目的 探讨以护理敏感性结局指标构建的防跌倒过程质量监控模式在老年住院患者防跌倒管理中的应用效果.方法 选择某院老年医学研究所的302例患者为研究对象,采用随机数字表法将患者分为对照组和研究组各151例.对照组采取常规的三级监控进行防跌倒管理;研究组在常规三级监控的基础上,采用基于护理敏感性结局指标构建的防跌倒过程质量管理模式对防跌倒护理质量进行监控.比较两组患者跌倒效能和跌倒发生率的差异及照顾者预防跌倒的知识、信念、行为的差异.结果 研究组患者跌倒效能的得分高于对照组,差异具有统计学意义(P ＜0.05);研究组照顾者在知识、信念和行为方面改变值的均值都大于对照组照顾者,差异均具有统计学意义(P＜0.05);研究组和对照组患者跌倒发生率差异无统计学意义(P＞0.05).结论 在老年病房护理管理中采用基于护理敏感性结局指标构建的防跌倒过程质量监控模式对老年患者进行防跌倒管理能够提升老年患者防跌倒信心,改善照顾者预防跌倒的知识、信念和行为.

目的 了解住院老年患者参与跌倒预防知识、态度和行为现状及其相关因素,为制定有针对性的跌倒预防方案提供依据.方法 采用便利抽样法,选取2019年10月—12月在广东省9家三级甲等综合医院住院的205例老年患者作为研究对象,采用一般资料调查表和住院老年患者参与跌倒预防知信行量表进行横断面的调查.应用多元线性回归分析探讨影响住院老年患者参与跌倒预防知识、态度、行为的主要因素.结果 住院老年患者参与跌倒预防知信行量表总分及其知识维度、态度维度、行为维度得分分别为(103.24±16.91)分及(32.90±7.04)分、(28.22±5.62)分、(42.11±6.94)分.多元线性回归分析结果显示,文化程度、排尿是否正常、是否使用助行器是影响老年住院患者参与跌倒预防知识的主要影响因素(P<0.05);是否使用助行器是影响老年住院患者参与跌倒预防态度的主要影响因素(P<0.05);性别、是否使用助行器是影响老年住院患者参与预防跌倒行为的主要影响因素(P<0.05).结论 住院老年患者参与跌倒预防知信行总体处于中等偏上水平,其参与跌倒预防知识有待提高;使用助行器情况同时影响老年住院患者参与跌倒预防知识、态度、行为.医护人员需善于发现患者对安全知识了解的意愿,针对不同文化程度和不同性别的患者,特别需关注使用助行器的患者,积极进行安全相关知识宣教,增强患者安全意识与参与行为,使患者主动参与到跌倒预防的工作中来.

目的 探讨饮食日记对出院后卧床老年患者营养状况的影响.方法 将120例老年卧床患者按出院时间顺序编号,奇数号为观察组,偶数号为对照组,每组各60例.出院前两天均对患者进行营养评估,对照组按常规对患者本人及其照顾者给予出院饮食宣教指导,观察组除常规宣教外,外展小组对其照顾者进行专业的饮食指导,教会其在设计好的表格上做记录,如实记录每天的进食情况,并每日向外展小组反馈当天的饮食情况,外展小组根据患者病情结合饮食日记进行分析讨论,对饮食问题进行及时有效的反馈沟通.经过持续干预6月,分别于出院时、3个月、6个月进行营养状况评估.结果 出院3个月时观察组营养不良的发生率(41.67％)低于对照组(63.33％),差异有统计学意义(P<0.05);出院6个月时观察组营养不良的发生率(39.65％)低于对照组(63.63％),差异有统计学意义(P<0.05).观察组患者营养状况有显著改善,而对照组患者营养状况变化不明显.结论 饮食日记能帮助老年卧床患者改善营养状况.

Objective:To establish a continuous monitoring system based on nursing sensitivity outcome indexes so as to improve the quality of fall prevention in elderly inpatients.Methods:By adopting the convenient sampling method, the elderly inpatients and their caregivers in 14 wards of the Institute of Geriatrics of Guangdong People's Hospital from April 2016 to January 2017 were selected as the research objects, and the nurses in 14 wards were also included in the research. A total of 14 wards were randomly divided into the control group with 7 wards and the experimental group with 7 wards. In the experimental group, there were 151 patients, 137 caregivers and 68 nurses. In the control group, there were 151 patients, 131 caregivers and 57 nurses. In the control group, the quality of fall prevention was monitored by the conventional three-level monitoring method of quality control department of the nursing department, head nurse of department and head nurse of ward. On this basis, the experimental group applied Fall-related Evaluation Scale for Elderly Inpatients to continuously monitor the quality of fall prevention. Modified Fall Efficacy Scale (MFES) was used to compare the fall performance scores and the incidence of falls during hospitalization between the two groups. Caregivers' Fall Knowledge, Attitude and Practice Scale was used to compare the knowledge, belief, attitude and practice of caregivers in the two groups before and after intervention. The General Self-Efficacy Scale was used to compare the self-efficacy of nurses in the two groups. The Fall-Related Evaluation Scale for Elderly Inpatients was used to compare the quality evaluation results of fall prevention before and after intervention in the experimental group.Results:None of the patients in the experimental group fell during their hospitalization, and 2 patients in the control group fell. There was no statistically significant difference in the incidence of falls between the two groups ( P>0.05) . The fall efficacy score at discharge was (70.77±16.85) in the experimental group and (62.77±18.78) in the control group, and the difference was statistically significant ( t=3.179, P<0.01) . After intervention, the scores of fall knowledge, attitude and practice of caregivers in the experimental group were higher than those in the control group, and the self-efficacy score of nurses was higher than that in the control group, and the differences were statistically significant ( P<0.01) . The quality score of fall prevention in the experimental group after intervention was higher than that before intervention, and the difference was statistically significant ( P<0.05) . Conclusions:The establishment of continuous monitoring system based on the nursing sensitivity outcome index can improve the quality and efficacy of fall prevention in elderly patients and improve the knowledge, attitude and practice of the caregiver and the self-efficacy of the nurses.

目的 研究家庭跟进服务对减轻老年卧床患者照顾者负担的效果,为老年卧床患者照顾者的干预提供理论支持.方法 将120例老年卧床患者照顾者分为研究组和对照组各60例,研究组在出院时给予1年的家庭跟进服务,对照顾者进行包括痰病用药指导、社会支持、照顾技能训练、康复技能训练、老年卧床患者并发症的预防、大小便护理技术训练等护理干预,并定期电话随访,对照组采用常规电话随访患者病情状态,分别于干预前和干预后3、6、9、12个月采用照顾者负担问卷评定两组照顾者的负担状况.结果 研究组和对照组干预后12个月和干预前照顾者负担的改变相比,差异有统计学意义(P＜0.05).干预后9个月和12个月研究组和对照组的照顾者负担比较,有统计学意义(P＜0.05).干预方法与时间存在交互作用(F=27.499,P＜0.001);研究组与对照组的差异有统计学意义(F=7.894,P=0.006),研究组照顾者负担量表得分呈现逐渐下降的趋势,对照组照顾者负担量表得分呈现逐渐上升的趋势;照顾者负担量表得分存在时间趋势(F=4.974,P=0.009),不同时间点的总体均数不全相同.结论 家庭跟进服务有助于减轻老年卧床患者照顾者的负担.

The prevention and treatment of chronic diseases has been gradually paid attention to by public health,and palliative care for patients with chronic diseases has become the main focus.The research on palliative care in China started late,so the palliative care for patients with chronic diseases is rarely mentioned.This article describes the development process and current situation of palliative care for chronic diseases of the elderly at home and abroad,points out the reωons why the development of palliative care for chronic diseases is slow in mainland China,and proposes some suggestions for the development of palliative care for chronic diseases in mainland China according to the obstacles and foreign countries.

目的 探讨专科护士主导的跌倒后随访对预防老年患者再次跌倒的效果.方法 对住院期间跌倒的31例患者进行跌倒后回访,患者出院后1周内、1个月、3个月、6个月分别上门随访1次,平时根据情况每1～2周电话随访1次,有特殊情况时随时上门随访,对防跌倒进行指导,了解患者防跌倒措施的落实情况、调查再次跌倒的情况并指导康复训练.结果 31例老年患者住院期间跌倒后,仅有2例在出院1周内发生跌倒;对防跌倒措施落实依从性较好.结论 由经过专科培训的老年专科护士主导的跌倒后随访,能有效提高老年患者对防跌倒措施的落实率,减少再次跌倒的发生.

目的:评价延续性营养护理服务对改善老年卧床患者营养状况的效果.方法:选取2016年1-12月在我院出院的老年卧床患者为研究对象,按出院时间顺序奇数号为实验组(n=58),偶数号为对照组(n=55);对照组患者及其照顾者接受常规出院指导和电话随访等护理服务,实验组在对照组的基础上接受延续性营养护理服务;持续干预6个月,在出院时,出院后3个月、6个月时采用微型营养评估量表(Mini-nutritional Assessment,MNA)对两组患者进行营养状况评估.结果:出院时,两组患者营养状况的差异无统计学意义;在出院后3个月、6个月时,两组患者营养状况的差异均有统计学意义(P<0.05),实验组患者营养不良发生率均低于对照组.结论:延续性营养护理服务有助于改善老年卧床患者的营养状况.

Objective Study bedridden senile patients ' caregivers knowledge level of home based nursing and mastery level of care skills. Method The situation of knowledge level of home based nursing and mastery level of care skills were obtained from an investigation carried out among 60 bedridden senile patients' caregivers. After that,we gave the caregivers a 3 months' system training focus on the common problems of home based nursing and care skills found in the investigation,included disease knowledge,rehabilitation training,movement,diet care,safety care,defecate and urinate nursing and prevention and nursing of complications. We compared the caregivers ' knowledge level of home based nursing and mastery level of care skills with the situation before and after the training ,and surveyed the caregivers ' attitude regarding to the training. Result The caregivers ' knowledge level of home based nursing and mastery level of care skills after the training are significant higher than before the training,the difference is statistically significant(P<0.05). Conclusion Providing homebased rehabilitation training to bedridden senile patients ' caregivers can effectively prove their knowledge level and care skills ,and then prove home based nursing quality.

Objectives:To analyze clinical application value of the self-made Inpatients'Fall Assessment Scale(IFAS),and compare with the Morse Fall Scale.Methods:The two scales were implemented in a third hospital in Guangzhou to assess fall risks of 2 826 patients.Reliability,validity and discrimination of the IFAS were conducted,so as to compare the effect of fall risk prediction between IFAS and MFS.Results:The Cronbach's α coefficients of the self-made Inpatients'Fall Assessment Scale for the whole population and that for the population over the age of 65 and above were 0.825 and 0.759,respectively.The Cronbach's α coefficients of the Morse Fall Scale for two populations were 0.693 and 0.638,respectively.Experts' scale content validity index(S-CVI) of IFAS was 0.915.Spearman correlation analysis showed that scores of all items were statistically significantly related the whole scale score(IFAS) (P<0.001).Score of IFAS was also statistically significantly related to MFS score(r=0.806,P=0.000).Differences between the high-score and low-score group under different boundary value standards were statistically significant in IFAS and MFS(P=0.000).Areas under the ROC curve of the IFAS and MFS in whole population were 0.717 and 0.632 respectively,and there was statistically significant different when compared with the reference(0.5),and the difference between each other was also statistically significant different(P<0.05).Conclusions:Reliability,validity,and discrimination were good in The self-made IFAS,and it could predict fall risks of inpatients better compared with MFS.

Objective To construct quality evaluation indexes system for the prevention of falls in elderly hospitalized patients based on nursing-sensitive outcomes. Methods With Delphi method,after 2 rounds of 23 experts consultation,the evaluation index system for the prevention of falls in elderly patients was developed. Results The quality evaluation index system for the prevention of falls in elderly hospitalized patients included 7 primary indicators and 29 secondary indicators. Two rounds of expert positive coefficients were 100% and 100% respectively and expert coordination coefficient of 2 rounds was statistically significant(P<0.01). The coefficient of the 2nd round of expert consultation was 0.91; familiar coefficient 0.94 and authority coefficient 0.93. Conclusion After consultation, modification and deletion of entries by experts, the established quality evaluation indexes system for the prevention of falls in elderly hospitalized patients is reliable and it provides method and reference for the evaluation of preventing falls in elderly hospitalized patients.

误吸(aspiration)指进食或非进食时在吞咽过程中有液体、固体食物或分泌物、血液等误人气管[1].误吸是老年吞咽障碍患者的常见并发症,也是该类人群肺部感染的主要原因之一[2-3].据文献[4]报道,因误吸所致吸入性肺炎死亡率可达40％～50％,严重时可引起突然窒息,甚至死亡.近年来,学者们对如何预防老年误吸进行了研究和探索,本文对引起老年卧床患者误吸的危险因素、误吸的诊断与评估、误吸的预防措施等进行综述,以期为临床护理工作者有效采取正确的护理预防措施,减少或避免老年卧床患者误吸的发生提供借鉴.

目的 探讨中药离子导入联合中医辨证护理治疗膝关节骨性关节炎(KOA)的临床疗效.方法 选取符合诊断标准的120例患者作为研究对象,随机分为治疗组和对照组各60例,两组均给予理疗、针灸等常规治疗及护理,治疗组在常规治疗及护理的基础上,给予中药离子导入及中医辨证护理,比较两组患者治疗后膝关节疼痛、僵硬程度、关节功能、hs-CRP等指标的差异.结果两组患者治疗后膝关节疼痛、僵硬、关节功能、hs-CRP等各项指标均有所改善,但治疗组疗效明显优于对照组,差异比较有统计学意义(P<0.05).结论 采用中药离子导入联合中医辨证护理治疗膝关节骨性关节炎疗效确切,可有效减轻患者膝关节疼痛及关节僵硬程度,改善关节功能,值得临床推广.

Objective To construct a fall risk assessment scale for hospitalized elderly patients and to improve the accuracy of fall risk assessment.Methods Based on the literature review, case control analysis and group discussion, the primary index of fall risk assessment scale for elderly patients was established.The index selection and weight assignment based on Delphi expert consultation method were adopted.Results Table of the recovery rate was 100%.Expert authority coefficient Cr were 0.905 and 0.900 separately.The second round of expert consultation coordination coefficient (Kendall'W) was 0.207.x2 is 102.043(P<0.001).After two rounds of expert consultation, a total of 13 primary indicators and 40 secondary level indicators were screened out.Conclusion The fall risk assessment scale of hospitalized elderly patients was constructed with high reliability, which can be used to assess the fall risk of hospitalized elderly patients and to further verify its clinical applicability.

Objective Discuss medical health integration continuance management mode in the prevention of elderly patients after discharge in bed household application effect of pressure ulcers. Methods To 120 cases of elderly patients in bed in hospital time order is divided into control group and experimental group,by the medical health outreach group respectively in the hospital two days before the assessment of patients and family rehabilitation plan,the control group given conventional discharge and telephone follow-up after discharge,the experimental group according to the medical health integration management mode,made up of medical health outreach team to stay in bed for elderly patients after discharge pressure ulcer risk factors assessment,targeted prevention of pressure sores rehabilitation plan,group management,remote care joint family supervision,timely follow up the capa and the exami-nation of the effect,the pressure ulcer management and quality of life scale to compare two groups of patients at discharge,6 months after hospital discharge,the quality of life of 12 months after discharge and the incidence of pressure ulcers in a year. Results The experimental group was lower than those of control group,the incidence of pressure ulcers was statistically significant difference(P<0.05); 6 months and 12 months after discharge physiological field,psychological field in the quality of life score were higher than control group,the difference was statistically significant(P<0.05); Score compared two groups of environmental and social sciences has no statistical significance (P>0.05). Conclusion Medical health integration continuance management can effectively reduce the incidence of pressure ulcers that occupy the home stay in bed for elderly patients,improve their quality of life.

Objective:To probe into the application effect of situation background-assessment recommenda-tion (SBAR)standardized bedside shift for elderly bed patients.Methods:The standardized bedside shift table was established for elderly bed patients based on SBAR,the sequence and content of nursing shift was stand-ardized,the shift quality and the satisfaction of health care workers in the department to shift work were evalu-ated at a week before SBAR standardized bedside shift and half a year after that,and the bedside shift time was analyzed before and after the implementation of standardized bedside shift.Results:After half a year,nurses' shift quality and the satisfaction of health care workers in department were higher than that before implementa-tion of standardized bedside shift,and the shift time was shorter than that before implementation,the differ-ence was statistically significant(P<0.01).Conclusion:SBAR standardized bedside shift for elderly bed patients was helpful to improve the nurses’shift quality and the satisfaction of health care workers in department and shorten the shift time.

[目的]了解老年住院跌倒高危病人照顾者对跌倒的认知情况。[方法]采用自行设计的老年住院跌倒高危病人认知调查表对118例照顾者进行问卷调查。[结果]对防跌倒的理论知识不足28.8%,照顾者选择合适活动方式的正确度86.4%,照顾者使用防跌倒器具的正确度60.2%,照顾者提醒病人预防的主动性46.6%,66.1%的照顾者认为跌倒不可预防且预防跌倒的主动性较差。[结论]老年住院跌倒高危病人照顾者对防跌倒措施执行较好,理论知识不足,主动性欠缺,防跌倒意识仍有待提高,护理人员需加强对老年住院跌倒高危病人的照顾者进行预防跌倒系统、规范的培训,让其掌握相关知识和技能,纠正预防跌倒的信念,才能转变为防跌倒的临床照顾行为。

Objection To analyze the influence factors of falling and to provide reference for the prevention of falling of elderly inpatients. Methods A total of 120 patients aged 65 or above and once falling down were included as observation group and another 120 patients were collected and paired as control group. Influence factors of falling were compared between two groups. Results History of falling, limb weakness/pain, visual changes and stand up test abnormality were related risk factors of falling of elderly hospitalized patients(P<0.05). Conclusion More attention should be paid to mental and physical condition of elderly inpatients with history of falling, visual changes, limb weakness /pain or stand up test abnormality. Falling risk assessment and prevention should be well performed.

目的 评价家庭随访对老年卧床患者康复依从性和生活质量的效果.方法 将120名老年卧床患者分为试验组与对照组各60例.对照组出院时给予常规出院指导,对患者及其家属进行家庭康复训练指导,并进行定期电话随访.试验组在出院时,由医生、治疗师、护士、营养师、患者和家属共同制订家庭康复计划,并进行家庭随访指导.出院6个月两组进行康复依从性和生存质量的评价.结果 出院6个月后,试验组的康复依从性及生存质量的评分均高于对照组,差异有统计学意义(P＜0.05).结论 家庭随访能提高老年卧床患者的康复依从性,增强患者的日常生活能力,减少卧床时间,提高其生活质量.