Excellent model of graduation thesis for college students majoring in nursing 1
Effect of evidence-based nursing on prognosis of hypertensive cerebral infarction
Objective To explore the effect of evidence-based nursing on the prognosis of patients with hypertensive cerebral infarction. Methods 92 patients with hypertension complicated with cerebral infarction were randomly divided into experimental group and control group, 46 cases in each group. Patients in the control group were given routine nursing care for hypertensive cerebral infarction, while patients in the experimental group were given evidence-based nursing care from health education, eating habits, medication compliance, psychology and self-management. After discharge, they were followed up regularly by phone or WeChat for 3 months, 6 months, 12 months and 24 months. The lifestyle, blood pressure, blood sugar and WeChat were compared between the two groups. Results Two years after discharge, the experimental group was better than the control group in controlling blood pressure, lifestyle, blood sugar, blood lipid, weight and cardiovascular and cerebrovascular accidents, with statistical significance (P < 0.05, P & lt0.0 1 or P
Key words: evidence-based nursing; Hypertension; Cerebral Infarction
The results of the third sampling survey on the causes of death among residents in China in 2008 show that stroke has become the first cause of death in China, with five characteristics: high morbidity, high mortality, high recurrence rate, high disability rate and heavy economic burden, which is a serious social development and public health problem in China. According to the survey, 7 1.4% of stroke patients suffered from hypertension before stroke [1]. Therefore, the prevention of stroke is the top priority in the treatment of hypertension in China. The popularization of hypertension prevention knowledge and lifestyle will affect the therapeutic effect of patients with hypertension complicated with cerebral infarction [2]. Patients' irregular medication, psychological factors and self-management behavior after discharge will all affect the control of cerebral infarction. From the perspective of evidence-based nursing, this study aimed at the above problems and adopted evidence-based nursing intervention, which achieved satisfactory results in improving the prognosis of hypertensive cerebral infarction.
1 data and methods
1. 1 general information
2065438+Choose our hospital in July 2003? 92 patients with hypertension complicated with cerebral infarction treated in July 20 14 were investigated. All patients meet the diagnostic criteria of hypertension except those with communication and cognitive impairment, malignant hypertension, progressive aggravation and severe organ failure. Cerebral infarction was diagnosed by head CT scanning or magnetic resonance imaging (MRI). Male 5 1, female 4 1, aged 37 years. There were 26 males in the experimental group, accounting for 56.52%; 20 cases were female, accounting for 43.48%; The age ranged from 45 to 80, with an average age (65.6? 7.5) years old, the course of disease 1 ~ 27 years. There were 25 males in the control group, accounting for 54.35%; 2 1 case is female, accounting for 45.65%; The age ranged from 50 to 78, with an average age (66.3? 6.2) years old with a course of 3-25 years. There was no significant difference in baseline data such as age, sex, weight, education level and primary disease type between the two groups (P & gt0.05), which was comparable.
1.2 nursing methods
1.2. 1 The control group received routine care for hypertensive cerebral infarction, that is, observing the condition, observing consciousness, pupils and vital signs according to the doctor's advice, and correctly implementing various treatments and nursing. 1.2.2 The experimental group used evidence-based methods to find out the main problems affecting the poor control of patients with hypertensive cerebral infarction, including lack of disease knowledge, poor lifestyle, poor medication compliance, psychological factors, poor self-management after discharge, and implemented nursing intervention from these aspects.
1.2.2. 1 Health knowledge education Patients with hypertension and cerebral infarction at all stages have a lack of health knowledge and unsatisfactory health behavior, and the level of health knowledge is directly proportional to health behavior [3]. The implementation of personalized health education can improve the level of health knowledge, thus improving unhealthy behavior and reducing the incidence of stroke [4]. During the patient's hospitalization, the responsible nurse investigates and collects the patient's positive examination results and related information about stroke, analyzes the risk factors of stroke [5], formulates appropriate education methods, issues targeted health promotion manuals, and carries out personalized health education by the responsible nurse. The main contents of health education include stroke risk factors, stroke precursors, stroke management, medication guidance, healthy diet and living habits, and the importance of reaching the standard of blood pressure. Patients and their families can patiently and repeatedly understand and cooperate, actively participate in treatment and nursing, and actively improve their lifestyle, which can effectively achieve better blood pressure control goals. Before the patient leaves the hospital, the nurse in charge should strengthen education according to the problems still existing in the questionnaire, deepen the patient's understanding of disease prevention, and strengthen the consciousness of taking medicine on time after discharge, and guide the patient not to increase or decrease drugs without authorization, and at the same time guide the patient to measure blood pressure correctly, self-monitor blood pressure, and guide the patient to visit the outpatient clinic regularly.
1.2.2.2 Healthy diet and lifestyle guide nursing intervention, which is helpful to control patients' blood pressure and improve prognosis [6]. What is the diet life of hypertensive stroke patients? Four cornerstones of health? Guidance, that is, reasonable diet, moderate exercise, smoking cessation and alcohol restriction, psychological balance. People who usually eat more fruits and vegetables have less chance of stroke and reduce the intake of dietary fat and salt? 6g/d, 3 ~ 4 eggs per week [7], and control of total calories, reasonable diet and moderate exercise can effectively control weight and reduce obesity. Exercise is regarded as one of the non-drug treatment measures in hypertension guidelines at home and abroad, and it must be combined with exercise frequency, duration and intensity: at least three times a week, each time for more than half an hour, and the intensity is suitable for heart rate 170- age. Proper intensity, step by step, not suitable for morning exercise on an empty stomach and excessive exercise, preferably at 4 ~ 5 pm, to avoid excessive movements and postures, such as body rotation, bending back, excessive bending, etc. [8], reduce the occurrence of cardiovascular and cerebrovascular accidents.
1.2.2.3 Psychological nursing will accompany patients with different degrees of psychological disorder after stroke. It is reported in domestic and foreign literatures that 50% of acute stroke patients have different degrees of depression [9], and the peak of depressive symptoms appears within 2 ~ 6 months after illness. Paying attention to psychological nursing can effectively treat diseases and improve the therapeutic effect [10]. Therefore, it is necessary to do psychological care for patients during hospitalization and after discharge. First of all, it shows that the development, prognosis and therapeutic effect of diseases are closely related to people's own psychological factors. Medical staff and their families give patients psychological support therapy such as comfort, encouragement and understanding, encourage patients to communicate with others, find out the breakthrough of psychological barriers, and implement psychological care in a targeted manner, so that patients can get out of the shadow of the disease, accept and face up to the occurrence of the disease, improve their anxiety, and promote patients to actively participate in rehabilitation training [165438+] The second is exercise therapy, in which patients are trained actively and passively at an early stage after their condition is stable. Third, drug treatment, patients with excessive anxiety and depression take oral drugs under the guidance of doctors to improve their mood.
1.2.2.4 instruct patients to take medicine on time. During hospitalization, guide patients to take drugs correctly and on time, and improve patients' medication compliance. Studies have shown that poor medication compliance is the main factor of re-admission of stroke patients [12]. The methods to strengthen taking medicine on time include setting an electronic alarm clock on the mobile phone, establishing an oral drug distribution list, and signing by both nurses and patients to prevent leakage. Nurses' bedside education focuses on the three cornerstones of secondary prevention of stroke: antithrombotic drugs, statins and antihypertensive drugs. If these three drugs have no contraindications and adverse reactions, they need to be taken under the guidance of a doctor for a long time. Hyperhomocysteine in hypertensive stroke patients and instructing them to take folic acid tablets for a long time can reduce the recurrence rate of stroke and do a good job in health education of adverse drug reactions, which is emphasized in discharge guidance.
1.2.2.5 Nursing intervention on patients' self-management behavior Pay attention to follow-up after discharge, establish health records for patients with hypertension and stroke, and follow up regularly for 3 months, 6 months, 12 months and 24 months after discharge to find out whether patients have self-management abilities such as regulating medication, self-monitoring blood pressure and unhealthy lifestyle, and carry out targeted health education. Regular follow-up can effectively control the self-management behavior of patients, develop a good lifestyle, effectively control the blood pressure of patients with hypertension complicated with cerebral infarction, and improve their prognosis and quality of life [13]. Let patients and their families with mobile phone WeChat scan the code, join the WeChat group for stroke prevention and treatment, send out health knowledge related to hypertension and cerebral infarction in the circle, and provide an information platform for mutual exchange, which is convenient for continuing education and follow-up after discharge, and has been affirmed by patients and their families, improving satisfaction.
Effect evaluation of 1.3
Health questionnaires were conducted in the experimental group at the time of admission, before discharge, after discharge 1 year and 2 years after discharge. The questionnaire was designed by ourselves and investigated by trained personnel. Questionnaire ① is a questionnaire about stroke health knowledge, including four items, including blood pressure classification, stroke risk factors, stroke precursors and stroke management, with 26 questions. Know or not know? For the evaluation results. Questionnaire ② is about lifestyle and medication compliance: including low-salt and low-fat diet, vegetables, fruits, cigarettes, alcohol, exercise and medication compliance, which is divided into regular (medication is routine), occasional, little, no, and regular or routine is excellent. Eat vegetables every week? Five times as a frequent visitor, Fruit Weekly? Three times the law, exercise every week? 3 times as normal. Besides lifestyle? No smoking, no drinking? As excellent, other lifestyles and medication compliance are judged as? Often? They are all considered excellent. Questionnaire ① and ② were completed at the time of admission, and the results of the two questionnaires were analyzed and evaluated during hospitalization, and evidence-based nursing such as health education and guidance was given individually. Before leaving the hospital, the patients were investigated by questionnaire again, and the patients with insufficient health knowledge were given repeated guidance. After discharge, they were followed up by telephone or WeChat for 3 months, 6 months, 12 months and 24 months respectively. To investigate whether patients have five kinds of cardiovascular and cerebrovascular accidents: new stroke, transient ischemic attack, coronary heart disease, myocardial infarction and acute coronary syndrome. Visit the stroke prevention clinic once a year, and review blood sugar and blood lipid at least once a year to understand the self-management behavior of patients. Patients have bad behaviors such as smoking, lack of exercise, disobedience or occasional use of secondary preventive drugs for stroke. Two years after discharge, the differences of blood pressure, lifestyle, medication compliance, blood sugar, blood lipid, weight and cardiovascular and cerebrovascular accidents between the two groups were compared.
1.4 statistical method
SPSS 13.0 statistical software package was used for statistical analysis. Use of counting data? 2 test, the measurement data adopts t test, P
2 effect
2. 1 Comparison of excellent and good lifestyle rate and medication compliance between the two groups after discharge.
The average excellent and good rate of lifestyle in the experimental group was 82.61%(152/184), which was higher than that in the control group (50.54%, 93/ 184). The difference between the two groups was statistically significant (? 2=42.5 1，P & lt0.00 1); The medication compliance was also better than that of the control group, with statistical significance (P
3 discussion
Hypertension is the most important risk factor for stroke [14]. Research shows that every decrease in systolic blood pressure 1.33kPa or diastolic blood pressure/0.665kPa can significantly reduce the risk of stroke by 4 1% [15], so active blood pressure reduction is the key to prevent stroke. In this study, evidence-based methods were used to find out five problems that affect the poor control of patients with hypertensive cerebral infarction, and the best individualized nursing and nursing decision were selected [16], which not only improved the satisfaction of nursing work, but also realized the patients' desire to prevent and treat diseases. Health education on stroke prevention and treatment not only emphasizes drug therapy such as lowering blood pressure, lowering blood lipid and preventing thrombosis, but also includes education on patients' basic diseases, such as hypertension, hyperlipidemia, diabetes and other related risk factors, bad living habits, diet and daily life. Whether education is in place is related to the comprehensive quality of nurses, such as knowledge mastery and sense of responsibility. The qualification of full-time follow-up staff of stroke needs to be higher, and they should be nurses with extensive knowledge of stroke prevention and treatment. During the follow-up period, it was found that smoking control was relatively poor, and some patients relapsed after quitting smoking. Health education should also pay attention to the harm of passive smoking. For hemiplegic patients, exercise should be moderate, master the correct rehabilitation exercise methods, pay attention to safety, prevent falls, and avoid joint ligament damage caused by improper exercise. After injury, patients resist rehabilitation exercise because of pain and fear of falling, which affects prognosis and quality of life.
The people with poor health behavior and medication compliance are elderly patients with poor economic conditions, low education level and over 70 years old. These people have a low degree of family support and cooperation. How to improve the healthy behavior of these people needs to be studied. This study also found that health education and follow-up management after discharge play an important role in preventing the recurrence of stroke. Through long-term follow-up management, the knowledge of stroke prevention and treatment is repeatedly preached to improve the health literacy of patients and the awareness of early diagnosis and treatment. Once the disease occurs, knowing how to identify the precursors of stroke and seeing a doctor in a hospital with thrombolytic conditions in time can reduce the disability rate and mortality rate of stroke recurrence. The results of this study show that long-term follow-up is an important measure to prevent and treat stroke. At present, there is a shortage of clinical nurses, and stroke patients receive less support and nursing services after discharge [17]. Rehabilitation training for stroke patients after discharge is mainly managed by the community, which can improve their daily living ability and quality of life [18]. However, a long-term mechanism for training community medical staff on the knowledge of stroke prevention has not yet been established. As the main force of primary prevention of stroke and secondary prevention after discharge, community nurses are unfavorable to the prevention and treatment of stroke. The comparison between the experimental group and the control group shows that the five nursing schemes in evidence-based nursing can effectively control the main high-risk factors of stroke, so that the hyperglycemia, hyperlipidemia, obesity and unhealthy lifestyle of patients with cerebral infarction can be effectively controlled, thus reducing the recurrence rate of stroke and improving their prognosis and quality of life, which is worthy of clinical recommendation.
References:
[1] Wan Lihong, Zhang Xiaopei, Hong Hua, et al. Study on health behavior of stroke patients and its influencing factors [J]. Nursing research: early edition, 20 10/0,24 (1):1-4.
[2]VERBERKWJ, KROONAA, LENDERSJW, etal. Self-measurement of blood pressure reduces the demand for antihypertensive drugs: a randomized controlled trial [J]. Hypertension, 2007,50 (6):10/9-1025.
[3] Deng Shifeng, Xiao Shan, Wan Lihong, et al. Study on the current situation and correlation between health knowledge and health behavior in patients with hypertension complicated with stroke [J]. Modern Clinical Nursing, 20 13,12 (1):1-.
Li, Huang, et al. Investigation on knowledge, attitude and behavior level of stroke patients and their families about stroke and rehabilitation [J]. China Rehabilitation Theory and Practice, 2009, 15 (3): 252-254.
[5] Mitkam. Lifestyle change Keytocuttstrokerisk: guidelines place emergency physiciansonfrontline [j]. JAMA, 20 1 1, 305(6):55 1-552.
[6] Feng Gong Ann, Liu Hong. Study on the influence of nursing intervention on lifestyle and curative effect of patients with hypertension [J]. Contemporary Medicine, 20 12,18 (11):122-123.
[7] Cerebrovascular Disease Group of Neurology Branch of Chinese Medical Association. Guidelines for primary prevention of stroke? Writing group. Guidelines for primary prevention of stroke in China (20 10)[J]. Liuzhou medicine, 2012,25 (3):151.
Ye Lihua, Tang, Correlation analysis between health behavior self-efficacy and family function in elderly patients with hypertension complicated with stroke [J]. Qilu Nursing Journal, 20 13, 19 (8): 3-5.
[9]CAEIROL, FERROJM, SANTOSCO, etal. Depressive stroke [J]. Journal of Neuroscience, 2006,31(6): 377-383.
Li Limei. Psychological nursing of depression after cerebrovascular disease [J]. Frontiers of Medicine, 2012,2 (4): 224-225.
[1 1] Wei, Huang Yongchun, et al. Effect of psychological intervention on anxiety state of stroke patients [J]. Journal of Youjiang Medical College for Nationalities, 2013,35 (3): 420-421.
Excellent model of graduation thesis for nursing students II
Discussion on perioperative clinical nursing of gynecological diseases complicated with diabetes mellitus
Objective To explore the clinical nursing effect of gynecological diseases complicated with diabetes in perioperative period. Methods Thirty-four patients with gynecological diseases complicated with diabetes who were hospitalized in our hospital from March 438+05, 1965 to March 438+06, 1965 were selected as the research objects of this medical study. After admission, they were randomly divided into observation group and control group, each group 17 cases. The control group was given routine nursing methods, while the observation group was given nursing intervention on the basis of routine nursing. After the treatment, the hospitalization time, intraoperative blood loss and nursing satisfaction of the two groups were compared. Results The hospital stay and intraoperative blood loss in the observation group were better than those in the control group, and the nursing satisfaction of the former was significantly higher than that of the latter, with statistical significance (P
Obstetric and gynecological diseases; Diabetes; Perioperative period; clinical care
1 data and methods
1. 1 general information
Thirty-four patients with gynecological diseases complicated with diabetes admitted to our hospital from March 20 15 to March 20 16 were selected as the subjects of this medical study. Divided into observation group and control group, 65438 07 cases each. The control group was 26-52 years old with an average age of (39. 14? 1.94) years old; Course of disease 1 ~ 10 months, with an average course of disease (5.8 1? 0.8 1) months. The control group was 27-54 years old with an average age of (39.68? 2.02) years old; The course of disease was 2 ~ 9 months, with an average course of disease (5.63? 1. 1 1) months. There was no significant difference in age and course of disease between the two groups (P & gt0.05).
1.2 method
Preoperative nursing: After the patient is admitted to the hospital, routine examination should be done for the patient, and the nursing staff should also make effective and targeted psychological nursing plan for the patient according to the actual psychological situation of the patient. Pay attention to the changes of patients' blood sugar, and reasonably arrange and control patients' diet, especially the intake of salt substances [1]. Nurses need to tell patients to use drugs scientifically and rationally in order to control blood sugar within a reasonable range. Three days before the operation, let the patient clean the vagina with ozone and do a good job to avoid infection. The day before the operation, the nursing staff need to do a good job of catharsis, so that the patient can discharge the feces in the intestine. Intraoperative nursing: Nurses need to know exactly the medical instruments needed by doctors during the operation, and observe the vital signs of patients at all times, and notify doctors immediately if there is any abnormality. In addition, effective psychological care is needed to improve patients' confidence in fighting diseases and divert their attention. Postoperative care: Nurses need to observe the changes of patients' vital signs at all times, and let patients use insulin reasonably and scientifically to help patients recover. Patients need to be informed to scrub perineum every day to keep it clean and prevent infection [2]. In addition, nurses need to strengthen the indwelling care of catheters, and must ensure the hygiene and cleanliness of indwelling catheters to avoid infection. Patients can be encouraged to exercise reasonably according to their own actual situation after operation to avoid complications [3].
1.3 observation index
After the treatment, the hospitalization time, intraoperative blood loss and nursing satisfaction of the two groups were compared. 1.4 statistical methods SPSS 19.0 statistical software was used for data analysis. x？ s？ Said measurement data, t test, percentage (%) said count data, x2 test, P.
Two results
2. 1 Compare the hospitalization time and intraoperative blood loss between the two groups.
The hospital stay and intraoperative bleeding in the observation group were lower than those in the control group, and the difference was statistically significant (P
2.2 Comparison of nursing satisfaction between the two groups
The nursing satisfaction of the patients in the observation group was 94.65438 0.2%, while that of the patients in the control group was 64.765438 0%, the difference was statistically significant (P < 0.05).
3 discussion
Diabetes will seriously affect the surgical effect of patients with gynecological diseases to some extent. If the patient's blood sugar is not effectively controlled, the patient is prone to acidosis and coma during gynecological surgery. Our hospital found that nursing intervention has a significant effect on gynecological diseases complicated with diabetes, which can improve the quality of life of patients. Therefore, the hospital stay and intraoperative blood loss of patients in the observation group were lower than those in the control group. The nursing satisfaction of patients in the observation group was 94.65438 02%, while that of patients in the control group was 64.765438 0%, with statistical significance (P < 0.05). Therefore, the perioperative nursing intervention for patients with gynecological diseases complicated with diabetes has a good effect, which is worthy of clinical promotion and study.
refer to
Zhu Hongmei. Discussion on strengthening perioperative nursing strategy of gynecological surgery patients complicated with diabetes [J]. Diabetes New World, 20 15, (16):140-141.
[2] Yang Xiu. Perioperative nursing care of elderly patients with gynecological tumor complicated with diabetes [J]. Diabetes New World, 20 14, (2 1): 102.
[3] Jia Yanhuan, Li Yuling. Analysis of perioperative clinical nursing care of gynecological diseases complicated with diabetes mellitus [J]. Nursing Research, 2014,28 (10): 3535-3536.
Guess you like:
1. references for graduation thesis of nursing specialty in colleges and universities
2. Reference examples of graduation thesis of nursing major in colleges and universities
3. Model essay on college nursing graduation thesis
4. Model essay on college students' nursing papers
5. Free thesis for graduation thesis of nursing major.
6. Download the model essay of graduation thesis of college nursing major.