中文摘要
目的：
探讨舒适护理模式对门诊手术患者术前焦虑情况、围手术期血压和心率情况、术后晕厥发生情况及术后患者对护理工作的满意度的影响，为进一步开展门诊手术患者舒适护理服务提供科学依据。
方法：
将 2012 年 6 月~2013 年 12 月在解放军第 208 医院接受门诊手术的 100 例患者按就诊先后顺序进行编号，单号为干预组，双号为对照组，每组各 50 例。两组患者的一般资料、术式具有可比性（P>0.05）。对干预组患者实施舒适护理模式，对照组实施普通护理模式。
术前用 Beck 焦虑量表对患者进行术前焦虑测验和评估；使用多功能监护仪测量患者手术前、手术中、手术后的血压和心率；观察患者术后发生晕厥的情况并记录；手术后护理人员向患者发放问卷调查表，以获得患者对护理工作的满意度评价。采用 SPSS17.0 统计软件对数据进行分析处理，定量资料采用 t 检验或秩和检验，定性资料两组间的比较采用 χ2检验，以P<0.05 为有统计学意义。
结果：
1. 干预组运用舒适护理模式干预前，与对照组在血压、心率及焦虑得分无显着性差异（P>0.05），具有可比性。
2. 干预组运用舒适护理模式干预后，患者术前焦虑得分低于对照组，差异具有统计学意义 P<0.01.
3. 干预组运用舒适护理模式干预后，与对照组患者术中血压和心率差异具有显着性，血压值均低于对照组（P<0.01）；干预组患者术中心率低于对照组，差异具有统计学意义（P<0.01）。
4. 干预组运用舒适护理模式干预后，与对照组患者术后收缩压、舒张压、心率经统计分析差异均有统计学意义（P<0.05）。
5. 干预组运用舒适护理模式，术后与对照组患者对护理工作的满意率存在差异（P<0.05）。
6. 干预组与对照组患者术后晕厥发生率无统计学意义（ P>0.05）。
结论：
1 运用舒适护理模式，体现人文关怀，可以降低患者的焦虑情绪，使患者处于平稳的生理状态，有利于顺利开展手术。
2 运用舒适护理模式，护士在手术前给患者提供感觉与认知方面的信息，有利于提高患者对护理服务质量的满意度。
关键词：
舒适护理模式；门诊手术；焦虑
Abstract
Application research on comfortable nursing model for outpatient operationObjective:
The effect of comfort care model on preoperative anxiety, perioperative blood pressure andheart rate, and postoperative syncope of the patients, as well as their satisfaction with the nursingwork were investigated, so as to provide scientific basis for further implementation of comfortcare model for patients receiving outpatient operationMethods:
Through random sampling method, a total of 100 patients admitted by the PLA No.208Hospital from June 2012 to December 2013 were numbered by the sequence they were admitted,and were divided into an intervention group and a control group by the number in single,double.50 cases for each. The baseline date of general information and operation mode werecomparable between the two groups without significant difference （P>0.05）。 Patients in theintervention group received comfort care model, while the control group received conventionalcare model. The Beck Anxiety Inventory （BAI） was used to access preoperative anxiety of thepatients; a multi-function monitor was used to monitor preoperative, perioperative andpostoperative blood pressure and heart rate; postoperative syncope of the patients was alsoobserved and recorded. After the operation the nurses gave out questionnaire to patients in order toaccess their satisfaction with the nursing work. The data were processed with SPSS 17.0 statisticalsoftware. Quantitative data were analyzed by t-test or rank sum test, and comparison of qualitativedata between two groups was performed by χ2 test. P <0.05 was considered statisticallysignificant.
Results:
1.Before application of comfortable nursing model, blood pressure, heart rate, BAI scoresbetween the intervention group and the control group had no significant difference（P > 0.05），being comparable.
2.After application of comfortable nursing model, BAI score of the intervention group wassignificantly lower than that of the control group .The difference was statistically significant（P<0.01）。
3.After application of comfortable nursing model, the differences between the interventiongroup and the control group in blood pressure and heart rate of patient was significant; bloodpressure values of the intervention group were significantly lower than that of control group（P<0.01）。Heart rate of the intervention group was lower than that of control group, the differencestatistically significant （P<0.01）。
4.After application of comfortable nursing model, the differences between the interventiongroup and the control group in the systolic pressure, diastolic pressure, heart rate showedsignificant differences through statistical analysis （P<0.05）。
5.After application of comfortable nursing model, the differences between the interventiongroup and the control group in nursing work satisfaction evaluation score from the patients wassignificant （P<0.05）。
6.Before or after the intervention of comfortable nursing model, the incidences of patientwith syncope had no statistical significance （P > 0.05）。
Conclusions:
1.Application of comfort care model,which embodied humanistic care, can reduce the anxietyof patients and keep patients stable in physiological state,so that it is conducive to the operation smoothly.
2.Through application of comfortable nursing mode, the nurses provide the patients with sensory and cognitive information before the operation, which helps to improve the patients' satisfaction to nursing service quality.
Keyword:
Comfortable nursing model; Outpatient surgery; Anxiety;
目 录
中文摘要 ……Ⅰ
Abstract……Ⅲ
第 1 章 绪论 ……1
1.1 护理模式的定义及发展 ……1
1.2 舒适护理模式概述 ……1
1.2.1 护理与舒适 ……1
1.2.2 舒适护理的概念 ……2
1.2.3 舒适护理的内涵 ……2
1.2.4 舒适护理的分类 ……3
1.2.5 舒适护理模式的特点 ……3
1.2.6 舒适护理模式的可行性 ……4
1.2.7 影响实施舒适护理的各种因素 ……5
1.3 舒适护理模式的研究进展 ……6
1.3.1 国外研究进展 ……6
1.3.2 国内研究进展 ……8
1.4 研究的目的与意义 ……9
1.4.1 研究目的 ……9
1.4.2 研究的意义 ……9
第 2 章 研究对象与方法……11
2.1 研究对象 ……11
2.1.1 患者来源 ……11
2.1.2 纳入标准 ……11
2.1.3 研究对象的排除标准 ……11
2.1.4 分组方式 ……11
2.2 研究工具与评价指标 ……11
2.3 干预措施 ……12
2.3.1 手术前舒适护理干预 ……12
2.3.2 手术中舒适护理干预 ……13
2.3.3 手术后舒适护理干预 ……14
第 3 章 结果 ……16
3.1 干预组与对照组患者一般资料比较 ……16
3.2 干预组与对照组患者的手术方式情况比较……16
3.3 干预组与对照组患者手术前焦虑状况比较……16
3.4 干预组与对照组患者围手术期血压水平状况比较……17
3.5 干预组与对照组患者围手术期血压与基础血压差值情况比较……17
3.6 干预组与对照组患者围手术期心率状况比较……18
3.7 干预组与对照组患者围手术期心率与基础心率差值情况比较……18
3.8 干预组与对照组患者对护理工作的满意度比较……18
3.9 干预组与对照组患者手术后晕厥的发生情况比较……19
第 4 章 讨论 ……20
4.1 舒适护理模式对患者手术前焦虑水平状况的影响……20
4.2 舒适护理模式对患者围手术期血压与心率的影响……20
4.3 舒适护理模式对护理工作的满意度评价的影响……21
4.4 舒适护理模式对患者术后晕厥的影响 ……21
4.5 影响舒适护理模式的因素 ……22
4.6 促进舒适护理模式开展的有效手段 ……23
第 5 章 结论与展望 ……25
附录……26
参考文献 ……28
致 谢……33
