| Objective To establish the perioperative nursing program for the ultrasound interventional treatment of liver abscess patients with using the Oamha system,so as to standardize the clinical nursing work and clinical nursing language,and enable the clinical nursing data to be digital,to lay the nursing data for informatization and sharing.Methods This study based on the convenience sampling.1.Retrospective analysis We used the system analysis model of content analysis and cross-mapping method,and analyzed the medical records of patients with liver abscess treated by ultrasound intervention in a hospital from January 2011 to December 2013 in Jinzhou.Excel 2003 was used to establish the category system database.SPSS 17.0 was to establish code database and for data analysis.All kinds of category tables needed statistical indicators including the frequency and percentage.Kappa value was used for coding reliability test,K>0.6.2.Current situation investigation We used the Medical Outcomes Study Short Form Health Survey(the MOS item short form health survey,SF-36)to investigate the health related quality of life of patients with liver abscess treated by ultrasound intervention in a hospital from March 2014 to December 2015 in Jinzhou.SPSS 22.0 was used to establish database for data analysis.Split-half reliability(R)and homogeneity reliability(Cronbach's ?)were used for reliability test,R>0.70,Cronbach's ? > 0.70.?2test was used for the comparison between the individual variables in each classification.All scores were expressed by “`c±S”.T test was used to compare the mean differences between the two groups.Variance analysis was used to compare the mean differences among groups.SNK method was used to compare the mean differences between every two groups.P < 0.05 indicated that there was statistical difference.3.Scheme formulation We formulated the perioperative nursing program for patients with liver abscess treated by ultrasound interventional based on theory of unitary human beings,Maslow's hierarchy of needs,holistic nursing care and nursing process,Omaha system as the theoretical basis,and based on the results of retrospective analysis of medical records as the main clinical basis.The investigation of the health related quality of life in patients with liver abscess treated by ultrasound intervention and review of the literature were as the clinical reference.Omaha system was the framework for the perioperative nursing program.Results1.Retrospective analysis1.1 General situation113 nursing records were collected,and 90 were selected ultimately.There were 832 statements describing the symptoms / signs of patients or health related problems,and describing nursing interventions statements were3274.1.2 Feasibility analysis Using the problem classification table and the intervention program of Omaha system coding ultrasound intervention treatment of liver abscess patients nursing records,the longitudinal and lateral coding reliability Kappa were more than 0.945.The perfect matches rate between the symptoms / signs or health related problems in medical records and the items in the problem classification table of Omaha system entries of 81.73%,similar matches rate was 6.73%,narrower matches rate was 11.06%,broader matches rate of 0.48%,and no matches rate was 0.36%.The perfect matches rate between the nursing interventions in nursing records and the items in the intervention direction of Omaha intervention program was 68.60%,similar matches rate was 11.09%,narrower matches rate was 14.23%,broader matches rate was 5.25%,and no matches rate was 0.82%.Omaha problem classification scale application rate was19.70%,which environment field was 7.50%,psychological and social fields was 3.53%,physiological field was 31.54%,health related behavior field was21.31%.The application rate of 75 specific intervention direction in Omaha intervention program was 68.00%.1.3 Medical records analysis The most common 10 questions of liver abscess patients treated by ultrasound interventional were followed by infection or infection(92.22%),pain(90.00%),digestive and hydration(75.56%),nutrition(50.00%),cycling(41.11%),nerve-muscle-skeleton function / sleep and rest form(40.00%),skin(32.22%),respiration(30.00%),mental health(28.98%),urinary function / drug therapy(23.33%).A total of 3190 nursing measures can be classified by Omaha's intervention,the frequency of education,guidance and consultation was49.78%,monitoring was 27.71%,treatment and procedure was 2.51%,and case management 20%,respectively.There were 2978 nursing interventions can be coded by the intervention direction of Omaha intervention program,and the highest frequency of 10 intervention direction were dietary management(9.07%),physical symptoms /signs(8.50%),drug administration(6.31),drug and side effects(4.97%),rest/sleep(4.37%),nursing care(4.30%),dressing change / wound care(4.23%),medical / dental care(4.03%),safety(3.96%),feeding program(3.09%).The patients most common needs of 10 intervention direction of Omaha System Intervention Program were dietary management(87 cases,96.67%),drug and side effects(87 cases,96.67%),physical symptoms / signs of(85cases 94.44%),Drug Administration(71 cases,78.89%),medical / dental care (69 cases,76.67%),safety(66 cases,73.33%),nursing care(65 cases,72.22%),the legal system(57 cases,63.33%),environmental(56 cases,62.22%),drug set(55 cases,61.11%).2.Current situation investigation2.1 Questionnaires situation Sixty-three SF-36 questionnaires were issued,fifty-nine questionnaires were recovered,and the recovery rate was 93.65%.The half reliability of SF-36 scale was R=0.941,and the Cronbach's ? of PF,RP,BP,GH,VT,SF,RE and MH were: 0.524,0.849,0.897,0.878,0.778,0.820,0.599 and 0.773.The KMO value of the SF-36 scale was 0.837,and the Bartlett's test of sphericity value was 149.891,p=0.000.2.2 Health changes Ten of fifty-nine patients(16.95%)had the consciousness of "as almost as a year ago”,thirty-three of them(55.93%)had the consciousness of " a little worse than a year ago",sixteen of them(27.11%)had the consciousness of"much worse than a year ago";there were significant differences among the three.2.3 All dimensions scores The average scores of all dimensions from low to high order were PF(14.49 ± 9.36),RP(22.03 ± 24.16),SF(36.44 ± 16.46),GH(37.27 ± 14.91),VT(55.97 ± 15.33),RE(55.99 ± 27.18),BP(58.07 ± 20.98),MH(72.14 ± 11.63).The average score of physiological(t=2.549,p=0.014)and the average score of psychological(t=4.000,p=0.000)all had significant differences in different age group.The average score of physiological(t=?2.599,p=0.000)had significant differences between “have other disease or symptom” and “no have other disease or symptom ”.2.4 Univariate analysis The average scores of all dimensions of PF,GH,VT,SF,RE,MH in “age?60” group were more than the average scores in “age?60” group,and the differences in different age group were significant(p ? 0.05).The average scores of all dimensions of RP and PF in “no have other diseases or symptoms” group was more than the average scores in “have other diseases or symptoms” group,and the differences were significant(p ? 0.05).The average score of PF in “no use of antibiotics before treatment” group were more than the average score in “use antibiotic therapy before treatment” group,and the difference was significant(p?0.05).3.Programme formulation Finally,we had established perioperative nursing programme for patients with liver abscess by ultrasound intervention.The programme included three parts.They were the process and methods of implementation,nursing record list and evaluation examples of health related problems of perioperative nursing program for patients with liver abscess treated by ultrasound intervention,respectively.Conclusion The Omaha System can be applied to nurse the ultrasound interventional therapy in patients with liver abscess in perioperation period in our country after being adjusted according to our country's specific clinical situation.The problem of the health related quality of life in patients with liver abscess by ultrasound intervention were most conspicuous in physical function,role physical and social function.Gender,age level,whether to take antibiotics before treatment is the influence factors of the health related quality of life of the patients.The perioperative nursing program for the ultrasound interventional treatment of liver abscess patients formulated with using the Omaha System has certain clinical significance. |
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