發(fā)布時(shí)間：2018-06-11 10:10

  本文選題：壓瘡 + 壓力性損傷�。� 參考：《天津醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:1.通過檢索和查閱大量國(guó)內(nèi)外有關(guān)壓瘡的文獻(xiàn)和指南,了解壓瘡評(píng)估、預(yù)防、處理和管理現(xiàn)狀,為建立住院患者規(guī)范化壓瘡護(hù)理體系提供依據(jù)。2.根據(jù)國(guó)情,構(gòu)建一套科學(xué)、系統(tǒng)、全面的住院患者規(guī)范化壓瘡護(hù)理體系,為護(hù)理實(shí)踐者和護(hù)理管理者提供壓瘡評(píng)估、預(yù)防、處理、管理等各方面的參考依據(jù)。方法:1.制定檢索式,計(jì)算機(jī)檢索PubMed、Cochrane library、EMbase、BMJ、EBSCO、中國(guó)生物醫(yī)學(xué)文獻(xiàn)數(shù)據(jù)庫(kù)(CBM)、中國(guó)知網(wǎng)、萬方等數(shù)據(jù)庫(kù),在指南網(wǎng)站National Guideline Clearinghouse(NGC)中檢索相關(guān)指南,檢索時(shí)限為2006年至2015年。通過閱讀摘要和全文篩選出符合納入標(biāo)準(zhǔn)的文獻(xiàn),使用澳大利亞JBI循證衛(wèi)生保健中心2010年版證據(jù)分級(jí)系統(tǒng)對(duì)其評(píng)估分級(jí),并從中提取資料,經(jīng)專家小組討論和分析,最終形成住院患者規(guī)范化壓瘡護(hù)理體系的初稿。2.應(yīng)用德爾菲法通過兩輪專家函詢,對(duì)一級(jí)條目和二級(jí)條目的重要性進(jìn)行評(píng)價(jià),對(duì)三級(jí)條目的重要性和可操作性進(jìn)行評(píng)價(jià),經(jīng)過分析和討論對(duì)條目進(jìn)行修改、增加和刪除,最終確立住院患者規(guī)范化壓瘡護(hù)理體系。結(jié)果:1.基于循證得到住院患者規(guī)范化壓瘡護(hù)理體系的初稿,包括4個(gè)一級(jí)條目、19個(gè)二級(jí)條目和79個(gè)三級(jí)條目,主要涉及壓瘡的風(fēng)險(xiǎn)評(píng)估、預(yù)防、處理和壓瘡的管理等內(nèi)容。2.兩輪函詢的問卷有效回收率分別是93.75%、100%,提出修改意見的專家比率分別為83.33%、16.67%;兩輪專家函詢的權(quán)威系數(shù)分別為0.91、0.92;兩輪專家意見的重要性協(xié)調(diào)系數(shù)為0.251~0.465(P0.05),可操作性協(xié)調(diào)系數(shù)分別為0.235、0.452(P0.05)。3.第一輪專家函詢一級(jí)條目重要性得分均值為4.43~4.93,變異系數(shù)為0.06~0.16,二級(jí)條目重要性得分均值為4.13~4.80,變異系數(shù)為0.09~0.17,三級(jí)條目的重要性得分均值為3.50~4.83,變異系數(shù)為0.09~0.34,可操作性得分均值為3.20~4.83,變異系數(shù)為0.08~0.32。4.第二輪函詢一級(jí)條目重要性得分均值為4.60~5.00,變異系數(shù)為0.00~0.15,二級(jí)條目重要性得分均值為4.33~4.87,變異系數(shù)為0.07~0.16,三級(jí)條目的重要性得分均值為4.27~4.97,變異系數(shù)為0.04~0.17,可操作性得分均值為4.07~4.97,變異系數(shù)為0.04~0.23。5.經(jīng)過兩輪專家函詢,對(duì)問卷結(jié)果進(jìn)行統(tǒng)計(jì)學(xué)分析,根據(jù)專家小組的討論后,一級(jí)條目仍是4個(gè)條目,二級(jí)條目修改2項(xiàng)、增加3項(xiàng),三級(jí)條目修改9項(xiàng)、刪除1項(xiàng)、增加7項(xiàng)。最終形成包含4個(gè)一級(jí)條目,23個(gè)二級(jí)條目和85個(gè)三級(jí)條目的住院患者規(guī)范化壓瘡護(hù)理體系。結(jié)論:本研究基于循證、應(yīng)用德爾菲法最終構(gòu)建了一套包括4個(gè)一級(jí)條目,23個(gè)二級(jí)條目和85個(gè)三級(jí)條目的住院患者壓瘡護(hù)理體系,涵蓋壓瘡的風(fēng)險(xiǎn)評(píng)估、預(yù)防、處理和管理等四個(gè)方面的內(nèi)容,為護(hù)理實(shí)踐者提供科學(xué)、規(guī)范的壓瘡護(hù)理依據(jù),為護(hù)理管理者規(guī)范壓瘡管理提供指導(dǎo)。
[Abstract]:Purpose 1. Through searching and consulting a lot of literature and guidebooks about pressure sore at home and abroad, we can understand the present situation of pressure sore evaluation, prevention, treatment and management, and provide the basis for establishing standardized nursing system of pressure sore for inpatients. According to the national conditions, a set of scientific, systematic and comprehensive nursing system for in-patients with pressure sores was set up to provide reference basis for nursing practitioners and nursing administrators to evaluate, prevent, deal with and manage pressure sores. Method 1: 1. A computer search method was developed for online search of PubMeden Cochrane library- EMbase BMJJ Besco, China Biomedical Literature Database (CBMU), China Zhiwang, Wanfang and other databases. The relevant guidelines were searched on the National Guideline Clearinghouse NGC website for the period from 2006 to 2015. The literature that meets the inclusion criteria is screened out by reading the abstracts and the full text. It is assessed and graded using the evidence classification system of the 2010 edition of the JBI Evidence-Based Health Care Centre in Australia, from which information is extracted and discussed and analysed by the expert group. In the end, the first draft. 2. 2 of the standardized nursing system of pressure sore for inpatients was formed. Through two rounds of expert letters, Delphi method is used to evaluate the importance of the first and second level items, to evaluate the importance and operability of the third level entries, and to modify, add and delete the items through analysis and discussion. Finally, a standardized nursing system for patients with pressure sore was established. The result is 1: 1. Based on the evidence, the first draft of the standardized nursing system for the hospitalized patients was obtained, including 4 first-level items, 19 second-order items and 79 third-level items, which mainly involved the risk assessment, prevention, treatment and management of pressure sores. The effective recovery rate of the two rounds of questionnaires was 93.75 / 100, and the expert ratio of the revised opinions was 83.33 and 16.67, respectively; the authoritative coefficient of the two rounds of expert letters was 0.91and 0.92respectively; the coordination coefficient of the importance of the two rounds of expert opinions was 0.251 / 0.465nP0.05and the operational coordination coefficient was 0.2350.452P0.05. In the first round of expert letter, the mean value of the importance of the first item is 4.43 / 4.93, the coefficient of variation is 0.06 / 0.16, the mean value of the second level item is 4.134.80, the coefficient of variation is 0.09 / 0.17, the mean value of the importance of the third level item is 3.504.83 and the coefficient of variation is 0.09 / 0.34. The mean score was 3.20 and 4.83, and the coefficient of variation was 0.08 and 0.32.4respectively. In the second round, the mean value of the importance of the first item was 4.60 / 5.00, the coefficient of variation was 0.000.15, the mean of the importance of the second level was 4.330.87, the coefficient of variation was 0.07 / 0.16, the mean value of the importance of the third level was 4.27 / 4.97, the coefficient of variation was 0.04 / 0.17, and the operational scores were all. The coefficient of variation was 0.04 ~ 0.23.5. After two rounds of expert letters, the results of the questionnaire were statistically analyzed. According to the discussion of the expert group, the first level item is still 4 items, the second level item is modified 2 items, the addition is 3 items, the third level item is revised 9 items, the deletion item is 1 item, increases 7 items. Finally, a standardized nursing system for patients with pressure sore was formed, which included 4 first grade items, 23 second grade items and 85 third grade items. Conclusion: based on the evidence-based method, the author finally constructed a nursing system for patients with bedsore, including 4 grade 1 items, 23 2 items and 85 3 items, covering the risk assessment and prevention of pressure sores. The four aspects of treatment and management provide scientific and standardized nursing basis for nursing practitioners and provide guidance for nursing managers to regulate the management of pressure sore.
【學(xué)位授予單位】：天津醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R472

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