应用奥马哈系统对社区128例慢性疾病患者健康问题及干预方式的分析

摘要

目的 探讨不同慢性疾病患者健康问题及采取干预方式的不同,为访视护理提供循证依据.方法 采用内容分析法,回顾性分析社区慢性病患者访视护理记录,按照奥马哈系统(Omaha System)条目对访视护理个案的健康问题及干预方式按心脑血管疾病和非心脑血管疾病进行归类.结果 两类访视患者在各个领域里存在的健康问题差异无统计学意义,生理领域和健康相关行为领域存在健康问题多见.每个心脑血管疾病患者平均存在6.37个健康问题,每个非心脑血管疾病患者平均存在5.30个健康问题.神经-肌肉-骨骼功能和自身照顾问题是慢性病患者常见的共性问题.10个常见问题中,心脑血管疾病患者更多存在语言和药物治疗方案问题,非心脑血管疾病患者更多存在皮肤问题及心理健康问题.访视过程中,最常用的干预方式是健康教育、指导和咨询,其次是监测.4种干预方式比较,治疗和程序、监测两种干预方式在两类患者中的应用差异有统计学意义(P＜0.05).护理心脑血管疾病患者时更多采用监测的干预方式,护理非心脑疾病患者时更多采用治疗和程序的干预方式.其他两种干预方式差异无统计学意义.结论 慢性病患者生理领域和健康行为相关领域是社区访视护理需重点关注的方面.健康教育和指导咨询,监测是最常采用的干预方式,需要加强护士针对不同人群进行健康教育及全面评估监测能力的培养.%Objective To explore health problems and different interventions for patients with differing chronic dieseses and to offer evidences to home visiting.Methods Retrospective content analysis was applied to analyze records of home nursing for patients with chronic diseases and their health problems and interventions applied were classified with Omaha System into cardiovascular cerebrovascular disease group and non-cardiovascular cerebrovascular disease group.Results There was no statistical difference among four kinds of health problems.There were 6.37 health problems averagely for every patient with cardiovascular and cerebrovascular disease and 5.30 for every without cardiovascular and cerebrovascular disease.The frequently reported problems were neuro-musculo-skeletal problem in patients with chronic diseases.Among the top ten problems documented by visiting nurse, patients with cardiovascular and cerebrovascular disease had more problems related with language and medication treatment while patients without cardiovascular and cerebrovascular disease had more with skin and mental health.The most frequent interventions were health education, guidance and counseling, and monitoring.Among four interventions, there are statistical differences between the application of treatment and procedure and monitoring in two groups (P＜O.05).Monitoring was the most frequent intervention adopted by visiting nurse for patients with cardiovascular and cerebrovascular disease, while treatment and procedure was for patients without cardiovascular and cerebrovascular disease.Conclusion More attention should be paid to physiological and health-related behavior problems for patients with chronic diseases during home visiting.The most frequent interventions are health education, guidance and counseling and monitoring.Nurses' competence of heath education, comprehensive evaluation and monitoring over different population should be strengthened.