PDCA循環護理管理對老年晚期肺癌化療患者繼發感染和自我效能感的影響

韓記真+阿米娜·曲海+阿依古麗·買買提

[摘要] 目的 觀察PDCA循環護理管理對老年晚期肺癌化療患者自我效能感、繼發感染及護理質量的影響。 方法 收集2012年1月～2014年12月于新疆醫科大學附屬腫瘤醫院特需一科（以下簡稱“我科”）接受化療治療的52例老年晚期肺癌患者作為對照組，2015年1月～2016年12月于我科接受化療治療的64例晚期肺癌患者作為觀察組。對照組患者給予常規護理干預，觀察組患者給予PDCA循環護理管理。分別采用一般自我效能感量表（GSES）和自制問卷調查評價自我效能感和護理質量。回顧性分析患者臨床資料，比較兩組患者自我效能感、繼發感染及護理質量。 結果 干預后，兩組患者GSES評分均升高，且觀察組干預后評分高于同期對照組（P < 0.05）。觀察組繼發感染率低于對照組，護理質量評分高于對照組，差異有統計學意義（P < 0.05或P < 0.01）。 結論 PDCA循環護理管理在老年晚期肺癌化療中應用效果良好，能夠提高患者的自我效能感，降低繼發感染發生率，提高護理質量，臨床上值得應用。

[關鍵詞] PDCA循環；護理管理；老年；晚期肺癌；化療；自我效能感；繼發感染；護理質量

[中圖分類號] R473 [文獻標識碼] A [文章編號] 1673-7210（2017）12（a）-0160-04

[Abstract] Objective To observe the effects of PDCA cycle nursing management on self-efficiency， secondary infection and nursing quality in elderly patients with advanced lung cancer treated with chemotherapy. Methods 52 elderly patients with advanced lung cancer who received chemotherapy in the First Department of VIP Service， Cancer Hospital Affiliated to Xinjiang Medical University （“our department” for short） from January 2012 to December 2014 were collected as the control group， and 64 elderly patients with advanced lung cancer who received chemotherapy in our department from January 2015 to December 2016 were collected as the observation group. The control group was given to conventional nursing intervention， while the observation group was given to PDCA cycle nursing management. General Self-efficiency Scale （GSES） and self-made questionnaire were employed to assess self-efficiency and nursing quality respectively. Retrospectively analyzing their clinical materials， self-efficiency， secondary infection and nursing quality were compared between the two groups then. Results After intervention， in comparison with the control group， the GSES score of the observation group was significantly increased and the incidence of secondary infection was significantly decreased （P < 0.05 or P < 0.01）. Self-made questionnaire showed that the scores of service attitude， professional skill and health education in the observation group was significantly increased compared with the control group （P < 0.05）. Conclusion PDCA cycle nursing management has good application effect in elderly patients with advanced lung cancer treated with chemotherapy. And it can increase self-efficiency， reduce incidence of secondary infection and promote nursing quality.

[Key words] PDCA cycle； Nursing management； Elderly； Advanced lung cancer； Chemotherapy； Self-efficiency； Secondary infection； Nursing quality

肺癌是常見的呼吸系統惡性腫瘤，老年人群占據多數，由于健康意識的薄弱，多數患者確診時已發展至晚期肺癌，錯過手術機會，從而選擇化療治療[1]。對于接受化療治療的老年晚期肺癌患者，自我效能感——即對自己實現特定領域行為目標所需要能力的信心或者信念普遍降低，會對認知行為產生負面調控，不利于疾病治療[2]。而且，在疾病本身、化療藥物毒副作用、患者免疫力低下等因素作用下，晚期肺癌患者常會發生繼發感染，影響肺癌預后[3]。因此，提高患者自我效能感，降低繼發感染發生對老年晚期肺癌化療患者具有重要意義。……