第 4 章 结论
(1)自行设计的“脑卒中患者延续性护理服务需求问卷”调查结果显示:脑卒中患者延续性护理服务需求处于较高水平,患者需求较强烈。
(2)通过实施延续性护理服务措施,试验组患者较对照组患者血生化指标明显改善,血压不同程度的降低,自理活动能力提升,减少了脑卒中再发或并发症的发生。
(3)通过实施延续性护理服务措施,试验组患者满意度提高,和谐了医患关系。
(4)通过实施延续性护理服务措施,试验组患者较对照组再次住院人数减少,减轻家属及社会的经济负担,充分利用有限医疗资源,为制定切实可行的医养结合政策提供一定依据。
参考文献
[1] 涂双燕,杨蓉,陈德智,等。缺血性脑卒中患者出院后有效社区管理的文献分析[J].护理研究,2013,12,(27):3962-3963.
[2] 于彬彬,柳骅。老年人居家照护现状影响因素的研究进展。中华护理杂志2013.8(48):764-766.
[3] 李建霞,画妍,化前珍,等。锁军丽,商倩倩。西安市社区老年人慢性病现状及影响因素的调查研究[J].护理研究,2012,3,(26):804-805.
[4] 化前珍。老年护理学[M].北京:人民卫生出版社,2006.40-42.
[5] 庞静。内科老年患者的心理特点分析和护理[J].继续医学教育,2013,9(27):39-40.
[6] 刘飞,王欣欣。慢性疾病影响老年人 QOL 的研究进展[J].中国老年学杂志,2011,10(21):4275-4277.
[7] 贾建平,崔丽英,王伟。神经病学[M].北京:人民卫生出版社,2008.171-175.
[8] 程朝晖, 刘慧慧 .简述我国慢性病流行现状和应对策略 [J]. 中外健康文摘,2014,2(6):56.
[9] 陈永良。缺血性脑卒中患者社区康复服务问卷调查研究[J].现代养生,2014,13(2):281.
[10] 欧海宁,康健。缺血性脑卒中患者肢体运动功能的综合康复治疗[J].中国康复医学杂志,1999,14(3):106-110.
[11] 马月利,张新根,张黎明。综合医院老年专科患者住院费用分析[J].中国民康医学,2010,19(22):2514-2517.
[12] 薛明,饶克勤。全国卫生部门综合医院门诊患者和住院患者医疗费用增长情况分析[J].中国卫生经济,2002;21(8):13-15.
[13] 吴继饶,刘开泰,李萱,等。29 名维吾尔族百岁老人生存质量测定[J].中华老年医学杂志,1998,17(1):32-34.
[14] 李新萍,汪莉,张千,等。脑卒中社区家庭康复协作网护理有效性研究[J].护士进修杂志,2011,5(26):773-776.
[15] 国务院 . 务十二五“期间深化医药卫生体制改革规划暨实施方案[EB/OL].(2012-03-23)[2012-08-05].
[16] 国务院 . 务十二五”期间深化医药卫生体制改革规划暨实施方案 .[2012-08-05].
[17] 戴明辉,幺莉,万巧琴,等。出院患者延续性护理服务需求调查分析[J].中国护理管理,2013,13(10):31-33.
[18] Quinn CC,Port CL,Zimmerman S,et al.Shortstay nursing home rehabilitationpatients:Transitional care problems pose research challenges[J].J Am GeriatrSoc,2008,56(10):1940-1945.
[19] Boockvar K,Vladeck B C.Improving the Quality of Transitional Care forPersons with Complex Care Needs[J].J Am Geriatr Soc,2004,52(5):855-856.
[20] John W,Saults MD,Waleed A,et a1.Interpersonal continuity of care and patientsatisfaction:a critical review[J].An Fam Med,2004,2:445-451.
[21] Dash K,Zarle NC,O,Donnell L,et al.Discharge Planning for the Elderly-A GuideFor Nurses.New York,Springer Publishing Company.1996.
[22] Forest H. Byrne I, Falls CE,et al,Hospital referral of patients for continuity ofnursing care[J].Am J Nurs,1947,47(11):761-764.
[23] Bristow O,Stickey C,Thompson S.Discharge Planning for continuity of care[M].New York:Nation League for Nursing,1976:14
[24] Naylor M, Brooten D,Jones R,et al.Comprehensive discharge pianning for thehospitalized eldery: A randomized clinical trial [J]. Ann Intern Med, 1994,120(12):999-1006.
[25] Naylor MD, Mccauley KM. The effects of a discharge planning and homefollow-up intervention on elders hospitalized with common medical andsurgical cardiac conditions[J].J Cardiovasc Nurs, 1999,14(1):44-54.
[26] Naylor MD,Brooten DA.Campbell RL.et al.Transitional care of older adultshospitalized with heart failure:a randomized.controlled trial[J].J Am GeriatrSoc,2004,52(5):675-676.
[27] Oermann MH,Flord JA. Outcomes research:an essential component of theadvanced practice nurse role[J]. Clincal Nurse Specialist,2002,16(3):41-42.
[28] Naylor M,Brooten D,Campbell R,et al.Transitional care of older adultshospitalized with heart failure:a randomized controlled trial[J]. J Am GeriatrSoc,2004,52(5):675-684.
[29] Wong Fk,Mok MP,Chan T,et al.Nurse follow-up of patients with diabetes:randomized controlled trial[J].J Adv Nurs2005,50(4):391-402.
[30] Coleman EA,Smith JD,Frank JC,et al.Preparing patients and cargivers toparticipate in care delivered across settings:the care transitions intervention[J].JAm Geriatr Soc,2004,52:1817-1825.
[31] Kyoung Hee Cho,Sang Gyu Lee,Byungyool Jun,et al. Effects of continuity ofcare on hospital admission in patients with type 2 diabetes: analysis ofnationwide insurance data[J].Health Serv Res,2015,15(107):1-10.
[32] 祁峰,薛忠义。日本居家护理服务的发展与启示[J].东北亚论坛 2010,19(4):81-89.
[33] 范卉,龚秀琴。老年患者居家护理服务的发展现状与思考[J].护理管理杂志2014,14(1):38-40.
[34] 张玲,郭红。老年人的居家护理[J].中国全科医学,2009,9(15):1290-1292.
[35] Dan K Kaye, Annettee Nakimuli, Othman Kakaire,et al. Gaps in continuity ofcare: patientsntskaire,et al. Gaps in continuity of care: patir ward handover inMulago hospital, Uganda[J]. Health Serv Res,2015.15(190):1-6.
[36] 戴卫东。台湾地区人口老龄化下长期护理政策及走向[J].人口学刊,2011,(4):65-67.
[37] 王少玲,黄金月,周家仪,建立慢性阻塞性肺疾病延续护理的循证实践[J].中华护理杂志,2009,44(5):431-434.
[38] 王少玲,黄金月,周家仪,建立慢性阻塞性肺疾病延续护理[J].中华护理杂志,2011,46(8):758-760.
[39] Wong FK, Mok MP,Chan T,et al.Nurse follow-up of patients withdiabetes:randomized controlled trial [J].J Adv Nurs,2005,50(4):391-402.
[40] Zhao Y,Wong FK.Effects of a postdischarge trasitional care programme forpatients with coronary heart disease in China: arandomised controlled trial [J].JClin Nurs,2009,18(17):2444-2455.
[41] Wong FK,Chow SK,Chan TM,Evaluation of a nurse-led disease managementprogramme for chronic kidney disease:a randomized controlled trial [J].Int JNurs Stud, 2010,47(3):268-278.
[42] 毛惠娜,邢誉,王晓阳。初产妇出院后延续护理[J].护理学杂志(外科版),2007,22(14):73-74.
[43] 付伟,李萍,钟银燕。延续护理研究综述[J].中国实用护理杂志 2010.4(26):27-30.
[44] 陈璐 , 陈湘玉 , 沈小芳 , 等 . 居家护理服务模式的构建 [J]. 中国护理管理,2014,14(2):195-197.
[45] Van Walraven C, Oake N, Jennings A, et al. The association between continuityof care and outcomes:a systematic and critical review [J]. J Eval ClinPract,2010(16):947-956.
[46] 郭燕红。2009 年护理管理工作回顾与 2010 年展望[J].中国护理管理杂志,2010,10(1):5-7.
[47] 卫生部。中国护理事业发展规划纲要(2011-2015)[J].中国护理管理,2012,12(2):5-8.
[48] 王亚亚,戴明辉,万巧琴,等。携带管路出院患者延续护理服务需求调查分析[J].中国护理管理,2013,13(10):31-33.
[49] 万巧琴,幺莉,侯淑肖,等。基于医院延续护理开展现状与问题质性研究[J].中国护理管理,2013,13(10):38-41.
[50] 罗福强,曾孜。面向互联网医疗的虚拟医院[J].医学信息,2015,28(2):1.
[51] 刘永兵,窦新芝,王淑霞,等。养老机构老年人健康素养与自我护理能力的典型相关分析[J].中国老年学杂志,2013,34(5):1349-1352.
[52] 付凌敏。 南昌市脑卒中患者社区护理需求调查及其影响因素分析[D].南昌大学,2011.
[53] 姚文,刘小芹,冯学山。社区脑卒中患者的日常生活能力与长期照料需求研究[J].中国初级卫生保健,2009,23(5):22-23.
[54] 张琼仙,谢弓芬,周小敏,等。开平地区脑卒中瘫痪患者家庭护理需求调查与分析[J].国际医药卫生导报,2005,11(24):105-107.
[55] 陈怡。脑卒中患者社会支持状况调查[J].实用心脑肺血,管病杂志,2008,16(4):305-306.
[56] 张雅琴,张玉洁。老年脑中风患者社区护理需要的调查[J].中华国际护理杂志,2004,3(2):153-154.
[57] 郑敏,李晓松,朱彩蓉。预防脑卒中复发长期效果的决策分析模型[J].现代预防医学,2008,35(12):2209-2211.
[58] 王茂斌。老年脑卒中的康复[J].实用老年医学,2001,15(2):71-77.
[59] 史云菊,沈晓君。心理护理对通脉降脂治疗动脉粥样硬化临床疗效的影响[J].护士进修杂志,2010,20(1)l64-165.
[60] 刘延锦,郭园丽。社区脑卒中患者的健康行为与自我护理能力的相关性[J].中华护理杂志,2011,3,46,(3):279-281.
[61] Maasland L, koudstaal PL, Habbema JD, et al. Knowledge and understanding ofdisease process.risk factors and treatment modalities in patients with a recentTIA and minor ischemic storke [J]. Cerebrovasc Dis.2007,23:435-440.
[62] 张春英,曾国勇,戴文娟,等。专科健康教育延伸服务在脑卒中二级预防中的应用[J].护士进修杂志,2012,6,(27):1004-1005.
[63] 曾德建,尤黎明,罗志民。出院后脑卒中患者日常生活活动和社会参与影响因素分析[J].2013,1(27):113-116.
[64] Akyol AD, Cetinkaya Y, Bakan G, et al. Self-care agency and factors related tothis agency among patients with hypertension [J].JClinNurs, 2007,16(4):679-687 .
[65] 王颖,齐晓飞。 我国各地脑卒中流行病学调查近况[J]. 包头医学,2010,01:1-3.
[66] Boushey CJ,Beresford SA,Omenn GS,et al.A quartitative assessment of plasmahomocysteine as a risk factor for vascular disease:probable benefits ofincreasing folic acid intakes.JAMA,1995,274:1049-1057.
[67] Graham IM,Daly LE,Refsum HM,et al.Plasma homocysteine as a risk factor forvascular disease:the European Concerted Action Project,JAMA, 1997,277:1775-1781.
[68] Robinson K,Arheart K,Refsum H,et al.Low circulating folate and vitamin B6concenteations:risk factors for stroke,peripheral vascular disease,and coronaryartery disease.European COMAC Group.Circulation,1998,97:437-443.
[69] Bostom AG,Rosenberg IH,Silbershatz H,et al.Nonfasting plasma totalhomocysteine levels and stroke incidence in elderly persons:the FraminghamStudy.Ann Intern Med,1999,131:352-355.
[70] Das RR,Seshadri S,Beiser AS,et al.Prevalence and correlates of silent cerebralinfarcts in the Framingham offspring study.Stroke,2008,39:2929-2935.
[71] Giles WH,Croft JB,Greenlund KJ,et al.Total homocysteine concentration andthe likelihood of nonfatal stroke:results from the Third National HealthExamination Survey,1988-1994,Stroke,1998,29:2473-2477.
[72] Tannc D,Haim M,Goldbourt U,et al.Prospective study of serum homocysteineand risk of ischemic stroke among patients with preexisting coronary heardisease.Stroke,2003,34:632-636.
[73] Wald DS,Law M,Morris JK.Homocysteine and cardiovascular disease:evidenceon causality form a meta-analysis.BMJ,2002,325:1202.
[74] Beydoun M A,Shroff M R,Beydoun H A,Zonderman A B.Serum folate,vitaminB-12,and homocysteine and their association with depressive symptoms amongU.S.adult[J].Psychosom Med,2010,72(9):862-873.
[75] Dong Y Y,Chen G L.Progress of hyperhomocysteinemia hazard andpathogenesis [J].Chin Pharmacol Bull,2014,30(9):1205-1208.
[76] He FJ,Nowson CA,MacGregor GA.Fruit and vegetable consumption andstroke:meta-analysis of cohort studies.Lancet,2006,367:320-326.
[77] Ascherio A,Rimm EB,Heman MA,et al.Intake of potassium, magnesium,calcumand fiber and risk of stroke among US men.Circulation, 1998,98:1198-1204.
[78] Khaw KT,Barrett-Connor E.Dietary potassium and stroke-associated mortality:a12-year prospective population study.N Engl J Med,1987,316:235-240.
[79] 黄改莲,宋秋香。康复指导对社区脑卒中病人自理能力重建的实践研究[J].护理研究,2013,12,27(12):4169-4170.
[80] 张霞 , 尤寿江 , 陈孝东 , 等译 . 卒中一级预防指南 [J]. 国际脑血管病杂志,2010,12,18(12):881-943.
[81] Chobanian AV,Bakris GL,Black HR,et al.Nation Heart,Lung,and Blood InstituteJoint National Committee on Prevention,Detection,Evaluation,and Treatment ofHigh Blood Pressure;Nation High Blood Pressure Education ProgramCoordinating Committee.The Seventh Report of the Joint Nation Committee onPrevention,Detection,Evaluation,and Treatment of High Blood Pressure:the JNC7 reprot.JAMA,2003,289:2560-2572.
[82] Lewington S,Clarke R,Qizilbash N,et al.Age-specific relevance of usual bloodpressure to vascular mortality.a meta-analysis of individual data for one millionadults in 61 prospective studies.Lancet,2002,360:1903-1913.
[84] Kartunen V,Alfthan G,Hiltunen l,et al.Risk factors for cryptogenic ischaemicstroke.Fur J Neurol,2002,9:625-632.
[85] Appel LJ,Brands MW,Daniels SR,et al. Dietary approaches to prevent and treathypertension:a scientific statement from the American Heart Association.Hypertension,2006,47:296-308.
[86] 陈丽丽。 为脑卒中患者实施出院后延续性护理对其生活质量及护理满意度的影响[J]. 当代医药论丛,2015,08:75-76.
[87] 文林华,孙双玲。 电话回访式健康教育在脑卒中病人中的应用效果[J]. 全科护理,2010,32:3001.
致 谢
时光如白驹过隙,转瞬即逝。在三年的硕士学习中,要感谢的人有很多,要感谢的话有很多,浓缩成精炼的语言,概括起来六个字,感谢、感恩、感悟。
感谢--感谢恩师李波教授的谆谆教导,李波教授是学业上的领路人,她严谨求实的科研作风,一丝不苟的治学态度,正直豁达的处事风格,都是学生学习的榜样。
感谢吉林大学公卫学院所有曾经授课的老师,您们的严谨治学和精益求精,是学生追求的目标。
感谢在开展课题研究期间给予我帮助的师兄、师妹、辽宁省人民医院王海丽硕士和神经内科、康复科、心理科、营养科、中医科等多学科的医生、护士姐妹的鼎力相助。
感恩--感恩所有帮助过我的老师、同学,相识就是一种缘分,我们在吉大共同学习、成长,有幸和您们相伴、相知,我将终生难忘。
感悟--感悟自己的成长。我已是人过中年,在三年难忘的学习时光里,我基本未缺席过理论课的学习,钻研难懂的医学统计学,深更半夜去查阅文献,亲身经历了做科研的艰辛,一分耕耘、一分收获,当我收获一份饱含心血、沉甸甸的毕业论文时,一切付出都是值得的。感悟自身成长的同时,为人妻、为人母,我要感谢在我学习过程中给予我最大帮助的家人,特别是我的爱人和女儿,是他们为我撑起一方理解、支持的天地,在我最困难、丧失信心的时候,给予我最大的支持和鼓励。
最后,再一次对所有给予我指导、支持和帮助的,我亲爱的老师、同学和朋友们,致以最深的谢意!谢谢你们!