote the patient's postoperative recovery, but at the time of the humanized nursing intervention still need to pay attention to the following: (1) nursing in the patients with preoperative www.fsjct.net www.sanheshun.net psychological counseling, should stand on the position of patients with thinking, always maintain patience, friendly attitude, answer the patient's doubts and problems, help patients to improve the awareness of performing a permanent, improve compliance; (2) in nursing after the operation, should ensure the temperature and humidity in the ward is appropriate, and according to the patient's postoperative reasonable diet plan, such as poor drainage should increase in patients with high vitamin, high fibre food [4], gut allergies should be prescribed for drug treatment; (3) should make corresponding nursing according to seasonal change, need to strengthen the winter to keep warm, in summer, such as wet season should pay close attention to colostomy in changes of the skin, and reduce the pocket change time [5], lest produce incision infection, unnecessary pain to the patient; (4) when patients discharged from hospital discharge guidance should be strengthened, and inform the patient and family in the matters of attention in the daily life, and strengthen the telephone follow-up in patients with permanent colostomy or on-site follow-up, help patients after discharge to set up a good life attitude, and promptly made pocket change. To sum up, the humanized nursing is beneficial to the abdominal wall colon permanent colostomy patients after the operation of illness recovery and the improvement of life quality, worthy of promotion of use.