基于行动研究法的质量改进对妇科腔镜术后患者早期活动管理的研究  

Study on quality improvement based on action research method for early activity management of patients after gynecological laparoscopic surgery

作　　者：丁永艳[1] 张水蓉[1] 张正娥[1] 阮晓旭[1] DING Yongyan;ZHANG Shuirong;ZHANG Zheng′e;RUAN Xiaoxu(Department of Gynecology,Jingzhou Central Hospital,Jingzhou,Hubei 434020,China)

机构地区：[1]湖北省荆州市中心医院妇科

出　　处：《重庆医学》2019年第23期4031-4034,4038,共5页Chongqing medicine

基　　金：湖北省荆州市科技局2016年医疗卫生科技计划项目（2016096）

摘　　要：目的 探讨基于行动研究法的质量改进活动对妇科腔镜术后患者早期下床活动的效果。方法采用行动研究法制订妇科腔镜术后患者早期活动实践的标准及流程,选取2017年9-11月妇科腔镜术后患者175例纳入观察组,按照制订的护理实践规范进行早期活动指导;另选取2017年3-5月未进行术后早期活动护理实践规范指导的妇科腔镜术后患者168例纳入对照组,比较两组患者早期下床活动的依从性、术后镇痛效果、首次下床时间、首次肛门排气时间、术后舒适度及质量改进小组成员的能力。结果 观察组患者妇科腔镜术后早期活动的依从性高于对照组(91.42%vs.33.93%),术后疼痛评分大于3分者百分比低于对照组(6.29%vs.41.07%),差异均有统计学意义(P<0.05);观察组患者术后首次排气时间、首次下床时间明显短于对照组,术后24h舒适度、术后72h舒适度明显高于对照组(P<0.05);质量改进后小组成员的质量改进手法、专业知识、团队合作能力、创新思维能力、沟通能力、护患关系融洽评分明显高于质量改进前(P<0.05)。结论 基于行动研究法的质量改进活动提高了妇科腔镜术后早期下床活动的依从性,促进了患者的康复,提高了小组成员的能力。Objective To investigate the effect of quality improvement activities based on action research on early bed-out activities in patients after gynecological laparoscopic surgery.Methods The standard and procedure of early activity practice for patients after gynecological laparoscopic surgery were determined by action research method.A total of 175 patients who underwent gynecological laparoscopic surgery from September to November 2017 were enrolled into the observation group,and the early activity guidance was carried out according to the established nursing practice norms.Other 168 patients who did not carry out the standard guidance of early postoperative activity nursing practice from March to May 2017 were included in the control group.The compliance of early bed-out activities,postoperative analgesia,first time of getting out of bed,time of first anal exsufflation,postoperative comfort and the ability of quality improvement group were compared between the two groups.Results Compared with the control group,the compliance of early bed-out activities after gynecological laparoscopic surgery was higher in the observation group(91.42%vs.33.93%),the percentage of patients with postoperative pain score greater than 3 points was lower in the observation group(6.29%vs.41.07%),and the differences were statistically significant(P<0.05).The first exhaust time and the first time of getting out of bed in the observation group were significantly shorter than those in the control group,and the comfort at 24 h and 72 h after operation of the patients in the observation group was significantly higher than that in the control group(P<0.05).After the quality improvement,the scores of quality improvement techniques,professional knowledge,teamwork ability,innovative thinking ability,communication ability and nurse-patient relationship of team members were significantly higher than those before the quality improvement(P<0.05).Conclusion The quality improvement activities based on the action research method improves the compliance

关 键 词：妇科外科手术 腹腔镜检查 早日下床活动 患者依从 

分 类 号：R473.71[医药卫生—护理学]