Orthopedic medical papers, model articles, 1 on orthopedic nursing work
In order to improve the quality of orthopedic nursing and further highlight the importance of nursing work, the orthopedic ward of our hospital has specially set up related work with humanization as the nursing theme, which has been solidly promoted in the work and achieved good results in humanized management of nursing work. Explain the necessity of developing humanized nursing service in orthopedic ward. It also laid a foundation for our hospital to better occupy the market.
Keywords humanization of orthopedic nursing
With the transformation of medical model from biological model to biological-social-psychological model, the concept and importance of nursing are also changing. In recent years, the concept of humanization is going deep into nursing work, and the guiding ideology of patient-centered is going deep into the hearts of treatment and nursing workers.
1 Promotion and education of humanistic nursing concept
To carry out humanized nursing service, we must first understand the concept of humanized service. Only by fully understanding what humanized nursing and service are, can humanized nursing be carried out correctly in orthopedic nursing work. To this end, our hospital has specially set up courses related to humanistic care and humanized nursing, so that every nursing staff can fully understand the advanced nursing development trend, understand the concept and requirements of humanized nursing service, and lay a theoretical foundation for carrying out humanized nursing work in wards. At the same time, it also pays attention to the practical work of nursing effectiveness, strengthens humanized nursing behavior and language training, and formulates detailed behavioral norms and standards. And implement and popularize it in the work.
2 the embodiment of humanized nursing in orthopedic ward
2. 1 Humanized nursing at admission
Most patients in orthopedic hospitals have fractures, which are life-threatening in severe cases. When first admitted to the hospital, patients often have severe pain and are unfamiliar with the treatment work. Patients (family members) are often worried about whether there are life-threatening and sequelae. Some patients are treated with bone traction or plaster or splint external fixation after admission, and severe cases will go directly to the operating room. These therapeutic behaviors will increase the fear of patients (family members).
Therefore, nurses should take the initiative to care for and comfort patients (family members), treat patients as relatives, put themselves in the patient's shoes, introduce the hospitalization environment, the doctor in charge and the nurse in charge to patients in detail in kind and enthusiastic language, make good living arrangements during hospitalization, and let patients (family members) know that the doctor in charge has rich clinical experience, which will certainly help them relieve their pain, reduce their ideological burden, and produce and improve medical services. Patients often complain of pain, and nurses should take the initiative to comfort patients, paying attention to the nature, location and progress of pain, swelling of affected limbs, peripheral blood supply, finger (toe) movement and feeling. Patiently explain the causes and laws of pain to patients. Let them relax, divert their attention and enhance their confidence in overcoming pain.
2.2 Humanized nursing in perioperative period
2.2. 1 preoperative care
Before operation, it is very necessary to enhance patients' self-confidence and overcome preoperative fear. Make patients grasp health knowledge faster and better, and stabilize their mood, which can enhance the confidence of surgical treatment. Nurses are required to patiently introduce the operation to them in detail, use simple and easy-to-understand language as far as possible, so that patients can gain confidence and treatment knowledge, and at the same time, they can use sedatives appropriately according to the doctor's advice to help them get through the preoperative fear period. The nurse in charge should educate and comfort patients before operation, explain the importance of skin preparation before operation, how to cooperate with doctors and nurses during operation, and matters needing attention after operation. At the same time, when making preoperative preparation, the movements should be as gentle as possible to avoid the discomfort caused by preoperative preparation, which will lead to emotional fluctuations of patients and increase the difficulty of treatment.
postoperative care
After the operation, the patient returns to the ward after anesthesia, and the nurse should go to the bedside in time to make a shift change with the anesthesiologist. Actively communicate with patients and their families, indicating that the operation has been completed, and let patients and their families know that the operation is successful. Understand the psychological and emotional changes of patients and try to meet their needs. Always smiling, with dignified appearance, caring language and warm and sincere attitude, to alleviate the pain caused by patients' surgery; By caring and respecting patients, we can alleviate the pain and enhance the confidence of rehabilitation; Through careful observation, timely reflect the patient's situation to the doctor, cooperate with the doctor to master the first-hand information, and add and subtract drugs in time to achieve the best effect of treatment and rehabilitation.
2.3 Humanized nursing and functional exercise
Postoperative functional exercise plays an extremely important role in the rehabilitation of orthopedic patients. Through the training of daily nursing courses, every nurse can understand the importance of orthopedic functional exercise and the correct exercise methods after various fractures. At the same time, patients should be aware of the necessity and timeliness of functional exercise. Nurses should use encouraging language to encourage patients to overcome pain, correctly use functional exercise methods with the guidance of doctors, and strive for an early recovery. Through specific and effective nursing, the recovery of patients can be accelerated.
2.4 Nursing staff humanized language art
The language behavior of nurses is an important means of psychological nursing, and the two-way function of language must be paid attention to. Gentle and friendly smiles and encouraging words can fully mobilize the positive emotions of patients, reduce their ideological burden and play a role in cooperating with treatment. On the contrary, rude and blunt language will cause bad stimulation to patients and even lead to iatrogenic diseases. In daily nursing work, use polite language when communicating with patients and their families; When patients encounter pain or lack of confidence, use words of comfort and encouragement; Overcome the patient's nervousness and let him relax. Avoid using blunt intonation to avoid hurting their self-confidence.
2.5 the application of humanized nursing in patients' families
Patients are hospitalized due to orthopedic diseases, and their families are also very anxious. At this time, humanization is needed. In addition to strengthening health education for patients, the nurse in charge also communicated with patients' families in time and gave health education guidance. For example, the importance of preventing three major complications for elderly bedridden patients; The importance of postoperative patient nutrition to disease rehabilitation: TCM diet care for patients with early, middle and late fractures; and timely tell their families about the treatment and let them know the purpose of treatment. To achieve the purpose of family support, patients actively cooperate with treatment and nursing work, and enhance patients' confidence in overcoming diseases.
3 Humanized management of nursing staff
The so-called humanized management refers to the realization of people-oriented management in management activities as the guiding ideology, adherence to all people-oriented, and full mobilization and stimulation of people's enthusiasm and creativity as the fundamental means to achieve the purpose of improving treatment efficiency and continuous development of people.
4. Implement humanized management for nursing staff, and continuously deepen the process of humanized management.
5. Nurses are under great pressure and have heavy daily work. The requirements of patients and society for nurses' work are constantly improving.
The core of humanized nursing service is people-oriented and respecting the needs of patients. Our hospital has mobilized the enthusiasm of nursing staff by carrying out humanized nursing and taking patients as the center. Patients' satisfaction with nursing work has also been greatly improved, and nursing work has been affirmed by patients and their families, greatly improving the quality of nursing service. Taking nursing work as the carrier, it has continuously improved our hospital's popularity, increased market share, increased our hospital's economic benefits, promoted social effects and promoted the development of nursing work.
Clinical study on traditional Chinese medicine nursing care of elderly patients undergoing hip replacement
With the increase of age, osteoporosis in the elderly is prone to fractures. Femoral neck fracture in the elderly is common in clinic, and the effect of hip replacement surgery is obvious, but for the physical condition of elderly patients, the postoperative recovery is slow. In this paper, 59 elderly patients with femoral neck fracture who underwent hip replacement in our hospital were given TCM nursing intervention, and the effect was satisfactory. The report is as follows.
1 data and methods
1. 1 general information
1 18 Elderly patients with femoral neck fracture who underwent hip replacement in our hospital on 20 10-20 13 were randomly divided into control group and observation group, with 59 cases in each group. In the control group, there were 42 males and 7 females/kloc-0, aged from 60 to 80 years, with an average age of (68.4438+0? 10.56) years old, with 35 cases of falls, 5 cases of traffic accidents and 9 cases of heavy injuries; Fracture types: 25 cases were subcephalic, 29 cases were transcervical and 5 cases were basal. Garden classification: type ⅱ 19 cases, type ⅲ 25 cases, type ⅳ 15 cases; There were 65438 05 cases of hypertension, 65438 03 cases of diabetes and 9 cases of bronchitis. There were 40 males and 9 females in the observation group, with an average age of 6 1~93 years (66.39? 1 1.27) Age, 3 1 falls, 18 car accidents, 10 heavy objects; Fracture types: 25 cases were subcephalic, 27 cases were transcervical and 6 cases were basal. Garden classification: type ⅱ 18 cases, type ⅲ 24 cases, type ⅳ 17 cases; There were 65438 06 cases of hypertension, 65438 03 cases of diabetes and 9 cases of bronchitis. There was no significant difference in sex, age, cause and type of injury between the two groups (P > 0.05). 0.05), which is comparable. Total hip replacement and hemihip replacement were performed according to the patient's condition, and active nursing measures were taken to intervene after operation.
1.2 nursing methods
The control group took routine orthopedic postoperative care, closely observed the patient's condition and vital signs, changed their posture regularly and paid attention to local blood circulation. The observation group took TCM nursing measures on the basis of the control group, and the specific methods included:
① TCM nursing based on syndrome differentiation. Most elderly patients are accompanied by liver and kidney deficiency, which is characterized by hearing loss and frequent urination at night. There are also some elderly people with poor spleen and stomach function, easy loss of appetite, indigestion and general weakness. Some elderly patients have strong heart fire, and most of them have oral ulcers and short urine. Therefore, elderly patients with femoral neck fracture should undergo various physical examinations to understand their physique and take corresponding clinical nursing measures according to the actual situation. For patients undergoing elective surgery, we can take Yiqi Buxue decoction (the prescription agreed by our hospital), Sijunzi decoction and other traditional Chinese medicines to adjust their physique according to their physical conditions. Encourage patients to eat more digestible foods such as high vitamins, high protein and high calcium, enhance the body's resistance, and improve the therapeutic effect and quality of life of surgery.
② Psychological nursing. The elderly have poor physical and psychological tolerance to accidental injuries, lack enthusiasm for surgical treatment, and are under great mental pressure. Clinical nurses should know the specific emotional and psychological situation of patients, so as to give guidance, communicate with patients more, eliminate their worries, and explain some related knowledge in combination with their illness, so that patients can adjust their mentality, improve their enthusiasm for surgical treatment and enhance their confidence in rehabilitation.
③ Pain nursing. Ask the patient's pain in time after operation, correctly evaluate the pain degree of the patient, and give reasonable analgesia methods to relieve the pain. You can use cold and hot therapy to relieve local pain, and you can also use ear points to press beans to relieve pain. For patients with severe pain, analgesic drugs can be given to relieve them. Avoid stimulating factors, keep the ward quiet and comfortable, so that patients can get enough rest.
④ Preoperative preparation and guidance. Patients with hypertension should monitor their blood pressure regularly, and patients with diabetes need to monitor their blood sugar. , thus improving various tests. Instruct patients to practice defecation in bed to avoid postoperative constipation and urinary retention [1]. For example, when the surgical patient uses the bedpan, the bedpan should be placed from the key side of the body to avoid pulling off the prosthesis at the affected part; For patients with dysuria, you can massage Zhongji point to promote urination or inject Zusanli point.
⑤ Postoperative rehabilitation nursing. After operation, patients should take early functional exercise to make ankle joint, toe joint and lower limb muscles move. On 1 day after operation, the patient was encouraged to contract the quadriceps femoris and extend and flex the ankle joint. Hip joint training began from the second day to the third day, and the practice was gradually increased according to the postoperative recovery; From day 3 to day 7, patients can sit up first and then stand by the bed for guidance. After 7 days, practice hip flexion, ranging from small to large. After 2 weeks, you can get out of bed and walk with crutches or walkers.
⑥ Prevention of postoperative complications. Dislocation of artificial joint, deep vein thrombosis and infection of lower limbs are common complications after hip replacement. Patients should exercise their ankles as early as possible after operation, and try not to use hemostatic drugs to prevent venous embolism of lower limbs. Pay attention to whether the lower limbs are swollen and whether the dorsal artery of the foot is weakened. Drink more water, reduce blood concentration and reduce the occurrence of venous thrombosis. In order to prevent dislocation of artificial hip joint, patients should lie flat on the bed after operation, avoiding internal rotation, external rotation and cross-legged, and the hip joint should not exceed 90 when sitting or standing. Flexion, if dislocation occurs, the doctor should reset it in time. Pay attention to the dryness and cleanliness of incision after operation, and use antibiotics reasonably to prevent incision infection.
1.3 criteria for judging curative effect
According to the effect of hip joint function recovery, it is divided into 4 grades, excellent: the patient's hip joint function returned to normal without pain; Good: the function of hip joint is obviously improved, and the pain of the affected limb is mild; Ke: The ability of hip joint has been improved, and the affected limb is often accompanied by pain; Poor: The function of hip joint has not recovered, and the affected limb has persistent pain. Excellent rate = (excellent+good)/total number of cases? 100%.
1.4 statistical method
SPSS 17.0 statistical software was used to analyze the research data. Are the measured data average? Standard deviation (x-? S) means t-test; The counting data is expressed by ratio (%) and tested. P & lt0.05 indicates that the difference is statistically significant.
Two results
Among the 59 patients in the observation group, the results were excellent 4 1 case (69.49%), good 16 cases (27. 12%), fair 2 cases (3.39%) and poor 0 cases. The excellent and good rate was 96.665438 0%, and the incidence of complications was 0.
Among 59 patients in the control group, 33 cases were excellent (55.93%), 65,438+065,438+0 cases were poor (65,438+08.64%), 9 cases were fair (65,438+05.25%) and 6 cases were P< (65,438+05.25%). 0.05)。
3 abstract
With the continuous growth of age, the bones of the elderly become brittle and loose, and minor injuries can easily lead to fractures, resulting in inability to walk or stay in bed for a long time. Hip replacement surgery is an effective treatment for elderly patients with femoral neck fracture, which can restore function and relieve pain. Because the elderly are old and accompanied by other diseases, postoperative complications are easy to occur. Therefore, postoperative care and guidance plays an important role in getting out of bed as soon as possible, restoring activities and functions, and reducing complications. According to the patient's physical condition, TCM nursing measures based on syndrome differentiation, combined with psychological, pain, diet and other aspects of nursing, can reduce the occurrence of complications, improve the success rate of surgery, and promote the functional rehabilitation of the affected limb. The clinical effect is satisfactory, which is worthy of popularization and application.
refer to
Huang Lihui. Traditional Chinese medicine nursing care of elderly patients with femoral neck fracture after hip replacement. Ordinary care, 20 1 1, 9 (29): 2648-2649.