Effect of continuous quality improvement on reducing the incidence of urinary retention after natural childbirth

doi:10.3760/cma.j.issn.1007-1245.2024.06.034

Abstract

Abstract:

Objective　To explore the effect of continuous quality improvement on reducing the incidence of urinary retention after natural childbirth. Methods　This study was a clinical observation study. We selected the parturients who gave birth naturally in Guangdong Women's and Children's Hospital from January to December 2021 as the research objects. Among them, 3 062 parturients in the first delivery area were taken as the experimental group, 3 112 parturients in the second delivery area were taken as the control group. The maternal age of the experimental group was (29.52±4.25) years old; perineal wound: there were 266 cases of no wound, 2 152 cases of grade I laceration, and 644 cases of grade II laceration and lateral incision. The maternal age of the control group was (29.68±4.09) years old; perineal wound: there were 244 cases of no wound, 2 179 cases of grade I laceration, and 689 cases of grade II laceration and lateral incision. The control group was given routine urine retention nursing measures, and the observation group was given continuous quality improvement management measures on the basis of routine nursing. The incidence of urinary retention, the rate of indwelling catheter, and the standardized use rate of nursing sheet in parturients with urinary retention were observed in the experimental group and the control group, and the incidence of urinary retention, the rate of indwelling catheter, and the standardized use rate of nursing sheet in parturients with urinary retention were compared before and after improvement. χ² test, rank sum test, and independent sample t test were used. Results　There were statistically significant differences in the incidence of urinary retention, the rate of indwelling catheter, and the standardized use rate of nursing sheet in parturients with urinary retention between the experimental group and the control group [3.20% (98/3 062) vs. 4.45% (139/3 112), 1.40% (43/3 062) vs. 2.80% (87/3 112), 88.78% (87/98) vs. 56.12% (78/139)] (χ²=6.702, 14.354, and 29.988, all P<0.05). The comparison before and after improvement showed that there were statistically significant differences in the incidence of urinary retention, the rate of indwelling catheter, and the standardized use rate of nursing sheet in parturients with urinary retention (all P<0.05). Conclusion　Continuous quality improvement can effectively reduce the incidence of urinary retention after natural childbirth and improve the level of nursing quality.

Key words:

Delivery, Urinary retention, Continuous quality improvement, Management, Nursing

摘要：

目的　探讨持续质量改进对降低产妇自然分娩后尿潴留发生率的效果。方法　本研究为临床观察研究，选取2021年1月至12月于广东省妇幼保健院自然分娩的产妇作为研究对象，其中将产一区3 062例产妇作为试验组、产二区3 112例产妇作为对照组。试验组产妇年龄（29.52±4.25）岁；会阴伤口情况：无伤口266例，Ⅰ度裂伤2 152例，Ⅱ度裂伤、侧切644例。对照组产妇年龄（29.68±4.09）岁；会阴伤口情况：无伤口244例，Ⅰ度裂伤2 179例，Ⅱ度裂伤、侧切689例。对照组实施常规尿潴留护理措施，试验组在常规护理基础上给予持续质量改进管理措施。观察试验组及对照组尿潴留发生率、留置尿管率、尿潴留产妇护理单使用规范率，对比改进前后尿潴留发生率、留置尿管率、尿潴留产妇护理单使用规范率。采用χ²检验、秩和检验、独立样本t检验。结果　试验组与对照组尿潴留发生率、留置尿管率、尿潴留产妇护理单使用规范率对比差异均有统计学意义［3.20%（98/3 062）比4.45%（139/3 112），1.40%（43/3 062）比2.80%（87/3 112），88.78%（87/98）比56.12%（78/139）］（χ²=6.702、14.354、29.988，均P<0.05）。改进前后对比发现，产妇尿潴留发生率、留置尿管率、尿潴留产妇护理单使用规范率对比差异均有统计学意义（均P<0.05）。结论　持续质量改进能够有效降低产妇自然分娩后尿潴留发生率及提高护理质量水平。

关键词:

分娩, 尿潴留, 持续质量改进, 管理, 护理

Zeng Liling, Zhuang Youqing, Rao Jin, Li Xueran.

Effect of continuous quality improvement on reducing the incidence of urinary retention after natural childbirth [J]. International Medicine and Health Guidance News, 2024, 30(6): 1043-1046.

曾丽玲庄幼青饶金李雪然.

持续质量改进管理对降低产妇自然分娩后尿潴留发生率的效果研究 [J]. 国际医药卫生导报, 2024, 30(6): 1043-1046.

References

[1] Mohr S, Raio L, Gobrecht-Keller U, et al. Postpartum urinary retention: what are the sequelae? A long-term study and review of the literature[J]. Int Urogynecol J, 2022, 33(6):1601-1608. DOI: 10.1007/s00192-021- 05074-5.
[2] Barba M, Frigerio M, Manodoro S, et al. Postpartum urinary retention: absolute risk prediction model[J]. Low Urin Tract Symptoms, 2021, 13(2):257-263. DOI: 10.1111/luts.12362.
[3] 庞艳,林芳初,李嫒,等.产后尿潴留发病危险因素Meta分析[J].护理学报,2020,27(20):1-6. DOI:10.16460/j.issn1008- 9969.2020.20.001.
[4] Ain QU, Shetty N, K S. Postpartum urinary retention and its associated obstetric risk factors among women undergoing vaginal delivery in tertiary care hospital[J]. J Gynecol Obstet Hum Reprod, 2021, 50(2):101837. DOI: 10.1016/j.jogoh.2020.101837.
[5] 李庆梅,何文婵,杜薇,等.盆底肌治疗仪治疗产后尿潴留的效果观察[J].广西医学,2019,41(6):796-797. DOI:10.11675/j.issn.0253-4304.2019.06.36.
[6] Mulder FE, Hakvoort RA, Schoffelmeer MA, et al. Postpartum urinary retention: a systematic review of adverse effects and management[J]. Int Urogynecol J, 2014, 25(12):1605-1612. DOI: 10.1007/s00192-014- 2418-6.
[7] Wells S, Tamir O, Gray J, et al. Are quality improvement collaboratives effective? A systematic review[J]. BMJ Qual Saf, 2018, 27(3):226-240. DOI: 10.1136/bmjqs-2017- 006926.
[8] 孙婷婷,东云霞.腹部叩诊-尿意法评估产后储尿量的研究[J].解放军护理杂志,2001,18(4):23-24. DOI:10.3969/j.issn.1008-9993.2001.04.014.
[9] Ogawa J, Shibata Y, Suzuki S. Micturition syncope during postpartum first walking[J]. J Matern Fetal Neonatal Med, 2021, 34(10):1683-1684. DOI: 10.1080/14767058.2019. 1640677.
[10] 马芳芳,李琳,杨美菊,等.低频脉冲电疗法配合穴位护理对产后尿潴留的效果[J].中国医药指南,2023,21(31):42-45. DOI:10.15912/j.cnki.gocm.2023.31.043.
[11] 刁晓丽,李晓红,曲月洁.基于循证的护理措施预防顺产后尿潴留效果观察[J].齐鲁护理杂志,2020,26(6):102-105. DOI:10.3969/j.issn.1006-7256.2020.06.035.
[12] 奉新英,黄敏.中医护理适宜技术在产后尿潴留的应用研究进展[J].国际医药卫生导报,2021,27(1):2-5. DOI:10.3760/cma.j.issn.1007-1245.2021.01.001.
[13] Luo L, Wang L, Zhang M, et al. Application of obstetric nursing-sensitive quality indicators in continuous quality improvement[J]. Am J Transl Res, 2022, 14(1):643-655.
[14] Lawal OO, Morhason-Bello IO, Atalabi OM, et al. Incidence of postpartum urinary retention in a tertiary hospital in Ibadan, Nigeria[J]. Int J Gynaecol Obstet, 2022, 156(1):42-47. DOI: 10.1002/ijgo.13659.
[15] Sinsky CA, Bavafa H, Roberts RG, et al. Standardization vs customization: finding the right balance[J]. Ann Fam Med, 2021, 19(2):171-177. DOI: 10.1370/afm.2654.
[16] 张焕芳,陈云,刘冰,等.基于循证的质量改进项目对产后尿潴留精准识别的效果[J].循证护理,2023,9(18):3272-3277. DOI:10.12102/j.issn.2095-8668.2023.18.008.
[17] 姜丽杰,蔺莉.产后尿潴留的研究进展[J].中国妇产科临床杂志,2018,19(4):372-374. DOI:10.13390/j.issn.1672- 1861.2018.04.027.
[18] Zhang Z, Zhu H. Evaluation of the effect of intensive nursing intervention based on process analysis[J]. Comput Math Methods Med, 2021, 2021:8769780. DOI: 10.1155/2021/8769780.
[19] 蔡春花,邱娃如,蔡秀梅,等.持续质量改进在ICU院内感染控制管理中的价值分析[J].现代医院,2021,21(10):1542-1544. DOI:10.3969/j.issn.1671-332X.2021.10.019.