标准化SBAR沟通模式联合多元化护理在血小板减少性紫癜患儿中的应用效果

doi:10.3760/cma.j.issn.1007-1245.2023.19.010

摘要/Abstract

摘要：

目的　评估标准化“现状-背景-评估-建议”（SBAR）沟通模式联合多元化护理在血小板减少性紫癜患儿中的应用效果。方法　回顾性分析2020年8月至2022年8月郑州大学附属儿童医院收治的88例血小板减少性紫癜患儿的资料，依照护理方式不同将其分为两组。对照组44例，患儿男26例，女18例，年龄（9.59±1.04）岁，体质量指数（22.21±0.34）kg/m²；家属男15名，女29名，年龄（34.21±1.25）岁，受教育年限（10.08±1.05）年，采取常规护理。观察组44例，患儿男25例，女19例，年龄（9.56±1.02）岁，体质量指数（22.19±0.32）kg/m²；家属男12名，女32名，年龄（34.19±1.23）岁，受教育年限（10.05±1.03）年，实施SBAR沟通模式联合多元化护理。两组均持续护理至患儿出院，并随访观察1个月。比较两组遵医依从性、凝血功能、家属对健康知识的掌握情况、不良事件发生率、生活质量和家属满意度。采用t检验、χ²检验。结果　观察组遵医依从率为95.45%（42/44），高于对照组的79.55%（35/44），差异有统计学意义（χ²=5.091，P=0.024）；观察组护理后血小板计数为（224.87±21.46）×10⁹/L、平均血小板体积为（9.19±0.53）fl、血红蛋白为（152.29±5.42）g/L，均高于对照组［（179.95±21.42）×10⁹/L、（7.04±0.42）fl、（134.67±5.39）g/L］，差异均有统计学意义（t=9.827、21.089、15.290，均P<0.05）；观察组护理后家属健康知识掌握中病情监测评分为（12.25±1.05）分、饮食指导评分为（12.33±1.14）分、并发症预防评分为（12.47±1.09）分、用药指导评分为（12.28±1.18）分、保健知识评分为（12.27±1.05）分、总分为（62.35±3.16）分，均高于对照组［（8.98±1.02）分、（9.02±1.08）分、（8.76±1.06）分、（9.92±1.15）分、（8.99±1.02）分、（42.79±3.12）分］，差异均有统计学意义（t=14.817、13.982、16.186、9.501、14.863、29.217，均P<0.05）；观察组不良事件发生率为6.82%（3/44），低于对照组的22.73%（10/44）（χ²=4.423，P=0.035）；观察组护理后诺丁汉健康调查问卷（NHP）中睡眠评分为（23.37±2.46）分、精力评分为（18.69±2.63）分、孤独感评分为（21.14±2.09）分、身体活动评分为（14.35±1.10）分、情绪评分为（22.38±2.14）分，均低于对照组［（28.68±2.50）分、（26.37±2.69）分、（26.67±2.15）分、（17.63±1.16）分、（27.24±2.19）分］（t=10.043、13.541、12.234、13.610、10.528，均P<0.05）；观察组家属满意度为95.45%（42/44），高于对照组的81.82%（36/44），差异有统计学意义（χ²=4.062，P=0.044）。结论　SBAR沟通模式联合多元化护理能够提高血小板减少性紫癜患儿遵医依从性，改善患儿凝血功能，提升家属对健康知识的掌握，降低不良事件发生率，促进生活质量提升，从而获得更高的家属满意度。

关键词:

血小板减少性紫癜, 标准化沟通模式, 多元化护理, 遵医依从性, 不良事件

Abstract:

Objective　To evaluate the application effect of standardized SBAR (situation, background, assessment, and recommendation) communication model combined with diversified nursing in children with thrombocytopenic purpura (ITP). Methods　The data of 88 children with ITP admitted to Children's Hospital Affiliated to Zhengzhou University from August 2020 to August 2022 were retrospectively analyzed. They were divided into two groups according to different nursing methods. In the control group, there were 26 boys and 18 girls, aged (9.59±1.04) years, with a body mass index of (22.21±0.34) kg/m²; there were 15 males and 29 females of the family members, aged (34.21±1.25) years, with years of education of (10.08±1.05) years. In the observation group, there were 25 boys and 19 girls, aged (9.56±1.02) years, with a body mass index of (22.19±0.32) kg/m²; there were 12 males and 32 females of the family members, aged (34.19±1.23) years, with years of education of (10.05±1.03) years. The control group took routine nursing, while the observation group implemented SBAR communication model combined with diversified nursing. Both groups received continuous nursing until the children were discharged, and the children were followed up for 1 month. The two groups were compared in terms of medical compliance, coagulation function, family members' mastery condition of health knowledge, incidence of adverse events, quality of life, and family satisfaction degree. t test and χ² test were used. Results　The medical compliance rate of the observation group was 95.45% (42/44), which was higher than that of the control group [79.55% (35/44)], with a statistically significant difference (χ²=5.091, P=0.024). After nursing, the platelet count in the observation group was (224.87±21.46)×10⁹/L, the mean platelet volume was (9.19±0.53) fl, and the hemoglobin was (152.29±5.42) g/L, which were higher than those in the control group [(179.95±21.42)×10⁹/L, (7.04±0.42) fl, and (134.67±5.39) g/L], with statistically significant differences (t=9.827, 21.089, and 15.290; all P<0.05). After nursing, the scores of disease monitoring, diet guidance, complication prevention, medication guidance, and health care knowledge of family members' mastery condition of health knowledge in the observation group were (12.25±1.05), (12.33±1.14), (12.47±1.09), (12.28±1.18), and (12.27±1.05) points, respectively, and the total score was (62.35±3.16) points, which were higher than those in the control group [(8.98±1.02), (9.02±1.08), (8.76±1.06), (9.92±1.15), (8.99±1.02), and (42.79±3.12) points], with statistically significant differences (t=14.817, 13.982, 16.186, 9.501, 14.863, and 29.217; all P<0.05). The incidence of adverse events in the observation group was 6.82%, lower than 22.73% in the control group (χ²=4.423, P=0.035). After nursing, the scores of sleep [(23.37±2.46) points], energy [(18.69±2.63) points], loneliness [(21.14±2.09) points], physical activity [(14.35±1.10) points], and mood [(22.38±2.14) points] of the Nottingham Health Profile (NHP) in the observation group were all lower than those in the control group [(28.68±2.50), (26.37±2.69), (26.67±2.15), (17.63±1.16), and (27.24±2.19) points] (t=10.043, 13.541, 12.234, 13.610, and 10.528; all P<0.05). The satisfaction rate of family members in the observation group was 95.45% (42/44), which was higher than that in the control group [81.82% (36/44)], with a statistically significant difference (χ²=4.062, P=0.044). Conclusion　SBAR communication model combined with diversified nursing can improve the medical compliance of ITP children, improve the children's blood coagulation function, enhance the family members' health knowledge mastery, reduce the occurrence rate of adverse events, promote the improvement of quality of life, and thus obtain higher family satisfaction degree.

Key words:

Thrombocytopenic purpura, Standardized communication model, Diversified nursing, Medical compliance, Adverse events

董新园李金霞.

标准化SBAR沟通模式联合多元化护理在血小板减少性紫癜患儿中的应用效果 [J]. 国际医药卫生导报, 2023, 29(19): 2708-2712.

Dong Xinyuan, Li Jinxia.

Application effect of Standardized SBAR communication model combined with diversified nursing in children with thrombocytopenic purpura [J]. International Medicine and Health Guidance News, 2023, 29(19): 2708-2712.

参考文献

[1] 戴海英,王芳,程桂芬. 家属参与护理对血小板减少性紫癜患儿恢复效果的影响[J]. 中国实用护理杂志,2020,36(21):1648-1653. DOI:10.3760/cma.j.cn211501-20191010- 02840.
[2] 赵小艳,都君,姚会玉,等.多元化健康教育对学龄期过敏性紫癜患儿疾病认知及治疗效果的影响[J].医学临床研究,2020,37(8):1279-1281.DOI:10.3969/j.issn.1671-7171. 2020.08.053.
[3] 王夕妍,刘晓帆,薛峰,等. 血栓性血小板减少性紫癜83例临床分析[J]. 中华血液学杂志,2020,41(3):216-221. DOI:10.3760/cma.j.issn.0253-2727.2020.03.006.
[4] 王晓娟. 家属参与护理在血小板减少性紫癜患儿中应用效果[J]. 中国药物与临床,2021,21(13):2405-2407. DOI:10.11655/zgywylc2021.13.086.
[5] 中华医学会血液学分会血栓与止血学组. 血栓性血小板减少性紫癜诊断与治疗中国专家共识(2012年版)[J]. 中华血液学杂志,2012,33(11):983-984. DOI:10.3760/cma.j.issn.0253-2727.2012.11.025.
[6] 司在霞,郭灵霞,周敏,等. 修订版Morisky服药依从性量表用于抗凝治疗患者的信效度检测[J]. 护理学杂志,2012,27(22):23-26. DOI:10.3870/hlxzz.2012.22.023.
[7] 白雪,朱亚鑫,曲波. 诺丁汉健康量表在医学生生命质量评价中的应用研究[J]. 中国卫生统计,2019,36(1):103-105.
[8] 牛洪艳,倪静玉,张玲,等. 护理满意度量表在临床住院病人中应用的信效度研究[J]. 护理研究,2016,30(3):287-290. DOI:10.3969/j.issn.1009-6493.2016.03.009.
[9] 石茂静,高伟波,黄文凤,等. 61例血栓性血小板减少性紫癜患者的临床分析[J]. 北京大学学报(医学版),2021,53(1):210-214. DOI:10.19723/j.issn.1671-167X.2021.01.032.
[10] 邵玥. 中医延续性护理方案对过敏性紫癜患儿生活质量的影响[J]. 长春中医药大学学报,2020,36(1):155-157. DOI:10.13463/j.cnki.cczyy.2020.01.043.
[11] 郭慧,梁丽云. SBAR沟通模式应用于急诊儿科患儿的效果评价[J]. 医学临床研究,2021,38(2):317-319. DOI:10.3969/j.issn.1671-7171.2021.02.048.
[12] 何嘉健,张颖,刘晓雯.SBAR沟通模式结合规范护理在新生儿科护理床头交接班中的应用[J].海南医学,2022,33(8):1083-1085.DOI:10.3969/j.issn.1003-6350.2022.08.035.
[13] 马燕. 针对性护理在小儿紫癜性肾炎中的应用观察[J]. 贵州医药,2021,45(7):1160-1161. DOI:10.3969/j.issn.1000-744X.2021.07.083.
[14] 李晶晶,乔建云,弋曼,等. 路径健康教育管理联合童趣化护理对小儿过敏性紫癜家长疾病知晓率及遵医行为的影响[J]. 中国医药导报,2022,19(23):190-193.
[15] 承丽,卢芹芹,孙会. Ahmadi延续性护理在过敏性紫癜患儿中的应用效果及对照护者心理状况的影响[J]. 川北医学院学报,2022,37(7):951-954,958. DOI:10.3969/j.issn.1005-3697.2022.07.031.
[16] 张雨萌,谢庆芝,刘永蛟,等. 饮食疗法联合益生菌对过敏性紫癜患儿肠黏膜屏障的影响研究[J]. 国际医药卫生导报,2020,26(10):1354-1356,1360. DOI:10.3760/cma.j.issn.1007-1245.2020.10.006.
[17] 李新,孙云秀,何丽亭,等. 重症过敏性紫癜患儿血液灌流联合血液透析的护理体会[J]. 西南国防医药,2020,30(5):460-462. DOI:10.3969/j.issn.1004-0188.2020.05.030.
[18] 陈述萍,王晓娜,刘聪聪,等. 基于奥马哈系统的延续护理对过敏性紫癜患儿复发率和免疫指标的影响[J]. 长春中医药大学学报,2019,35(4):753-757. DOI:10.13463/j.cnki.cczyy.2019.04.040.
[19] 汤令群,卢小芹. 中医辨证联合情志干预对腹型过敏性紫癜患儿临床疗效、心理状况及免疫功能的影响[J]. 国际护理学杂志,2022,41(14):2658-2662. DOI:10.3760/cma.j.cn221370-20200605-00677.
[20] 叶春春,苗秀欣. 系统化家庭管理对过敏性紫癜患儿家庭功能及生存质量的影响研究[J]. 护理管理杂志,2020,20(8):560-565. DOI:10.3969/j.issn.1671-315x.2020.08.006.
[21] 谢凯丽,王二晓,梁娟. 趣味化健康教育对过敏性紫癜患儿负性情绪及临床症状改善效果的影响[J]. 中国医药导报,2022,19(31):194-196,封3. DOI:10.20047/j.issn1673- 7210.2022.31.46.
[22] 张琴琴. 基于行为转变理论的健康教育对紫癜性肾炎患儿家属行为及心理状况的影响分析[J]. 贵州医药,2021,45(8):1329-1330. DOI:10.3969/j.issn.1000-744X.2021.08.085.
[23] Nicoara O, Twombley K. Immunoglobulin A nephropathy and immunoglobulin A vasculitis[J]. Pediatr Clin North Am, 2019, 66(1):101-110. DOI: 10.1016/j.pcl.2018. 08.008.
[24] 郑小霞,程耀敏,郑凤弟. 家庭教育-环境改良-功能干预模式在小儿过敏性紫癜护理中的应用[J]. 齐鲁护理杂志,2019,25(21):58-60. DOI:10.3969/j.issn.1006-7256.2019. 21.019.
[25] Atkinson K. Thrombopoietin receptor agonists: eltrombopag and romiplostim for the treatment of chronic immune thrombocytopenia purpura[J]. Clin J Oncol Nurs, 2019, 23(2):212-216. DOI: 10.1188/19.CJON.212-216.
[26] 邱青霞. 视频宣教结合回授法对过敏性紫癜患儿及家长健康教育效果的影响[J]. 国际护理学杂志,2021,40(23):4304-4307. DOI:10.3760/cma.j.cn221370-20200505- 01210.
[27] 陶青,蔡榕,赵丽,等. 个性化健康管理对过敏性紫癜患儿治疗效果及负性情绪的影响[J]. 现代医学,2020,48(11):1440-1443. DOI:10.3969/j.issn.1671-7562.2020.11.017.
[28] 蔡明阳,任献青,李盼盼,等. 基于食复理论探讨小儿过敏性紫癜阶梯饮食护理方案[J]. 湖南中医药大学学报,2019,39(10):1259-1262. DOI:10.3969/j.issn.1674- 070X.2019.10.019.
[29] 杨洁,吴春青,王薛平. 孟鲁司特钠联合卡络磺钠治疗儿童过敏性紫癜疗效及对血清细胞因子、信号转导抑制蛋白3和低糖基化IgA1水平的影响[J]. 儿科药学杂志,2020,26(2):14-17. DOI:10.13407/j.cnki.jpp.1672- 108X.2020.02.005.
[30] 韩明华,张理想. 心智图在过敏性紫癜患儿主要照顾者负性情绪及疾病认知中的应用[J]. 蚌埠医学院学报,2019,44(3):384-387. DOI:10.13898/j.cnki.issn.1000-2200. 2019.03.030.