安宁疗护患者远程居家照护方案的构建及初步应用  

Construction and preliminary application of a telemedicine-based home care program for hospice patients

作　　者：郭俊晨 许湘华[2] 刘超毅 王英[4] 刘君清照 谌永毅[2] 朱丽辉 肖亚洲 刘阳 GUO Junchen;XU Xianghua;LIU Chaoyi;WANG Ying;LIU Junqingzhao;CHEN Yongyi;ZHU Lihui;XIAO Yazhou;LIU Yang

机构地区：[1]湖南省肿瘤医院肿瘤护理教研室,长沙市410013 [2]湖南省肿瘤医院护理部,长沙市410013 [3]湖南省肿瘤医院信息科,长沙市410013 [4]湖南省肿瘤医院安宁疗护病房,长沙市410013 [5]湖南省肿瘤医院办公室,长沙市410013 [6]南华大学护理学院

出　　处：《中华护理杂志》2024年第5期517-525,共9页Chinese Journal of Nursing

基　　金：湖南省科技厅重点领域研发计划项目(2020SK2121);中国卫生人才培养项目护理研究子项目(RCLX2220034);湖南省卫生健康委员会一般指导项目(D202314058838)。

摘　　要：目的构建安宁疗护患者远程居家照护方案并进行初步应用,为开展安宁疗护远程居家照护实践提供参考。方法以支持性照护模型为理论指导,在文献研究的基础上结合质性访谈初步拟订安宁疗护患者远程居家照护方案。2023年3月进行2轮函询,征询专家意见并修订方案,形成终稿。2023年4月,采用便利抽样法选取湖南省长沙市某三级甲等肿瘤专科医院安宁疗护病房即将出院的10例患者初步应用该方案,采用不良事件发生例数、远程照护满意度评价方案应用效果。结果共16名专家完成2轮函询,其权威系数为0.928。2轮函询的有效问卷回收率分别为94.12%、100%,专家意见提出率分别为100%、25.00%,条目评分的变异系数分别为0.05~0.18、0~0.16,肯德尔和谐系数分别为0.093、0.210(P<0.001)。最终构建的方案包括症状管理、生活照护、心理及精神照护、社会信息支持4个维度,疼痛管理、呼吸困难管理、胃肠道症状管理、咳嗽/咳痰管理等17个模块,涵盖37项具体实施内容。方案应用期间脱落1例患者,最终纳入9例。患者均未发生不良事件,其远程照护满意度问卷得分为(60.22±7.41)分,处于高满意度水平。结论该研究构建的方案具有较强的科学性、针对性及可行性,可为医护人员开展安宁疗护远程居家照护实践提供指导。Objective To construct a telemedicine-based home care program for hospice patients that will provide a reference for hospice telemedicine-based home care practices.Methods Using the Supportive Care Model as a theoretical guide,a preliminary telemedicine-based home care program for hospice patients was developed based on literature research combined with qualitative interviews.2 rounds of expert consultation were conducted in March 2023 to solicit their opinions and revise the proposal to form the final draft.In April 2023,9 patients who were about to be discharged from the palliative care ward of a cancer hospital in Hunan Province,were selected for the preliminary application of the program by the convenience sampling method;the number of cases of adverse events and the Telemedicine Satisfaction Questionnaire were used for the effectiveness of the program.Results A total of 16 experts completed 2 rounds of consultation,and the coefficient of expert authority was 0.928.The effective questionnaire recovery rates of the 2 rounds of consultation were 94.12%and 100%;the expert opinion submission rates were 100%and 25.00%;the coefficients of variation of item scores were 0.05~0.18 and 0~0.16.The coefficients of Kendall harmony in 2 rounds were 0.093 and 0.210(P<0.001).The constructed final program included 4 dimensions of symptom management,daily life care,psycho-spiritual care and social information support,and a total of 17 modules such as pain management,dyspnea management,gastrointestinal symptom management and cough management,which covering 37 specific items.No adverse events occurred during the application and the score of care satisfaction was(60.22±7.41),which indicated a high level of satisfaction.Conclusion The program constructed in this study is scientific,relevant and feasible,and can provide guidance for healthcare professionals in conducting hospice telemedicine-based home care practices.

关 键 词：安宁疗护 远程护理 家庭护理 德尔菲技术 

分 类 号：R473.2[医药卫生—护理学]