老年住院患者高危压力性损伤预防个案管理护理方案的构建及效果评价  

Construction and Effect Evaluation of Case Management Model in Prevention of High Risk Pressure Injury in Elderly Inpatients

作　　者：笪俊 辛辰[3] 李斗艳 陈琳[1] 杨明莹 DA Jun;XIN Chen;LI Dou-yan;CHEN Lin;YANG Ming-ying(Orthopedics Department,The First Affiliated Hospital of Southwest Medical University,Luzhou Sichuan 646000;Dept,of Gastroenterology,The Affiliated Hospital of Southwest Medical University,Luzhou Sichuan 646000;Nursing Department,The Second Affiliated Hospital of Kunming Medical University,Kunming Yunnan 650101;Nursing Department,The Second Affiliated Hospital of Kunming Medical University,Kunming Yunnan 650101,China)

机构地区：[1]西南医科大学附属医院骨科,四川泸州646000 [2]昆明医科大学第二附属医院护理部,云南昆明650101 [3]西南医科大学附属医院消化内科,四川泸州646000 [4]昆明医科大学第二附属医院整形外科,云南昆明650101

出　　处：《昆明医科大学学报》2021年第10期178-184,共7页Journal of Kunming Medical University

基　　金：云南省科技厅-昆明医科大学应用基础研究联合专项基金面上项目(2019FE001-234);西南医科大学校级基金项目(2020ZRQNB010)。

摘　　要：目的初步构建老年住院患者高危压力性损伤预防的个案管理护理方案,并探讨应用效果。方法应用德尔菲法,以奥马哈问题评估及干预系统为框架制定出老年住院患者高危压力性损伤(pressure injury,PI)预防个案管理护理方案。选择某三级甲等医院符合纳入标准的100例患者作为研究对象,采用配对设计法行对照组常规护理,实验组在常规护理基础上实施个案管理护理方案,分别从实验组干预前后的认知、行为、状况(knowledge-behavior-status,K-B-S),2组压疮愈合计分量表(pressure ulcer scale for healing,PUSH)、Braden评估表、营养风险筛查2002(nutrition risk screening2002,NRS-2002)、PI的发生率、血红蛋白(hemoglobin,HB)、血清白蛋白(serum albumin,ALB)的监测指标进行评价。结果2组患者年龄、收入等基本资料差异无统计学意义(P>0.05)。实验组患者住院期间护理问题共503个,常见(发生率≥30%)问题有11个。实验组PI发生率与发生风险低于对照组(P<0.05)。结论个案管理护理方案的构建科学、合理,可分析老年高危PI患者住院期间不同领域的常见护理问题,选择相应的干预措施进行干预、动态评价,一定程度上减少PI发生的高危因素,降低PI发生率,改善护理结局。Objective To establish a high-risk pressure Injury prevention case management model for the elderly inpatients,and evalutate the effect of the high-risk pressure injury prevention case management model for the elderly inpatients.Methods A case management and nursing plan for the prevention of high-risk stress injury in elderly hospitalized patients was developed through the Delphi method.100 patients with high incidence of pressure injury in a third-A-grade hospital were selected from May to November 2018.The patients in each department were randomly divided into two groups,with 50 patients in each group.The control group implemented a routine care regimen.The experimental group implemented the high-risk pressure Injury prevention case management model for the elderly inpatients based on the routine nursing program.On the day of hospitalization,on the fourth day after hospitalization,and before the discharge,the nursing problems were found and improved,evaluated from three aspects of Knowledge-Behavior-Status(knowledge-behavior-status,K-B-S).On the day of hospitalization,on the fourth day after hospitalization,and before the discharge,the investigators used Pressure Ulcer Scale for Healing(pressure ulcer scale for healing,PUSH),the Braden evaluation form,Nutrition Risk Screening 2002(NRS-2002)for evaluation.Observe the occurrence of pressure injury,hemoglobin(HB),serum albumin(serum albumin,ALB)detection indicators.Results There were no significant differences in baseline data of age,sex,education,family economic income between the two groups(P>0.05).The experimental group had 503 nursing problems during hospitalization.There were 11 common nursing problems(incidence rate≥30%).The experimental group performed better than the control group(P<0.05).Conclusions The research confirms that the case management model can analyze nursing problems,and objectively evaluate the effectiveness of interventions.The case management model can reduce the incidence of pressure injuries in elderly inpatients with high-risk pressu

关 键 词：老年住院患者 高危压力性损伤 个案管理 

分 类 号：R47[医药卫生—护理学]