摘要目的 培养肛肠外科专科护士对拟行肠造口术的患者进行术前造口定位,以提高肠造口术前定位率及培养肛肠外科专科护士的术前造口定位能力.方法 调查2016年7-10月拟行肠造口术的148例患者术前造口定位率,并对未进行术前造口定位的原因进行分析.改变传统的肠造口术前定位由造口治疗师和医生共同定位的模式,对19名责任护士进行肠造口术前定位的培训.由经培训合格的护士对2016年11月至2017年2月拟行肠造口术156例患者进行术前造口定位.比较改变模式前后术前造口定位率、定位准确率、护士造口定位知识掌握率.结果 转变模式前术前造口定位率为91.89%(136/148),转变模式后为98.72%(154/156),差异有统计学意义(χ2=8.06,P<0.05),其中未定位原因为造口治疗师不足,对周末手术、晚夜间急诊手术的患者无法进行定位.转变模式前肠造口术前定位准确率为94.12%(127/136),转变模式后为92.86%(143/154),差异无统计学意义(χ2=0.03,P>0.05).护士造口定位知识掌握率由转变模式前的8/19提高至转变模式后的18/19,差异有统计学意义(χ2=12.18,P<0.01).结论 肠造口术前定位由造口治疗师和医生共同定位转变为由培训后的护士进行定位后再由造口治疗师进行位置把关,此模式的转变提高了拟行肠造口患者术前定位率,且对定位准确率无明显影响,并培养了一批具有肠造口术前定位能力的专科护士,提高了科室整体专业水平.

abstractsObjective To cultivate specialist nurses to perform preoperative stoma site marking in patients to receive enterostomy and improve the rate of preoperative stoma site marking and the ability of preoperative stoma site marking in specialist nurses. Methods The rate of preoperative stoma site marking in 148 patients from July 2016 to October 2016 was investigated and the reason of not receiving preoperative stoma site marking was analyzed. Nineteen primary nurses were trained to perform preoperative stoma site marking instead of the traditional pattern which was performed by enterostomy therapist and physician. The training included the criteria of preoperative stoma site marking, difficult preoperative stoma site marking, demonstration, group exercises, theoretical and operational assessment. The preoperative stoma site marking of 156 patients were performed by specialist nurses from November 2016 to February 2017.Then,the rate of preoperative stoma site marking,accuracy of stoma location,and knowledge of preoperative stoma site marking were compared between the traditional and new management pattern. Results The preoperative stoma site marking rate was 91.89%(136/148)and the accuracy rate was 94.12%(127/136)in traditional management pattern.The lack of enterostomy therapist, surgery performed on weekends and emergency surgery were the reasons that preoperative stoma site marking was not performed.After changing the management pattern,the preoperative stoma site marking rate was increased to 98.72%(154/156) and there was a significant difference between them (χ2=8.06, P <0.05).The accuracy of localization was decreased to 92.86%(143/154),but there was no significant difference between them(χ2=0.03,P>0.05).The rate of acquiring preoperative stoma site marking knowledge in nurses was increased from 8/19 to 18/19 with a significant difference(χ2=12.18,P<0.01). Conclusions The pattern of preoperative stoma site marking was changed and the new pattern improved the rate of preoperative stoma site marking,and didn′t affect the accuracy of preoperative stoma site marking.Meanwhile,we also improved the nurses′level of preoperative stoma site marking in our department.