手術(shù)室細(xì)節(jié)護(hù)理在確保手術(shù)室護(hù)理安全中的應(yīng)用效果

章幗瑛

[摘要]目的 觀察和探討手術(shù)室細(xì)節(jié)護(hù)理在確保手術(shù)室護(hù)理安全中的應(yīng)用效果。方法 選取2016年1～12月在我院進(jìn)行手術(shù)治療的64例女性患者作為研究對(duì)象，隨機(jī)分為兩組，每組32例。觀察組采用手術(shù)細(xì)節(jié)護(hù)理，對(duì)照組采用常規(guī)護(hù)理，觀察對(duì)比兩組患者的護(hù)理質(zhì)量評(píng)分、護(hù)理人員形象與職業(yè)素養(yǎng)評(píng)分、術(shù)后護(hù)理綜合評(píng)分、護(hù)理滿意度以及術(shù)前術(shù)后SAS評(píng)分等。結(jié)果 觀察組的護(hù)理質(zhì)量評(píng)分（儀器設(shè)備管理、器械設(shè)備、護(hù)士配合等）均顯著優(yōu)于對(duì)照組患者，差異有統(tǒng)計(jì)學(xué)意義（P<0.05）。觀察組患者的手術(shù)時(shí)間短于對(duì)照組患者，差異無(wú)統(tǒng)計(jì)學(xué)意義（P>0.05）。觀察組的護(hù)理人員形象與職業(yè)素養(yǎng)、術(shù)后護(hù)理綜合評(píng)分及護(hù)理滿意度方面均顯著優(yōu)于對(duì)照組，差異有統(tǒng)計(jì)學(xué)意義（P<0.05）。兩組患者術(shù)前的SAS評(píng)分比較，差異無(wú)統(tǒng)計(jì)學(xué)意義（P>0.05）。術(shù)后1 d，觀察組患者的SAS評(píng)分顯著低于對(duì)照組，差異有統(tǒng)計(jì)學(xué)意義（P<0.05）。結(jié)論 手術(shù)室細(xì)節(jié)護(hù)理顯著提高了手術(shù)室的護(hù)理安全及護(hù)理質(zhì)量評(píng)分，提升了護(hù)理人員的形象與素養(yǎng)，增強(qiáng)了患者的自信心，效果顯著，值得臨床推廣應(yīng)用。

[關(guān)鍵詞]手術(shù)室細(xì)節(jié)護(hù)理；護(hù)理安全；效果

[中圖分類號(hào)] R472.3 [文獻(xiàn)標(biāo)識(shí)碼] A [文章編號(hào)] 1674-4721（2017）09（b）-0195-03

The application effect of operating room detail nursing to ensure the safety of nursing in the operation room

ZHANG Guo-ying

The operating room，Maternal and Child Health Hospital in Yichun City，Jiangxi Province，Yichun 336000，China

[Abstract]Objective To observe and discuss the application effect of operating room detail nursing to ensure the safety of nursing in the operation room.Methods A total of 64 female patients who underwent surgical treatment in our hospital from January to December 2016 were selected as the study subjects，and patients were randomly divided into two groups，32 cases in each group.The observation group adopted operating room detail nursing，while the control group adopted conventional nursing method.The nursing quality scores，the image and occupation accomplishment of nursing staffs，postoperative nursing comprehensive score，nursing satisfaction and postoperative SAS score of the two groups were observed and compared.Results The nursing quality scores of observation group （equipment management，equipment，the nurses cooperate and etc） were significantly better than those of the control group，and the differences were statistically significant （P<0.05）.The operation time of the observation group was shorter than that of the control group，and the differences was not statistically significant （P>0.05）.The image and occupation accomplishment of nursing staffs，postoperative nursing comprehensive score and nursing satisfaction of the observation group were significantly better than those of the control group，and the differences were statistically significant （P<0.05）.The preoperative SAS scores were compared in the two groups，and the differences was not statistically significant （P>0.05）.After 1 day of operation， the SAS scores in the observation group was significantly lower than that in the control group，and the difference was statistically significant （P<0.05）.Conclusion The operation room details nursing can significantly improve the safty of operation room nursing and nursing quality score，promote the image and occupation accomplishment of nursing staffs and strengthen the patients′ self-confidence.The efficacy is significant，so it is worthy of clinical application.endprint

[Key words]Operation room detail nursing；The safety of nursing；Effect

手術(shù)室的護(hù)理工作具有工作強(qiáng)度大、風(fēng)險(xiǎn)高、復(fù)雜多變等特點(diǎn)。如護(hù)理不當(dāng)，會(huì)造成患者的損傷或者機(jī)能損害。目前，常規(guī)護(hù)理方法已經(jīng)很難滿足手術(shù)室患者的需求。近些年來(lái)，細(xì)節(jié)護(hù)理被應(yīng)用于護(hù)理過(guò)程中。有文獻(xiàn)研究表明，細(xì)節(jié)護(hù)理可以降低護(hù)理風(fēng)險(xiǎn)，提高護(hù)理質(zhì)量，但總體來(lái)講，此類研究的成果和詢證還是比較少的[1-3]。為了更好地積累循證護(hù)理證據(jù)，進(jìn)一步提高我院手術(shù)室的護(hù)理質(zhì)量，本研究分析了細(xì)節(jié)護(hù)理在提高手術(shù)室護(hù)理安全中的作用，現(xiàn)報(bào)道如下。

1資料與方法

1.1一般資料

選取2016年1～12月在我院進(jìn)行手術(shù)治療的64例女性患者作為研究對(duì)象，隨機(jī)分為兩組，每組32例。觀察組患者年齡19～65歲，平均年齡（42.8±4.2）歲；剖宮產(chǎn)16例，婦科手術(shù)8例，腹部腔鏡手術(shù)8例。對(duì)照組患者年齡20～67歲，平均年齡（41.1±3.9）歲；剖宮產(chǎn)16例，婦科手術(shù)7例，腹部腔鏡手術(shù)9例。兩組一般資料比較，差異無(wú)統(tǒng)計(jì)學(xué)意義（P>0.05），具有可比性。本研究經(jīng)我院醫(yī)學(xué)倫理委員會(huì)審核及同意，患者均知曉本研究情況并簽署知情同意書(shū)。

1.2護(hù)理方法

對(duì)照組患者行常規(guī)護(hù)理。常規(guī)無(wú)菌處理后，鋪巾，建立靜脈通道，擺好手術(shù)體位等。觀察組患者行手術(shù)室細(xì)節(jié)護(hù)理。①術(shù)前。依據(jù)患者的病情以及身體狀況，制定針對(duì)性的護(hù)理方案。護(hù)理人員以溫和的語(yǔ)氣、禮貌的態(tài)度向患者講解手術(shù)的必要性和手術(shù)過(guò)程，向患者家屬講解術(shù)中術(shù)后可能出現(xiàn)的風(fēng)險(xiǎn)以及手術(shù)獲益，讓患者及其家屬了解手術(shù)的優(yōu)勢(shì)。及時(shí)疏導(dǎo)患者的不良情緒，與患者及其家屬保持密切的溝通，降低患者的負(fù)面情緒。并提前告知患者術(shù)前1 d在飲食、生活上的注意事項(xiàng)，以免影響第2天手術(shù)的進(jìn)行。并術(shù)前核查檢查手術(shù)器械是否缺失，是否經(jīng)過(guò)消毒滅菌，手術(shù)相關(guān)儀器和設(shè)備是否運(yùn)轉(zhuǎn)正常。②術(shù)中。患者進(jìn)入手術(shù)室后，其緊張情緒增加，護(hù)理人員幫助患者熟悉手術(shù)室的設(shè)備、環(huán)境及參加手術(shù)的人員，使其心理處在平穩(wěn)的狀態(tài)。麻醉后，護(hù)理人員注意保護(hù)患者的隱私，幫助患者調(diào)整至合適體位，緩解其焦慮情緒。并在手術(shù)過(guò)程中，與主治醫(yī)生密切配合，清理血跡與膿物，保證手術(shù)現(xiàn)場(chǎng)的干凈與整潔。③術(shù)后。手術(shù)完畢后，護(hù)理人員及時(shí)查對(duì)清點(diǎn)儀器，避免手術(shù)器械物品遺落在患者體內(nèi)，做好整個(gè)手術(shù)過(guò)程的記錄工作[4-5]。在患者麻醉清醒后，及時(shí)對(duì)其進(jìn)行心理護(hù)理，告知患者與家屬術(shù)后以及飲食等方面的注意事項(xiàng)。注意對(duì)患者術(shù)后的疼痛護(hù)理等。

1.3觀察指標(biāo)與評(píng)價(jià)標(biāo)準(zhǔn)

護(hù)理質(zhì)量評(píng)估指標(biāo)包括儀器設(shè)備管理、器械準(zhǔn)備、護(hù)士配合、消毒隔離和護(hù)理質(zhì)量安全，滿分100分，得分越高，護(hù)理質(zhì)量越高。護(hù)理滿意度采用自己設(shè)計(jì)的護(hù)理滿意度調(diào)查表，分滿意和不滿意兩項(xiàng)。并對(duì)護(hù)理人員的形象和術(shù)中護(hù)理進(jìn)行評(píng)分。記錄手術(shù)時(shí)間。

1.4統(tǒng)計(jì)學(xué)方法

采用SPSS 17.0統(tǒng)計(jì)學(xué)軟件進(jìn)行數(shù)據(jù)分析，計(jì)量資料用均數(shù)±標(biāo)準(zhǔn)差（x±s）表示，兩組間比較采用t檢驗(yàn)；計(jì)數(shù)資料采用率表示，組間比較采用χ2檢驗(yàn)，以P<0.05為差異有統(tǒng)計(jì)學(xué)意義。

2結(jié)果

2.1兩組患者手術(shù)室護(hù)理質(zhì)量的比較

觀察組患者的各項(xiàng)護(hù)理質(zhì)量評(píng)分均高于對(duì)照組，差異有統(tǒng)計(jì)學(xué)意義（P<0.05）。

2.2兩組患者手術(shù)時(shí)間及護(hù)理滿意度的比較

兩組患者的手術(shù)時(shí)間比較，差異無(wú)統(tǒng)計(jì)學(xué)意義（P>0.05）。觀察組患者在護(hù)理人員形象與職業(yè)素養(yǎng)、術(shù)后護(hù)理綜合評(píng)分、護(hù)理滿意度方面均高于對(duì)照組，差異有統(tǒng)計(jì)學(xué)意義（P<0.05）（表2）。

2.3兩組患者SAS評(píng)分的比較

術(shù)前，兩組患者的SAS評(píng)分比較，差異無(wú)統(tǒng)計(jì)學(xué)意義（P>0.05）；兩組患者術(shù)后1 d的SAS評(píng)分與術(shù)前比較，差異有統(tǒng)計(jì)學(xué)意義（P<0.05）；術(shù)后1 d，觀察組患者的SAS評(píng)分顯著低于對(duì)照組，差異有統(tǒng)計(jì)學(xué)意義（P<0.05）（表3）。

3討論

手術(shù)室護(hù)理工作具有緊張、繁忙、高強(qiáng)度、高壓力、風(fēng)險(xiǎn)程度高、工作壓力大等特點(diǎn)。如果護(hù)理不當(dāng)，出現(xiàn)一點(diǎn)差錯(cuò)，都將會(huì)危害患者的生命，造成致殘致endprint