随着人口老龄化、生活方式的改变,眼科疾病患病人数的增加、国家眼病诊疗相关政策的持续推动、居民健康意识的逐渐提升,眼科门急诊患者数量持续增长,亟需构建科学的眼科急诊预检分诊标准,合理配置医疗资源,确保患者得到及时、恰当的治疗。国外已有医院依据患者症状或体征的严重程度对患者进行等级划分,建立起相对成熟的眼科急诊预检分诊模式,我国目前尚没有统一的、权威的眼科急诊预检分诊标准,国内外现行的眼科急诊预检分诊模式的分诊精准度及临床适用性有待进一步探索。该文通过综述国内外眼科急诊分诊标准及应用评价、眼科远程急诊预检分诊方式研究进展,以期为构建符合我国国情的、科学有效的眼科急诊预检分诊标准、提高眼科急诊分诊质量提供参考。
With the aging of population, the changing of lifestyle and the increasing number of ophthalmic emergency patients,Chinese national policies related to ophthalmic diagnosis and treatment are continually promoted, and residents' health awareness are gradually improved, the volume of ophthalmic outpatients and emergency patients continues to increase. It is urgent needed to establish scientific ophthalmic emergency pre-examination and triage criteria, to reasonably allocate medical resources, and to ensure that patients receive timely and appropriate treatment. The relatively mature ophthalmic emergency pre-examination and triage models with the severity of patients' symptoms or physical signs,have been established in foreign hospitals. Currently, there is no unified and authoritative ophthalmic emergency triage criteria in China. The accuracy and clinical applicability of the existing ophthalmic emergency triage models at home and abroad need to be further explored. This article reviewed the ophthalmic emergency triage criteria and application evaluation at home and abroad, and remote emergency triage in ophthalmology, in order to provide a reference for establishing a scientific and effective ophthalmic emergency triage criteria comformed Chinese national conditions, and improving the quality of ophthalmic emergency triage.
目的:构建眼科日间病房护理质量指标,为眼科日间病房的护理质量管理提供理论依据。方法:以Donabedian三维质量结构模式为理论框架,通过查阅文献、小组讨论,初步拟定眼科专科护理质量评价指标。通过专家函询,对指标进行筛选和修订,确定了眼科日间病房护理质量指标。结果:经过2轮函询,专家意见趋向一致,2轮问卷回收率均为100%,协调系数分别为0.129、0.342(P<0.01)。构建的眼科专科护理质量指标包括3项一级指标,分别为结构指标(二级指标2项)、过程指标(二级指标8项)和结果指标(二级指标3项)。结论:该指标具有较高的科学性、可靠性、可行性以及专科特色,可为眼科日间病房护理质量的评价提供良好的方法。
Objective: To set up nursing quality indicators for ophthalmic intra-day ward, providing theoretical basis for nursing quality management in ophthalmic intra-day ward. Methods: Based on the "Donabedian three dimensional quality structure model" as the theoretical framework, the preliminary ophthalmic specialized nursing quality assessment indicators were designed by literature review and group discussion. The ophthalmic nursing quality indicators for intraday ward were finalized by expers consultated, indicators screened and revised. Results: After two rounds of inquration by letters, the opinions from the experts were consistent. Questionnaire response rates were both 100% in two rounds, with coordination coefficients of 0.129 and 0.342 respectively (P< 0.01). The nursing quality indicators for ophthalmic intra-day ward were established, including 3 primary indicators, which are structual indicators (2 secondary indicators), process indicators (8 secondary indicators) and outcome indicatiors(3 secondary indicators). Conclusion: The indicators are scientific, reliable, feasible with specialized characteristics, which can provide a good reference for evaluating the nursing quality in ophthalmic intra-day wards.
目的:探讨眼底外科医护一体组团合作模式在管理眼底病日间手术患者实践效果。方法:选取2022年1—6月进行日间手术的582例眼底病患者为对照组,2023年1—6月进行日间手术的633例眼底病患者为研究组,对照组实施责任制整体护理,研究组采取实施医护一体组团合作管理模式进行全流程患者管理。使用χ2检验和t检验比较两组患者围术期护理知识健康教育知晓度、满意度、出院24 h内眼科急症就诊率、出院24 h内随访率、护士职业获益感的差异。结果:研究组患者健康教育知晓度高于对照组,组间比较差异具有统计学意义(t=–18.47,P<0.05);研究组患者满意度高于对照组,组间比较差异具有统计学意义(t=–4.005,P<0.05);研究组患者出院24 h内随访率为100%,对照组为98.1%,两组比较差异有统计学意义(χ2=12.073,P<0.05);研究组患者出院24 h内眼科急症就诊率0.94%,对照组为1.89%,组间比较差异无统计学意义(χ2=1.951,P=0.222);实施后护士职业获益感分值高于实施前,组间比较差异具有统计学意义(t=–6.637,P<0.001)。结论:医护一体组团合作管理模式进行眼底外科日间手术患者围术期的全流程管理,改善患者就医感受,提升患者就医体验,提高眼底外专科日间手术患者的依从性,保障患者的安全,提高护士职业获益感。
Objective: To investigate the practical effect of the integrated group cooperation model in managing patients with fundus diseases in day surgery. Methods: 582 patients with fundus disease who underwent day surgery from January to June in 2022 were included as the control group, and 633 patients with fundus disease who underwent day surgery from January to June in 2023 were selected as the study group. The control group implemented the overall responsibility nursing system, while the study group carried out the collaborative management model, integrating medical and nursing for the entire process of patient management. Chi-square test and T-test were used to compare the differences of perioperative nursing knowledge, health education awareness, satisfaction, emergency ophthalmological consultation rate within 24 hours of discharge, follow-up rate within 24 hours of discharge, and nurses' sense of professional benefit between the two groups. Results: The awareness of health education in the study group was higher than that in the control group, and there was significant statistically difference between two groups (t=–18.47, P<0.05). The satisfaction of patients in the study group was higher than that in the control group, and there was significant statistically difference between two groups (t=–4.005, P < 0.05). The follow-up rate within 24 hours after discharge was 100% in the study group and 98.1% in the control group, and the difference was statistically significant (χ2=12.073, P<0.05). The incidence of ophthalmic emergencies within 24 hours of discharge in the study group was 0.94%, while in the control group it was 1.89%. There was no statistically significant difference between the two groups (χ2= 1.951, P=0.222). The perceived benefit score of nurses after implementation was higher than that before implementation, and there was statistically significant between two groups (t=–6.637, P<0.05). Conclusions: The medical and nursing integrated group cooperation management model is used to manage the entire perioperative process of patients undergoing day surgery in fundus surgery. This model can improve patients' medical experience, enhance their compliance with ophthalmic surgery, ensure their safety. At the same time, it can enhance the senses of professional benefits for nurses.
本文总结了15例自膨胀水凝胶眶内植入术患儿围手术期的护理要点。术前主要评估患儿是否完善术前检查,给予患儿及其家属个性化的心理护理,进行术前准备以及禁食禁饮的管理。术后主要给予患儿安全管理,饮食、疼痛、眼部用药以及弹力绷带包扎护理,关注有无并发症的发生及给予相应的护理,并对患儿及其家属做好出院指导。15例患儿均顺利完成手术,术后均出现术眼疼痛,2例出现眶压增高,1例出现呕吐,均得到妥善处理。术后随访3~18个月,患儿均获得了较为满意的眼部外观,生活质量得到了提高。
This paper summarized the nursing experience of 15 children with self-expanding hydrogel orbital implantation during perioperative period. Before operation, children were fully evaluated, given with psychological care, preoperative preparation and management of fasting and drinking. After the surgery, the patients were mainly given with safety management, diet, pain, medicine and elastic bandage dressing care. Nurses should pay attention to the occurrence of complications and give corresponding nursing care and offer useful discharge guidance for the children and their parents. All 15 children completed the operation successfully, postoperative eye pain occurred in 15 cases after operation, and the orbital pressure increased in 2 cases, 1 case vomited, and all cases were properly treated. After postoperative follow-up for 3–18 months, 15 children were satisfied with the appearance of the eye,and the life quality was improved.
目的:总结全身麻醉斜视矫正日间手术服务模式的创建与安全管理方法。方法:回顾2015年10月至2018年10月期间全身麻醉下行斜视矫正日间手术患者共9 570例。改革护理管理模式,实施医护一体化,在实施过程中对患者进行严密的术前、术后护理管理:术前评估,健康教育前移、加强核查制度、严格监测患者生命体征;术后病情严格交接,家属及患者同步术后指导、离院后回访。结果:全身麻醉斜视矫正日间手术的9 570例患者,均未发生手术并发症,术后不适34例,占0.36%,其中2例患者离院时出现头晕,2例发生尿储留,30例出现恶心、呕吐。护理人力由开展前16人减少到12人,节约25%;患者等候手术时间缩短了8 d,满意度由70%提高到90%,平均住院时间由3.2 d减少为1 d。结论:全身麻醉斜视矫正日间手术模式是一种新的医疗模式,开展全身麻醉日间手术不但可以节省医疗资源,还可提高患者满意度。
Objective: To summarize the establishment and safety management methods of ambulatory strabismus surgery that can provide the basis for carrying out ambulatory surgery nursing under general anesthesia. Methods: We carried out ambulatory surgery management that reformed nursing management model and delivered the integration of medical care in 9 570 patients undergoing strabismus surgery under general anesthesia from October 2015 to October 2018. In implementation process, we carefully managed the patients before and after operation including performing preoperative assessment and health education in advance, strengthening the verification system, strictly monitoring vital signs of the patients, strict shifting state of patients after operation, providing postoperative guidance to patients and their families, and performing follow-up clinic visits after leaving the hospital. Results: No surgical complications occurred in any of our cases. 34 patients had postoperative discomfort, accounting for 0.36%. Among these 34 patients, 2 had dizziness, 2 had urinary retention and 30 hadnausea and vomiting. After treatments, all patients were discharged on schedule. The number of nurses reduced from 16 to 12 that fell by 25%. Wait times for operation reduced by 8 days. Patient satisfaction was improved from 70% to 90%. The mean length of hospital stay was reduced from 3 days to 1 day. Conclusion: The management of ambulatory surgery under general anesthesia is a new medical care service model. Careful planning and strict preoperative and postoperative safety management can ensure the safe implementation of strabismus surgery. Ambulatory surgery under general anesthesia has benefits to save medical resources and improve patient satisfaction.
目的:探讨标准化沟通模式(SBAR)在眼球穿通伤患者护理交班中的应用效果。方法:60例患者作为对照组,使用传统口头方式交班;60例患者作为观察组,使用SBAR沟通模式进行交接。比较两组交班耗时、两组护士对患者病情掌握程度以及患者对护理服务满意度的差异。结果:观察组与对照组比较,上述指标差异具有统计学意义(P<0.05)。结论:采取SBAR沟通模式交班有助于降低在眼球穿通伤护理中的不良事件发生率,保障了护理质量,提高了交接班效率和患者满意度,适宜推广应用。
Objective: To evaluate the SBAR communication model in the nursing care handover of patients with penetration injuries of eyeball. Methods: Transfer time, receivers’ information retention, and patient’s satisfaction were compared between two groups of patients with penetration injuries of eyeball. A total of 60 patients were handled with the traditional oral communication handover as comparison group and other 60 patients were handled with the SBAR handover as intervention group. Results: When comparing intervention group with comparison group, statistically significant improvements (P<0.05) were observed in all three factors tested. Conclusion:Implementing the communication tool SBAR in the nursing care of patients with penetration injuries of eyeball reduces rate of adverse events, improves patient care quality, enhances transfer efficiency, and boosts patient’s satisfaction.
为使眼科手术铺巾方法更安全、便捷、利于操作,本研究团队在原有眼科手术铺巾基础上,增加不同规格尺寸、标识定位、背胶等功能,发明了一种眼科手术铺巾[专利号:国家实用新型专利(ZL 201921410018.3)]。该种眼科手术铺巾采用一次性防水无纺布为主要制作材料,具有规格多样、结构简单、便于操作、无菌屏障功能更强等特点,能更好地满足眼科手术术前消毒铺巾的使用要求。
In order to make ophthalmic surgical draping safer, more convenient and easier to operate, this research team invented an ophthalmic surgical drape [patent number: National Utility Model Patent (ZL 201921410018.3)] based on the original ophthalmic surgical drape, adding functions such as various sizes, marking and positioning,and glutinosity. This kind of ophthalmic surgical drape is made of disposable waterproof non-woven fabric, which has the characteristics of various specifications, simple structure, easy operation and strong function of aseptic barrier, which can better meet the requirements of disinfection drape before ophthalmic surgery than the original drape.
为在眼科日间手术模式下既能满足玻璃体视网膜术后体位需求,又能合理利用有限空间,本研究团队在原有的眼科日间病房座椅的基础上,增加玻璃体手术后体位护理等功能,发明了一种护理座椅[专利号:国家实用新型专利(ZL 2017 2 0942404. 1)]。该座椅采用钢喷塑(或不锈钢)、木板、海绵和人造革皮等材料,其结构主要包括座椅的主体部分、俯卧台、杂物篮、收纳架、输液杆套筒等部分。其制作材料简单,操作方便,安全使用,既能保证临床体位护理需求,又能节省空间,便于病房环境管理。
To meet the needs of the postoperative position nursing after pars plana vitrectomy in the day surgery mode,this research team has designed a nursing chair [patent number: National Uutility Model Patent (ZL 201720942404. 1)] based on the original chair of ophthalmic day ward, adding the functions of postvitreous nursing and so on. The seat is made from steel spray plastic (or stainless steel), wood, sponge and artificial leather, and the structure mainly consists of the main body, the countertop for prone position, the junk basket, the storage rack, and the infusion rod sleeve. The seat can be made by simple materials. The seat is easy to operate and safe to use, which can not only meet the needs of clinical body position nursing care, but also save the ward’ space and facilitate the environmental management of the ward.
目的:调查眼病患儿家长在患儿手术前的健康教育需求,为责任护士开展个性化、高质量的健康教育提供依据。方法:采用自制的眼病儿童手术前家长的健康教育需求调查问卷对2020年4月至2020年6月的眼病手术患儿家长进行问卷调查,并对调查结果进行统计分析。结果:家长对眼病患儿手术术前健康教育需求排名前3位的是手术治疗的效果、意义及眼病相关专科健康知识。医疗付费方式的差异、患儿年龄、疾病的差异及家长年龄、职业状态的差异对术前健康教育需求得分差异有统计学意义(P<0.05);家长获取健康教育知识的途径以医务人员讲解和公众号等网络平台为主。结论:眼病患儿家长对患儿术前健康教育需求较高,医务工作者应丰富知识层面,加强专科学习及相关知识培训,把专科知识与健康教育有机地结合,并探索有效的线上健康教育方式,更好地为患者服务。
Objective: To investigate the health education needs of parents of children with eye diseases before operation, and to provide basis for more targeted and high-quality health education for primary nurses. Methods: A self-made questionnaire was used to investigate the health education needs of parents of children with ophthalmopathy before surgery from April 2020 to June 2020, and the results were statistically analyzed. Results: The top three of parents’ needs for preoperative health education of children with eye diseases were the effect and significance of the surgery and the related professional health knowledge of eye diseases. The differences of medical payment methods, children’s age, diseases, parents’ age, and occupational status was significant in the scores of preoperative health education needs (P<0.05). The main ways of parents obtaining health education knowledge were network platforms such as medical staff explanation and official accounts. Conclusion: The parents of children with eye diseases have a high demand for preoperative health education. Medical workers should enrich their knowledge, strengthen specialty learning and related knowledge training, organically combine professional knowledge with health education, and explore the methods of effective online health education to serve patients better.
目的:构建具有较强科学性和实用性的眼科专科护士培训体系,为眼科专科护士的准入、培养、考核提供理论基础。方法:通过查阅文献、焦点小组和专家会议法,拟定眼科专科护士培训体系的课程、带教、评价体系。结果:构建的眼科专科护士培训体系内容包括课程体系、培训过程、临床实践指标、考核评价方法4个部分。其中,课程体系部分包含一级指标5项,二级指标11项,三级指标55项;培训过程包括一级指标4项、二级指标12项;临床实践指标包括一级指标6项、二级指标23项;考核评价方法包括一级指标5项、二级指标10项。结论:眼科专科护士培训体系构建过程科学,内容设置合理,对开展专科护士培训具有较好的指导意义。
Objective: To develop a scientific and practical training system for ophthalmic specialist nurses and provide theoratical basis for the the admission, training and assessment of ophthalmic specialist nurses. Methods: Through extensive review of domestic and foreign literatures, a focus group interview and an expert meeting, the curriculum, teaching and evaluation system of the ophthalmic specialist nurses training system was developed.Results: The training system for ophthalmic specialist nurses consists of four parts: training content, training process, clinical practice, assessment and evaluation. Among them, the training content includes 5 first-level indicators, 11 second-level indicators and 55 third-level indicators. The training process of ophthalmic specialist nurses includes 4 indicators of the first level and 12 indicators of the second level. The clinical practice indexes of ophthalmic specialist nurses include 6 indexes of the first grade and 23 indexes of the second grade. The methods of assessment and evaluation of ophthalmic specialist nurses include 5 indicators of the first level and 10 indicators of the second level. Conclusion: The scientific process and reasonable content of the training system for ophthalmic specialist nurses have a good guiding significance for the training of ophthalmic specialist nurses.