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  本文關(guān)鍵詞：學(xué)齡期急性白血病患兒腰椎穿刺期間護(hù)理需求的調(diào)查分析　出處：《蘇州大學(xué)》2016年碩士論文　論文類型：學(xué)位論文

  更多相關(guān)文章： 白血病 患兒 腰椎穿刺 護(hù)理需求 影響因素

【摘要】：目的本課題以患兒自我報告的需求作為關(guān)注點,通過對學(xué)齡期白血病患兒腰椎穿刺期間護(hù)理需求的調(diào)查,旨在了解其護(hù)理需求現(xiàn)狀,深入分析其護(hù)理需求的特點及其影響因素,為該類患兒的臨床護(hù)理實踐制定個體化干預(yù)措施提供科學(xué)依據(jù)。方法本研究以人類基本需要層次理論為理論框架,通過概念界定、文獻(xiàn)回顧、參考血液病循證指南、半結(jié)構(gòu)訪談、Delphi專家函詢等方法初步構(gòu)建《學(xué)齡期AL患兒腰椎穿刺期間護(hù)理需求問卷》,該問卷共31個條目,5個維度,分別是信息需求(條目數(shù)為10)、溝通需求(條目數(shù)為8)、尊重需求(條目數(shù)為5)、舒適需求(條目數(shù)為4)、自我實現(xiàn)需求(條目數(shù)為4)。選取20名不同年齡、性別、疾病類型的腰椎穿刺期間的急性白血病患兒進(jìn)行預(yù)調(diào)查,考察問卷的可行性,分析整理結(jié)果并對問卷進(jìn)行相應(yīng)調(diào)整。調(diào)查100例急性白血病患兒來檢驗問卷的信效度,結(jié)果顯示可靠,最終保留30個條目,并增設(shè)一個開放性問題,形成正式問卷。應(yīng)用此問卷調(diào)查240例學(xué)齡期AL患兒腰椎穿刺期間的護(hù)理需求情況,最后獲得216份有效問卷,采用Epidata3.1軟件建立數(shù)據(jù)庫,將數(shù)據(jù)導(dǎo)入SPSS17.0軟件對數(shù)據(jù)進(jìn)行統(tǒng)計學(xué)分析,根據(jù)資料的性質(zhì)和研究目的選擇合適的統(tǒng)計方法,主要包括描述性的統(tǒng)計分析、獨立樣本t檢驗、方差分析及多元逐步回歸分析,P0.05視為有統(tǒng)計學(xué)意義,所有P值均為雙側(cè)概率。比較不同人口統(tǒng)計學(xué)因素及疾病相關(guān)因素對AL患兒腰椎穿刺期間護(hù)理需求的影響差異性,分析學(xué)齡期AL患兒腰椎穿刺期間護(hù)理需求的影響因素。結(jié)果1、學(xué)齡期急性白血病患兒對腰椎穿刺期間護(hù)理工作的總體需求得分是124.37±14.27分。五個維度中,需求程度從高到低依次為:信息需求、溝通需求、尊重需求、舒適需求、自我實現(xiàn)需求。2、按患兒對護(hù)理需求各單項均值大小進(jìn)行排序,前五位的需求是“腰穿時盡量減少我的身體暴露”、“護(hù)士安慰我、幫我轉(zhuǎn)移注意力,以減輕我的不舒服和緊張”、“床上大小便時,護(hù)士為我提供屏風(fēng)、拉上床簾等”、“護(hù)士教我一些放松方法”、“護(hù)士考慮我的感受并盡量滿足我的要求”。后五位的護(hù)理需求依次為“護(hù)士告訴我床上進(jìn)食、大小便的原因及方法”、“護(hù)士提前告訴我腰穿可能引起的不舒服”、“護(hù)士提前告訴我腰穿時家長不能陪同的原因”、“護(hù)士告訴我腰穿的必要性并解釋腰穿過程”、“護(hù)士帶我熟悉做腰穿的房間”。3、將不同特征的學(xué)齡期al患兒進(jìn)行分類比較,比較在不同性別、年齡、出生地、是否獨生子女、已完成的最高年級、有無其他病史、疾病類型、腰椎穿刺次數(shù)、照顧者、照顧者文化程度、照顧者婚姻狀況以及醫(yī)療費用支付方式等方面,患兒對腰椎穿刺期間護(hù)理需求各維度的差異性,結(jié)果顯示:在性別、年齡、出生地、是否獨生子女、已完成的最高年級、腰椎穿刺次數(shù)、照顧者、照顧者文化程度方面,患兒對腰椎穿刺期間的護(hù)理需求存在差異,且差異有統(tǒng)計學(xué)意義(p0.05)。4、將不同人口學(xué)變量進(jìn)行多重線性回歸分析,影響學(xué)齡期al患兒對腰椎穿刺護(hù)理總體需求的主要因素是腰椎穿刺次數(shù)、患兒性別、年齡及照顧者。信息需求層面的的主要影響因素是腰椎穿刺次數(shù)和年齡。溝通需求層面的主要影響因素是性別、腰椎穿刺次數(shù)、年齡、出生地和照顧者。尊重需求層面的主要影響因素是性別、是否獨生子女、患兒已完成的最高年級和照顧者文化程度。舒適需求層面的主要影響因素是性別、腰椎穿刺次數(shù)、年齡、照顧者和照顧者文化程度。自我實現(xiàn)需求層面的主要影響因素是患兒年齡、性別和腰椎穿刺次數(shù)。5、患兒在開放性問題中提出了“做腰穿時,操作室的人員應(yīng)該少一些,不希望被很多人圍觀”、“腰穿時不想看到針頭、針筒及血跡之類的東西”、“需要父母在腰穿室內(nèi)陪伴”等方面的需求。結(jié)論1.腰椎穿刺期間學(xué)齡期al患兒護(hù)理需求多樣化,對信息的需求仍是主要的。在腰椎穿刺護(hù)理需求的前五位排序中,有3項需求是尊重方面的需求,說明患兒希望醫(yī)護(hù)人員在關(guān)注他們疾病的同時,考慮他們的真實感受,尊重并注意保護(hù)其隱私,彼此建立相互尊重的平等關(guān)系。醫(yī)院管理者應(yīng)鼓勵護(hù)士擴(kuò)充人文學(xué)、心理學(xué)方面的知識,尊重患兒,關(guān)注與患兒的溝通,真正做到“以人為本,以患兒為中心”。2.影響學(xué)齡期AL患兒對腰椎穿刺護(hù)理需求的主要因素是腰椎穿刺次數(shù)、患兒性別、年齡及照顧者,提示臨床醫(yī)護(hù)人員及管理者應(yīng)加強(qiáng)對這些方面的關(guān)注力度。貫徹落實“精準(zhǔn)護(hù)理”的服務(wù)理念,最終提供以需求為導(dǎo)向的個體化護(hù)理。3.臨床醫(yī)護(hù)人員在關(guān)注患兒外在生理狀態(tài)的同時,應(yīng)傾聽來自患兒內(nèi)心的聲音,采取各種方法滿足腰椎穿刺期間患兒的需求,減輕其生理上的不適,降低其焦慮水平,真正提高其腰椎穿刺依從性,最終提高其生活質(zhì)量。
[Abstract]:The purpose of this subject to self reporting with demand as the focus, through the investigation of the nursing needs of school-age children with leukemia during lumbar puncture, to understand the status of nursing needs, in-depth analysis of the characteristics and influence factors of the nursing needs, provide scientific basis for clinical nursing practice of the children to develop individualized intervention measures. Methods on the hierarchy of needs theory as the theoretical framework, by definition, literature review, reference blood disease evidence-based guidelines, semi-structured interviews, expert consultation method of preliminary construction of Delphi < school-age children with AL during lumbar puncture and nursing needs questionnaire ", the questionnaire included 31 items and 5 dimensions, respectively is the demand of information (number 10), communication (number 8) needs, respect the needs (number of entries is 5), comfort (number of entries is 4), the self realization needs (number 4) selected 20 different. Age, gender, children with acute leukemia during lumbar puncture and the type of disease of the pre survey questionnaire, feasibility study, analysis results and make corresponding adjustments to the questionnaire investigation of 100 cases of children with acute leukemia. To test the reliability and validity of the questionnaire, the results show reliable and ultimately retained 30 items, and the addition of an open-ended question, the formation of a formal questionnaire. This questionnaire applied nursing needs of 240 school-age children with AL during lumbar puncture, finally obtained 216 valid questionnaires, using Epidata3.1 software to establish the database, import data into SPSS17.0 software for statistical analysis of data, according to the nature of the materials and the selection of appropriate statistical methods, including descriptive analysis statistics, independent sample t test, variance analysis and multiple stepwise regression analysis, P0.05 is regarded as statistically significant, all P values were two-sided probability. Comparison of different demographic factors and disease related factors during AL with lumbar puncture effect of nursing demand differences, analysis of school-age children with AL during lumbar puncture effect of nursing demand factors. The results of 1 school-age children with acute leukemia on lumbar puncture during the nursing work of the overall demand score is 124.37 + 14.27. Five dimensions in the demand degree from high to low are: information needs, communication needs, respect needs and comfort needs, self actualization needs.2, according to the sort of nursing needs individual mean value of children, five of the demand is "puncture my body to minimize exposure", "the nurse comforted me, help me to divert attention, to ease my uncomfortable and nervous", "bed size, the nurse offered me a bed screen, pull curtain", "the nurse taught me some relaxation method", "the nurses consider my feeling And try to meet my requirements. Care needs after five are "eating the nurse told me on the bed, because of the size and the method", "the nurse told me in advance of lumbar puncture may cause discomfort", "the nurse told" parents can not accompany me when the puncture nurse told me, "the necessity of lumbar puncture and explain the puncture process", "nurse took me familiar with lumbar puncture room".3, the al of school-age children with different characteristics of classification, comparison in different gender, age, place of birth, whether only child, has completed the most high grade, there is no other history, type of disease, lumbar the number of puncture, caregivers, caregivers who take care of the cultural degree, marital status and payment of medical expenses, with the differences in each dimension of care needs, lumbar puncture during the results showed that: in gender, age, place of birth, whether alone Children, the highest grade completed, lumbar puncture times, caregiver, caregiver education, nursing needs for patients with lumbar puncture during the difference, and the difference was statistically significant (P0.05.4), the different demographic variables analysis of multiple linear regression, the main factors affecting the demand for nursing care of lumbar puncture in general school-age children with Al is the number of children lumbar puncture, gender, age and caregivers. Main factors affecting the level of demand information is lumbar puncture frequency and age. The main influence factors of communication demand level is sex, lumbar puncture times, age, place of birth and caregivers. Respect the main influencing factors of the level of demand is sex. That is only one child, children completed the highest grade and caregiver education. Main factors affecting the comfort level of demand is the gender, age, number of lumbar puncture, caregivers and photos Gu cultural degree of self realization. Main factors affecting the level of demand is in age, gender and the number of lumbar puncture.5, were made in the open problems in lumbar puncture, operating room personnel should be less, do not want to be a lot of people watching "," do not want to see when the puncture needle and needle things like blood "," parents need lumbar puncture in indoor company "and other needs. During the conclusion of the 1. lumbar puncture in children with Al care needs of school-age diversification, the demand for information is still the main. In the top five ranking in the lumbar puncture nursing needs, there are 3 requirements is respect for the demand that children hope that medical personnel in their disease at the same time, consider their true feelings, respect and protect their privacy, to establish mutual relations of equality mutual respect. Hospital managers should encourage nurses to expand humanities, psychology Knowledge, respect for children, and the children's attention to communication, truly "people-oriented, to children as the main factors affecting the.2. center of school-age children with AL of lumbar puncture nursing needs lumbar puncture is the number of children with gender, age and caregivers, medical staff and management should be strengthened in these aspects concern efforts. Implement the" precise care "service concept, to provide the final demand oriented individualized nursing.3. clinical medical personnel in the children with attention external physiological state at the same time, from the children should listen to the voice of the heart, adopt various methods to meet the demand during the children lumbar puncture, relieve physical discomfort, reduce the level of anxiety, really improve the lumbar puncture compliance, and ultimately improve their quality of life.

【學(xué)位授予單位】：蘇州大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2016
【分類號】：R473.73

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