NGHieN CUU KHOA HOC
trung binh gidm tu 37,1% xuIng 15,2% va kiln thuc yiu giam tu 30,5% xuIng 6,6%.
Sy khdc biet cd y nghTa thing ke vdi p
<6,05.
Nhan vien y t l cin phai tang cudng thye hidn cdng tde giao dgc sue khde cho ba me trudc vd sau sinh ve vang da so sinh, dgc biet ehu y tdi ddi tuang bd me mang thai, eung nhu cae Idp tu van tiin san, chuang trinh tivi tgi phdng kham thai,... Npi dung giao due sire khde can chii trpng kiln thuc v l muc dp, tic dp vang da benh ly va nhan biit mau sde nude tieu va phan ciia tre, each nhan biit vang da, thdi gian xuat hien vang da va theo doi trd vang da.
TAI Lieu THAM K H A O
1. Bd y t l (2011), Thdng tu so 07/2011/
TT-B YT - Thdng tu hudng dan cong tde diiu dudng ve cham sdc ngudi benh trong bdnh vien, https://thuvienphapluat.vn/van-ban/
The-thao-Y-te/Thona-tu-Q7-2011 -TT-BYT- huong-dan-cong-tac-dieu-duong-cham-soe- nQuoi-benh-118433.asDx, xem 15/8/2015.
2. Pham Diep Thuy Duang (2013), "Kiln thue - thai dp - thyc hanh v l vang da so sinh cua bdme tai TP. Hd Chi Minh", Tap chi Yhoc TP Hd ChiMinh, 17(2), 69-73. '
3. Nguyen Cdng Khanh (2007), "Vang da so sinh", Tiip cdn chan doan Nhi khoa, Nha xuat ban Y hpe, tr. 18 - 22 va tr. 70 - 86.
4. Pham Thj Luya va Tran Tdn NuAnhTy (2009), "Khao sdt kiln thuc, thdi dp, hanh vi v l benh vdng da eiia eac ba me cd con dang ndm dieu tri tgi khoa so sinh bdnh vien Nhi Dong - Dong Nai", Hoi nghj khoa hoc Dieu Dirdng nhi khoa toan quoc lin thir VI - Benh vien Nhi TW, tr. 167-172.
5. Dao Minh Tuylt (2009), Danh gia kk qua dieu trj vang da tang Bilirubin tir do d tre sa sinh bing lieu phap anh sang tai khoa Nhi bdnh vien da khoa trung uang Thai Nguyen, Luan van thac sy y hpc, Dai hgc Y - Duoc Thai Nguyen.
6. Ngd Minh Xudn (2001^, Phin cap chan doan va diiu tn vang da sa sinh do tang Bilirubin gian tiep, Lugn an tiin sT y hpc, thanh phd Ho Chi Minh.
THAY D d i NHAN THO'C C O A D I ^ U D U a N G L A M S A N G V ^ C H A M S 6 C TU" T H ^ VA VAN OONG S a M CHO NGU'CXI B E N H O O T QUY TAI BENH Vl£N
DA KHOA TfNH NAM DINH
'Ngo Huy Hodng, ^Pham Thi Thu Huang ^Hoang Thi Kim Yin, ^Vu Thi Phuang, ^Pham Thj Hue
^Tnmng dai hoc Bleu dtrong Nam Bjnh, 'B§nfi vi§n 6a khoa tinli Nam Binh T6M TAT
Muc tidu: Khao sat thirc trang va danh gia thay doi nhan thirc cua dieu dirctng lam sang vi eham sdc tw thi va van dgng sam
Ngudi chiu trach nhiem; Ngd Huy Hoang Email: [email protected] Ngdy phan bien: 20/01/2018 Ngdy duydt bai: 22/02/2018 Ngdy xuat ban: 14/03/2018
cho ngiral benh dgt quy sau can thiep giao due. Phuxmg ph^p: Can thiep giao due mdt nhdm cd so sanh truac sau eho 45 dieu dirang lam sang tnre tiip cham soc ngirdi bdnh ddt quy tai Benh vidn da khoa tinh Nam Djnh. NQI dung can thiep dira tren khuyin cdo cua Bd Y te vi tidu chudn chat lirang xir tri dot quy nao. Su- dung cung phliu hdi tu- diin di danh gia nhan thtrc cua dieu du-ang tai eac thdi diem tnrac can thidp. ngay sau can thi$p va sau can
Khoa hpc Diiu dudng - Tap 01 - S l 01
NGHIEN c u u KHOA HOC
thiep 30 ngay. Ket cjua: Nhan thirc cua diiu duang lam sang vi chdm sdc tw thi va van dong sam cho ngu-di bdnh ddt quy tnrac can thiep thip, dat 7 ±2,14 diem tren tong 20 diim va dup'c cai thien ro ret vdi 76,62 ± 1,81 diim ngay^ sau can thiep va duy tri a 15,13 ± 3,34 diim sau can thiep 30 ngay (p
< 0,001). Trum: can thiep, (y/e dieu dudng nhdn thire dirac day du cae biin chimg cd thi xay ra sau dot quy do kem van ddng Id 0%, tw thi cua ngwdl bdnh phu hap vai tinh trang ngirai benh la 2,2%, tho'i diem de van dong sam la 0% va qui trinh van dong sam
cho ngwai benh la 55,5%,. Cac ty le nay deu tang a cae thai diim ngay sau can thiep va sau can thiep 30 ngay, theo trinh twla 8,9%
va 24,4%>; 44%, va 40%; 53,3%, va 37,8%o;
100% va 95,5%. Kit luan: Nhan thire eua diiu duang vi cham sdc tw thi va vdn dgng sdm chp ngirai benh dot quy tnrac can thiep con thip va dwac cai thien dang ke sau can thl^p gido due. Nghidn ciru cho thiy swcan thidt cda can thiep gido due phii hap vi noi dung, hinh thire va doi twang tham gia cho moi cho ITnh vwc cham sdc cu thi.
Tir khoa: van dong sam, dot quy.
CHANGES IN THE AWEARNESS OF CLINICAL REGISTERED NURSES OF POSITIONING AND EARLY MOBILIZATION CARE FOR STROKE PATIENTS
IN NAM DINH GENERAL HOSPITAL ASTRACT
Objectives: To asssess the awearness of clinical registered nurses of positioning and early mobilization care for patients with stroke before and after the educational inten/ention. Methods: Based on the quality criteria guideline by Ministry of Health 2014 for caring stroke patients, the one group pre- test and post-test educational intervention was conducted among 45 clinical registered nurses in Nam Dinh general hospital. Using the same self-completed questionnaire to measure nurses' knowledge before, right after the completion of the Intervention and 30 days later Results: The mean score of nurses' awareness of positioning and eariy mobilization care for patients with stroke was 7 ± 2,14 of the total 20 points before the intervention, then went up to 16,62 ± 1,81 points right after the completion of the Intervention and remained at 15,13
± 3.34 points at the time of 30 days later (p values of 0.001). The percentages of clinical nurses perceived adequately the complications caused by poor positioning and eariy mobilization care; patients' positions in accordance with specific stroke conditions; the time and required clinical signs and symptoms allowing a nurses to begin mobilization care for a stroke patient;
and the right process of early mobilization before the intervention were 0%, 2.2%,, 0%,
and 55,5%. These percentages Increased immediately after the Intervention and retained at high levels at 30 days later, equal to 8.9%, and 24.4%, 44%, and 40%o, 53.3%, and 37.8%, 100%, and 95.5%o, respectively Conclusions: The awareness of clinical nurses of positioning and eariy mobilization care for stroke patients within the study was low before the inten/ention, then improved significantly after completing the educational programme. The research results revealed the necessity to conduct educational programmes which have to be appropriate In contents, leaming method, and especially In target participants for specific nursing care.
Key words: early mobilization, stroke.
I.DATVAND^
Theo To chirc Y t l Thi gidi JI 2], dot quy nao hidn la nguydn nhdn pho biln dung thir hai vd dy bao den nam 2030 se trd thanh mdt trong nhCrng nguyen nhan hdng d l u gdy tu vong trdn pham vi toan t h i gidi.
Nhung ngudi sdng sdt sau dot quy thudng gdnh chju nhirng di chirng suy giam hogc mit chdc nang nao tuy theo muc dp va vj tri eua ton thuang nao sau dot quy [11].
Nhung hieu qud ro ret khdng nhu'ng giam tan p h i v l mat co t h i md edn cai thidn trang thai tam ly cua cham sdc tu t h i va van
Khoa hpc Didu dudng - Tap 01 - So 01
NGHIEN ClJU KHOA HOC
ddng sdm eho ngudi b^nh dot quy da dup'c khdng dinh. Nhung cac quan sat thyc te lai cho thay mdt thuc trang la ngudi b$nh sau ddt quy thudng ndm bat ddng [2], [4]. Viec bit dau thay doi tu t h i cho ngudi b0nh dot quy trdn giudng benh va vgn ddng sdm cho ngudi bdnh thudng bi han chi do hd qua tu ydu ciu bit ddng ngudi benh cua bac sy diiu tri trong nhung gid dau khdi phat dot quy, su e ngai tu phia ngudi bdnh va ngudi nhd ddi vdi viec thay doi tu t h i vd van dpng eho ngudi benh [2], va ttr chinh ngudi dieu dudng [4]. Vai trd dac biet quan trpng va duy nhit cua ngudi diiu dudng trong cai thien tinh trgng nay thdng qua vide eham sde lien tue ngudi benh dot quy cung da dup-c khang dinh [4], [5]."
Tai Viet Nam, rit it cdng bo v l hidu qua cua can thidp giao dgc nham thay doi nhdn thirc v l dot quy hudng tdi van dpn^
sdm cho ngudi benh. Xudt phat tu thyc te cham sdc ngudi benh dpt quy va nham mgc dfch tdng cudng nhan thue cho ngudi diiu dudng tryc tilp chdm sdc ngudi bgnh dot quy dac biet la trong giai doan cap, chiing tdi tiin hdnh d l tai Thay doi nhdn thuc ciia didu dudng lam sang v l chdm sdc tu t h i va van ddng sdm cho ngudi benh dOt quy" vdi mgc tieu; Khao sat thwe trang nhan thwc va danh gia thay doi nh$n thire eua diiu dwang lam sang ve cham sde tw thi va v$n ddng sdm cho ngirdi benh ddt quy sau can thiep giao due.
2. 0 6 l TUaNG VA PHUaNG PHAP NGHIEN CI>U '
2.1. Doi tu'ang va thdi gian nghien CLFU Nghidn ciru dup-c tlln hanh tu thang 4 din thang 6 nam 2017, vdi sy tham gia cua todn bd 45 diiu dudng iam sang trye tilp cham sdc ngudi bdnh ddt quy tgi eae khoa Npi A, Tim Mach, Hoi sue cap cuu va Than kinh thuOc Benh vien DK tinh Nam Djnh,
2.2. Phuang phap nghien ciru Nghien cuu can thigp giao dgc mdt nhdm cd so sanh trudc - sag. Cae npi dung v l cham sdc tu thd vd vdn dpng sdm cho ngudi benh dpt quy dya trdn khuyin eao eua Bp Y t l ve tieu chuin chat lupng xir tri dot quy
nao [1], dup-c eg t h i hda vdi nhdn thircv^
phdng ngua cac biln chu-n^, tu thi ngifoi bdnh phu hp'p, thdi diem bat dlu van dgng sdm va qui trinh vdn ddng sdm eho ngiroi benh dot quy. Md hinh "Modified Kolb's Model for Vietnam" [10] dupe dp dung i3|
chuyin tai kiln thirc, trong dd ngudi diiu dudng lam sang td thye tien cham soc, chia se nhCrng trai nghidm vd cac van de gap phai, ciing nhau thao luan vdi nhirng y kiln tuang dong hoac trai chieu, di din cdng nhdn cai diing va thira nhgn kiln thifc, d l ttr dd dp dgng trd Igi thye tien cham soc mdt each tit hon. Su dung cDng mot bd cau hoi ty dien vdi tong diim Id 20 de danh gia nhan thirc cua dieu dudng tai 3 thdi diem trudc can thiep (Tl), ngay sau can thiep (T2) va 30 ngay can thiep (T3).
2.3. Xu ly so lieu: SCr dgng phdn mem SPSS 22.0, t-test dup'c su dgng de so sanh 2 gid tri trung binh.
3. K^T QUA NGHIEN CUU 3.1.Thong tin chung ve doi tuong tham gia nghidn cOu
Trong s l 45 diiu dudng tham gia nghien cuu, ed 40 nu' diiu dudng. Tuli tmng binii ciia diiu dudng trong nghien edu la 33 + 8,7 vdi ngudi it tuoi nhdt la 24 vd ngiroi nhieu tuoi nhat Id 53. Trinh do chuydn m5n dupe dao tao d bdc trung d p la 44,4%, b§c dai hpc Id 37,8% cdn Igi 17,8% Id eao dlnp.
Hau hit didu dudng cd thdi gian tm-c tiep lam cdng tac eham sdc ngudi benh dot quy tren 1 nam. Da s l dieu dudng (84,6%) tra Idi ring hp chua dup'c tilp cdn them nguon thdng tin chinh thue nao ve eham sdc ngip&i benh dot quy k l ttr sau khi tit nghiep ra trudng.
3.2. Nhan thu>c cua dieu dudng ve cham sdc tu t h i va van dong sdm cho ngu^i benh dot quy
3.2.1. Kit qua chung nh$n thirc ve Cham soc tw the va van dgng sdm cho ngirdi benh dot quy
Kit qua ehung nhan thuc eua diiu du6ng lam sang v l cham sdc tu t h i va van dong sdm cho ngudi benh dot quy dya tren diem tra Idi bd cau hoi trude va sau can thiep dup-c the hidn trong Bang 1.
Khoa hpc Dieu dudng - Tgp 01 - S l 0^
NUHIbN CUU K H U A H U U
Bang 1. Diem tra Idi bo cau hoi trifdc va sau can thiep (n = 45) Thai diem danh gia
Tai'O'C can thiep (Tl) Ngay sau can thiep (T2) Sau can thiep 30 ngay (TS)
Diim dat Thiip nhat
2 12 8
Cao nhat 10 19 20
Trung binh 7,00 ±2,14 16,62 ±1,81 15,13 ±3,34
p (t-test)
p(2-1)< 0.001 p(3-1)< 0.001 Trudc can thiep diem nhgn thuc dat 7,00 ± 2,14 dllm trdn tong sd 20 diem. Ngay sau can thiep diim so nay Id 16,62 ± 1,81 diem vd giCr d 15,13 ± 3,34 diim sau khi kit thiic can thiep 30 ngay, sy khac biet so vdi trudc can thi^p cd y nghTa thing k§ vdi p < 0,001.
3.2.2. Ket qua nhan thirc theo cac ngi dung can thiep
Ty id diiu dudng cd kiln thue dOng eho ttrng npi dung lien quan d i n cham sdc tu t h i va van ddng sdm cho ngudi bdnh dOt quy tai cac thdi diem trude can thiep (Tl), ngay sau can thiep (T2) va 30 ngdy sau can thiep (T3) dup'c the hign trong cdc bang va Hinh dudi day.
Bang 2. Ty le dieu dudng nhan thiPC d u w : cac bien chirng do kem van dong Bien chipng
1. Loet ep
2. Nhiem l<huan ho hap 3. Cling I<h6p 4. Teo ca
5. Nhilm khuan tilt nieu 6. Giam t i m v§n dpng 7. Phu ne 8. Tac mach phoi 9. Giam bao hda 6 xy mau 10. Giam huyit ap tu" the dijng 11. Tao bon
12. Cac van de ve tam ly Dijng ca 12 biln chiing
T l So iu'O'ng
39 33 27 26 9 6 1 1 0 0 0 0 0
Ty le % 86,7 73.3 60,0 57.8 20,0 13,3 2.2 2,2 0,0 0,0 0,0 0,0 0,0
T2 So lu'O'ng
44 45 45 44 44 40 37 31 27 19 42 22 4
Ty le % 97,8 100.0 100,0 97.0 97,0 83,9 82,2 68,9 60,0 42,2 93,3 48,9 8.9
T3 So lu'O'ng
45 42 41 42 40 27 38 28 26 18 40 16 11
Ty B % 100.0
93,3 91,9 93,3 88,9 60,0 84,4 62,2 57,8 40,0 88,9 35,6 24,4 Trudc can thiep, 4 bien chirng gIm loet dp, nhiem khuan hd hap, cung khdp vd teo co dup'c nhan thuc dung vdi eac ty Ig cao theo thir ty la 86,7%; 73,3%; 60% va 57,8%. Tuy nhien, khdng cd dieu dudng nao nhdn thue day dii 12 biln chung. Sau can thiep ty Id nhan thire dung cac biln chirng deu cao han so vdi trude can thiep va ed 4 va 11 diiu dudng nhan thuc dup'c day du 12 biln chdng ngay sau can thiep va sau can thidp 30 ngay.
Trudc can thidp, da so diiu dudng (86,7%; 88,9% va 97,8%) nhan thuc dup'c cdc tu the phD hp'p vdi tinh trang ngudi bgnh, nhung hau hit khdng giai thich dup-c tdc dgng eiia hai tu the dau va ehi ed mdt ngudi tra Idi vd giai thi'eh dung ca ba cham sdc tu the. Sau can thidp, tai 2 thdi diim danh gia, ty Ig nhan thuc dung cho cae cham sdc tu t h i deu eao han so vdi trudc can thiep (Bang 3).
Khoa hpc Diiu dudng - Tdp 01 - So 01
Bang 3, Ty ie d i i u du'ang xac djnh du'O'C cac tU' the cham Tu' the cho ngu'd'i benh
1. Nam phang khi K H O N G bilu hien tang ap lyc ngi sg
Tao dung: Tao thuan lgi cho tu-di mau va 6 xy tai nao
2. Nim dau cao ti> 20 din 30 dp khi C6 bieu hi#n tang ip lyc ngi sg Tac dung: Cai thien din lyu tuin hoan nao giijp giam ap lyc npi sp 3. Thay dii vi tri co the tilp xuc vai
giuang benh moi 2 gio Tac dung: Tranh de ep qua lau ngan ngOa biln chiing loet ep Tra l&i va giai tiiicti dung ca 3 fw tiiS
T1 So iyp-ng
39 1 40 2 44 22 1
TJIS
%
86,7 2,2 88,9
4,4 97,8 48,9 2,2
soc phu T2 So lypng
44 31 45 30 45 44 20
TJI§
%
97,8 68,9 100 66,7 100 97.8 44.4
hp'p(n = 45) T3 Si lyang
42 22 43 22 45 44 18
Tyl?
%
93,3 48,9 95,6 48,9 100.0 97,8 40,0 Tho'i diim phu hap de co t h i bat d l u van dOng sam cho ngyoi benh la khi tinh trang lam sang cua ngyd'i benh cho phep vo-i cac dieu kien gIm y thiic tinh, huyit ap tam thu on dinh va phii ^ 120rnmHg, mach on dinh va trong khoang 60 -100 lan/phiit, khong xuit hien them ton thyang thin kinh. Kit qua danh gia npi dung nay dyac t h i hi$n d Hinh 1.
DBung gSai
T3 37,8%
T2
Tl
53,3%
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% lOOX IHinh 1. Ty le d i i u dyang xac dmh dyac thai diem cho ngyai benh van dong Truac can thiep, khong ai xac djnh day du cfic diiu kien d l co t h i bit dau van d6ng sdm cho ngyai benh. Sau can thiep. co 53,3% dieu dyang da nh^n thiic dyac n6i dung nay va con 37,8% sau can thiep 30 ngay
Khi tinh trang ngyai b§nh chp phep de van dgng sam, cac van dgng cho ngyai bentl phai theo trinh ty dam bao cho ngyai benh tiiich iing va phuc hii, bao gom: h i trg ngii t;i giudng benh. h i trg ngoi ngoai giyang benh, di chuyen cho bang phyang ti?n. lan nqhiSng de ngoi day ngii khong can h i trg, va h i trg di chuyen bang chan tren sSn nha. Kit quS danh gia npi dung nhan thiic nay cua dieu dyang dygc the hien trpng Hinh 2.
Tryac can thlSp, od 25 diiu dyang (55,5%) nhlin thiic dung qui trinh van dpng sam otio npyo'i benh. Ngay sau can thiep va 30 ngay sau can thiep so dieu dy&ng nhan thiic dung ve qui trinh nay theo thii ty la 45 ngygi (100%) va 43 ngygi (95,5%).
Khoa hgc Bilu dyang - Tap 01 - S l 01
i-i^iduNClJU KHOA HOC
DOung DSai
55^5% ^ ^ -
10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Hinh 2. Ty le diiu dirdng xac dmh dung qui trinh van dong sdm (n = 45) 4. BAN LUAN
Trong tong s l 45 diiu dudng, nu dtlu dudng ehilm da so (40 ngudi), phu hp-p vdi thg-c t l vd nghe nghidp dllu dudng Id nd chiim da so. Vdi tuli trung binh la 33 ± 8,7 tuoi va hdu hit ed thdi gian trg'c tilp lam cdng tdc cham sdc ngudi bdnh dot quy trdn 1 nam, cd the thiy cac diiu dudng tham gia nghidn edu da cd mot khoang thdi gian du lau de trai nghidm vdi thg-c tiin eham sdc ngudi benh dot quy,
Tuy khong cd nghien cuu tuong tu d l so sanh nhung kit qua d Bang 1 eho thay, trudc can thiep, nhan thuc v l cham sdc tu the va van ddng sdm eho ngudi benh dot quy cua diiu dudng dat 7 ± 2,14 diem tren tong 20 diim Id kha thdp. Mac du, tuli ddi va thdi gian cd trg-c tilp chdm sde ngudi benh dot quy khd lau, nhung nhung ydu td nay la chua du cho diiu dudng vd cdn cd nhung tde ddng eg t h i vd trpng tam vao chdm sdc tu thi va van ddng sdm eho ngudi benh dot quy.
Xet trdn phuong dien thdi gian, trong khi khuyin cao v l van ddng sdm cho ngudi benh dpt quy cd thdi diim ban hanh la ngay 15/7/2014 [1], nhan thirc thap trude can thiep eho thiy t i n tai mot khoang each Idn tu van ban hudng ddn din thg-c tien cham sdc. Sau can thiep, cd sg' tang diem ddng k l len tdi 16,62 ± 1,81 diem va edn dgy tri d 15,13 ±3,34 dllm. Kha nang nhd va luugiu kiln thirc dupe chung mmh la giam ddn theo
thdi gian [6], thdng thudng ngudi hpc nhd dup'c 75% nhCfng gi da hpc vao lOe kit thiic viec hpe va luu giu dup-c khdng qua 10% d 30 ngdy sau, nghTa la hon 90% nhung gi da hpc se bj quen di sau 30 ngay. Mdt khdc, kha nang luu giu kiln thirc phu thudc nhieu yiu td, trong dd phuang phap hpe cd vai trd quan trpng, ngudi hpc ed the nhd dupe 75% kiln thuc da hpc nlu kiln thirc dup-c dp dyng vao thye hanh va nhd dup-c 90% nlu kiln thire dd dupe day lai eho ngudi khac [6].
Trong nghidn cuu cua ehung tdi, nlu xem muc chenh diim ngay sau can thiep (T2- T1*!l6-7*9 diem) tuong duong vdi 100%
kiln thuc dd hpe dup'c cOa didu dudng, thi d thdi diim 30 ngdy sau khi can thiep kit thiie, vdi mue luu giu kiln thuc (T3-T1*15- 7=8 diim) tuang duong vdi 88,9% kiln thue dupe ngudi dieu dudng luu giij thi day la mpt kit qua vup-t xa so vdi mong dp-i. Kit qua nay cd t h i do kiln thdc trong can thiep gido dgc cua nghien cuu kha cd dpng, cd lien quan true tiep den hoat ddng eham sdc cOa ngudi diiu dudng vd cd t h i da dup'c ngudi diiu dudng ap dgng ludn vdo cham sde ngudi benh ddt quy. Hiln nhien cdn cd them nghien eiru de khdng djnh, song kit qua eai thien nhdn thdc ciia dieu dudng trong nghien euu cd gia tri thu'c tiin hon la y' nghTa thing ke, gdp phan chirng minh cho sy phii hap v l ndi dung, phuang phdp, doi tuang eung nhu kha nang dp dung vdo thye tidn eham sdc [3].
Khoa hpc Diiu dudng - Tap 01 - So 01
Cdc bien chdng do kem thay doi tu the va van dpng phgc hdi chuc nang sdm eho ngudi benh dot quy da dup'c chirng minh bdi nhieu nghien edu [4], [7], 18]. Nh$n thdc dly du cac biln chdng cd t h i xay ra eho ngudi benh se giiip ngudi diiu dudng y thdc duac tam quan trpng vd chu ddng han trong cdc hoat ddng eham sdc d l phdng ngua va han c h i tdi da cac biln chu-ng cho ngudi benh [11]. Tarde can thidp, nhilu diiu dudng da nhan thue duac cdc biln chung nhu loet ep, nhilm khuan hd hip, cung khdp va teo CO, theo thu ty Id 86,7%; 73,3%, 60%
va 57,8%. Tuy chua ed thong ke cu the tai dja ban nghidn cuu, song cd the do day la nhung biln ehung md ngudi dieu dudng thudng phdi doi mat trong cham sdc ngudi benh dot quy. Cac biln ehung cdn lai nhu eac vln d l ve tam ly; giam huyit dp tu t i l l dung; gidm bdo hda d xy mau; tdo bdn; tac mach phii; phii ne... hdu nhu khdng dupe dieu dudng nh$n biit, cd the day la nhung bien chung it ggp hon tai dja ban nghien cdu hoac chua dup'c quan tdm diing muc. Ly do nay dup'c cCing eo bdi sau can thiep 30 ngay nhung biln chdng dup-c nhdn thdc vdi ty le eao trude can thiep thi dupe duy tri vdi ty le eao va ngupc Igi. Trudc can thi^p, td chd khdng cd ngudi ndo nhan thuc duac dly du 12 biln chung thi ngay sau can thiep, con sd nay la 4 ngudi vd len tdi 11 ngudi d 30 ngay sau can thiep. Sy eai thien nay eung cd gia tn thyc tien han la ^ nghTa thing kd, bdi Id them mdt diiu dudng nhdn thuc tot thi nhilu ngudi benh do dieu dudng eham sdc se nhdn dup-c nhung eham sdc tit han.
Nhan thdc dupe tac dung cCia tu t h i ngudi benh phai phu hp-p vdi tinh trang ngudi benh trong giai doan cap cua ddt quy ddng vai trd quan trpng trong ciing cd hanh vi cham sde dung ddn eOa dieu dudng cho ngudi benh [9]. Trudc can thidp, mac dil gap khd khan trong giai thich tac dung, song da so diiu dudng nhdn thuc diing v l tu t h i ngudi benh theo tinh trgng cd hay khdng cd phii nao vd 44 tren 45 ngudi nhan thue dup-c phai thay doi tu t h i cho ngudi
benh 2 gid/1 lan. Day la nhung eon so tich eye eho thay thyc hdnh cham sdc ngwi bdnh eua dieu dudng tai dja ban nghien cuu da hudng tdi chuan myc. Vdi ty le dieu dudng gidi thich dup-c tac dung ciia cac tui t h i khdng cao, xet trdn khia canh eham soc dya tren nang lyc, cho thiy sy cin thilt cua dao tao lien tgc ddi vdi nhung ITnh vyc cham soc eg the.
Trong nhung gid dau cua dot quy, do yeu cau cua chan doan va dieu tri tir bac sy, ngudi benh phai nam bat dOng va day la m6t chi djnh dieu tn dup-c chip nhan. Tuy nhien, vide bat dlu van ddng sdm cho ngu-di benh thudng bj han ehi, ngodi vi^c do yeu cau cua bac sy td luc ban dau, con do sy e ngai tii phia ngudi benh vd ngudi nha, va tu chinh nhdn thuc cua ngudi diiu dudng tryc tiep eham sdc ngudi benh [5]. Day cd le chfnh la ly do eho ket qua trude can thiep khong co dieu dudng ndo nhan thdc dupe khi nao thi cd the cho ngudi benh van ddng. Cai thien nhdn thdc ciia diiu dudng ve npi dung nay se cd gid trj thyc tien Idn va ngay sau can thiep hon mdt nua sd diiu dudng (53,3%) da nhgn thuc duac ndi dung nay. Sau 30 ngay ty Id nay giam di va cdn 37,8% cho thdy day van la mpt npi dung nhan thdc khd khan va can thudng xuyen dup'c eOng c l .
Nhgn thdc dung v l qui trinh vdn dOng sdm cd kit qua kha quan, ngay tu trudc can thiep da cd tdi 55,5% dieu dudng nhan thdc dimg, ngay sau can thidp ty id nay la 100% va sau can thiep 30 ngay ty Id nay van giu dup'c d mdc rat cao tdi 95,5%. Ket qua ndy cd t h i do hoat dOng cham sdc diiu dudng thudng gdn vdi cac qui trinh giiip ho dd ddng tilp thu, va cd t h i qui trinh da dupe dieu dudng dp dung vao eham sde nen duy tri vdi ty le eao sau 30 ngdy. Tuy nhidn, d n cd danh gid khach quan d l khang djnh.
5. K^T LUAN
Nhgn thuc v l cham sdc tu thi va van dpng sdm eho ngudi bgnh ddt quy cua diiu dudng tham gia nghien cdu trude can thie^
giao due thap, chi dat 7 ± 2,14 tren tong so
Khoa hpc Dieu dudng - T^p 01 - S6 01
..ENCU'UKHOAHOC
20 diem. Can thiep da eai thidn dang k l nhan thue ciia dieu dudng vdi 16,62 ± 1,81 diim ngay sau can thiep va duy tri d 15,13 + 3,34 diem sau can thiep 30 ngay. Ty le diiu dudng nhan thuc dOng mdi ndi dung kiln thuc cung tang sau can thiep va cdn duy tri a mue eao sau can thiep 30 ngdy Tuy nhien, nhan thuc v l thdi diim cd the van dpng sdm cho ngudi benh vdn cdn hgn che va cdn dup-c ciing c l . Kit qua nghien cuu cho thay sy cdn thiet cua viec cimg c l va cap nhdt kiln thuc ed trpng tdm eho nhung ITnh vyc cham sdc rieng biet va can ed them nghidn cuu de dam bao rdng kien thuc dup-c ap dung vao thyc tien cham sdc.
T A I LIEU THAM K H A O
1. Bd Y t l (2014). Tieu ehuan chdt lup-ng ve xu tri dot quy nao ap dgng thf diim trong bdnh vien d Viet Nam. Quyit djnh so 86/
QD-KCB ngay 15/7/2014, Cgc Quan ly Khdm, Chua benh
2. Le Van Thinh va edng sy (2008). Tinh hinh va thyc trang eham sdc dot quy trong cae bdnh vien da khoa tu tuyen tinh trd Idn d Viet Nam. http://hoidotquyvietnam.com.
Truy cgp ngay 02/03/2017
3. Ngd Huy Hoang (2015). Nang cao nhdn thuc va kha nang thyc hdnh su dung hap ly khdng sinh cua edn bd y t l tuyen xa tinh Nam Dinh. Tap chi Yhgc cong dong. So 23 thang 09/2015, trang: 47-53
4. Askim T et al (2012) Stroke patients do not need to be inactive in the first two weeks after a stroke: results from a stroke unit focused on eariy rehabilitation. International Joumal of Stroke; 7:1,25-31
5. Bernahardt J et al (2007). Little therapy, little physical activity: rehabilitation within the first 14 days of organised stroke unit care. J Rehabll Med 2007; 39: 43-48
6. Kdre Letrud (2012). A rebuttal of NTL Institute's learning pyramid. Education Vol.
133 No. 1 January 2012, pp. 117-124 7. Keating M el al. (2012) Positioning and eariy mobilization in stroke. Nursing Times;
V0IIO8, No47, pp. 16-18
8. Kilbride C and Kneafsey R. (2010) Management of physical impairments post stroke: In William J et al (eds). Acute Stroke Nursing. Oxford: Wiley Blackwell
9. Munoz-Venturelli et al (2015). Head Position in Stroke Trial (Head Post)-sitting up vs lying-flat positioning of patients with acute stroke: study protocol for a cluster randomized controlled trial. Trials 16:256dol. 10.1186/s^ 3063-015-0767-1
10. Ngo Huy Hoang (2016). The development of a conceptual framework and model for information, education and communication (lEC) to reduce antibiotic misuse among the Vietnamese population in Nam Dinh province. Hanoi: Vietnam National University Press
11. Royal College of Physicians (2016).
National clinical guideline for stroke.
Prepared by the Intercollegiate Stroke Working Party. Fifth edition 2016. NICE accredited
12. Worid Health Organization (2008), Worid Health Statistics 2008. Geneva, Switzeriand, WHO, 2008
Khoa hpe Diiu dudng - Tap 01 - Sd 01
