NGHIEN c a u KHOA HOC
THUC TRANG TUAN THU
QUY TRINH DAT VA C H A M SOC KIM LUON TINH MACH NGOAI VI CUA DIEU DUfiNG VA MOT SO YEU TO LIEN QUAN TAI 3 KHOA
HOI SUfC, BENH VIEN NHI TRUNG UONG, NAM 2014
NGUVeNKIMSON >
Hirimg dinf JRAN MINH O I E N , N G U Y E N T H ! THOY NGA Ngtfdi thim djhh: TS. T R A N QUANG H U ^
TdMTAT
Gidm sat sy tudn thu quy trinh dgt va eham sdc kim luon tTnh mach ngoai vi (TMNV) d l dam bao an loan va ndng cao chat lugng d i l u trj cho ngudi bdnh.
M^c tieu: Md ta thyc trgng va tim hieu mot so y l u to lien quan d i n s y tudn thu quy trinh ddt vd cham sdc kim luon tTnh mgch ngogi vl eua didu dudng 3 khoa Hoi sdc, Bdnh vidn Nhi Trung uang.
P h u a n g phdp nghien c u u : Md ta cat ngang.
Ket qua: Khdng cd d i l u dudng vien nao tuan thu hoan toan quy trinh dgt kim ludn eiJa bdnh vien da dua ra. Cd 6 dieu d u d n g vien da thyc hanh hodn lodn dung theo quy Irinh cham sdc kim ludn benh vien da quy dinh d u g c 22 diem. Khi phan tieh dan bidn thl cac ydu to lien quan d i n s y tuan thu quy trinh dgi kim ludn it han cdc y l u td lidn quan d i n s y tudn thij quy trinh cham soc kim luon nhung khi loai cac yeu to nhidu thi k i t qua cdc yeu l6 lien quan cCia hai quy trinh ddu giong nhau.
K i t luan; Cdc yeu to lidn quan den s u tuan thu quy trinh la bang cap chuyen mdn, kien thuc v l quy trinh va yeu to trung binh sd ngudi bdnh eham sdc/ngay.
T u khda: Bgnh vien Nhi Trung uang, tuan thu quy trinh ky thugt, dgt kim luon, cham sdc kim luon.,..
IDJiTVANDl
Khi vao mdt ea s d y te de kham, chua bdnh, ngudi bdnh tjy thdc tai san quy gia nhai cua minh
la sue khde cho cdc thay thuoc. Hg eung Id trung lam, la khaeh hang cua cdng tdc cham sdc trong bgnh vign nen phai d u g e cham sdc loan di^n, lien luc, bao dam hai Idng, c h i t lugng vd an todn.
Do dge thij cua nganh d i l u dudng la lam cong viec chdm sdc t d d a n gian nhat den phdc tap, t u viee thay ga trdi g i u d n g t d i nhung cdng viec nghidn e d u , quan iy ddo tgo nen d i l u dudng ddng vai trd quan trpng trong vide dam bdo ati todn t h y c hanh tai ede bdnh vidn thdng qua \ngc eham sdc ngudi bgnh hang ngay an loan va Nlu qua.
Tidm an toan (TAT) la mpt quy trinh lifim khdng gdy nguy hai cho ngudi nhan miji tietn, khdng gdy phai nhidm eho ngudi thyc hign mui tiem, khdng lao chat thai nguy hgi cho ngu'di khde vd cpng ddng. Tiem khdng an lodn cd the gay lay nhiem nhieu logi bdnh khac nhau nhu vi mt, vi k h u i n , nam va ky sinh trOng. Hdi Dieu dudng j Vigt Nam da khdo sat ve thye trgng TAT trong loan qu6c vao nhdng thdi d i l m khac nhau (2002, 2005, 2008). Ket qua nhung khao sat ndi trin cho thay: 55% nhan vien y te cdn chua c§p h h ^ thdng tin ve TAT lidn quan d i n k i l m sodljihietn khuan (KSNK), phan Idn nhdn vidn y te chua lu£ln thu quy trinh ky thual (QTKT) va cde thao t^c KSNK trong t h y c hdnh tidm (vd sinh lay, mang gang, s u dung panh, phdn logi va thu gom v|t sde nhpn sau tidm ...), ehua bdo cao va theo d rui ro do vgt sac nhpn (87,7%).Oieu ndy cho IN c i n ddnh gia nang l y c thuc hdnh didu dudng l a ^
N G H I E N CCrU KHOA HOC
sdng t h u d n g xuydn de gdp p h i n lidn lgc nang cao c h i t l u g n g eham sde ngudi bdnh.
Nhi>ng ngudi benh nam trong 3 khoa h l i sue trong linh Irang nguy kjch nen dieu d u d n g vidn phai thuc hign nhieu ky thugt chdm sdc ngudi bgnh: dat kim ludn, cham sde kim luon, chdm sdc ngudi bdnh t h d may... Cung g i l n g nhu mpi dan vj y te khac, viec gidm sdt s y ludn Ihu QTKT nham dam bao Hdm an loan, gidm nUi ro, s y c6, gdp phan nang cao tay n g h i vd k i l n Ihue eho dieu d u d n g vidn, gdp phan nang cao cdng tdc khdm ehua bgnh. Chinh vi vdy chung tdi tien hanh nghien c u u " T h u c t r a n g t u a n t h u q u y t r i n h dat v a c h a m s d c k i m l u o n ttnh m g c h ngoai v i c u a Oieu d u o n g va m o t s o y l u t o lidn quan tai 3 khoa Hoi s u e , B e n h v i e n Nhi T r u n g u a n g , nam 2014" vdi mue lieu md ta t h y c trgng va tim h i l u mdt sd y l u to lidn quan den s y tudn thu quy trinh ddt vd cham sdc kim ludn.
2. fidin^NfiVA PHUOMG PHAP
D o l t u a n g : D i l u d u d n g vien trye tiep chdm sdc ngudi bgnh hidn cdng tae tgi 3 khoa: Hoi sue S a sinh, Hdi sue cap c d u , Hdi sue ngogi khoa Irong thdi gian nghien c u u .
T h d i g i a n : T u thdng 02 d i n thdng 4 nam 2014.
Dja d i e m : 3 khoa Hdi sue, Bdnh vign Nhi Tmng u a n g .
Bd cdng cu thu thgp sd lieu:
- Bp phdt van thu thgp thdng tin chung vd k i l n thdc eua d l i t u g n g nghidn a>u;
- Bdng kiem quan sat thye hidn quy trinh: doi t u g n g ed t h y c hign hay khdng t h y c hign.
P h u a n g phap t h u t h a p : Phat vdn vd quan sdt.
Nhgp s o ligu: Tren Epidata 3.1 vd phan lieh tren Spss 16.0
3. KtT QUA
3 . 1 . Ket q u a p h a n t i c h d a n bien
B d n g 1. T h o n g t i n c h u n g v l dieu d u d n g vien N9I dung
c m Unh Nam Nii Tuii S34tu6l 35-44tu6i
^45 tuoi Bang cap chuyen mo Trung cap Cao dang Dai hgc tra len Th3m nl^n cong tac
£5 nam 5-10 nam
£ 10 nam Phoi ho-p vo'l bac sT Phg thuOc hoSn toan Dpc l^p Phu thu$c mgt phan Th6ng tin ve cong vlf c cua dleu dirvng vien Tmng binh Trung vi Do Igch chuin Gia trj nhd nhit Gia th 16'n nhit
Tin so
18 130
137 9 2 ithi tot nghiep
103 26 19
94 35 19
2 135
11 Trung binh so buoi lam C3 tip
21h-7h/thang 7,53
7,5 0,49
6 3
Tilf(%)
12,2 87,8
92,6 6,1 1,4
69,6 17,6 12,8
63.5 23,6 12,8
1,4 91,2
7,4 Trung binh s6
ngtrari b^nh Cham s6c/ngiy
7,32 6 4,02
2,5 20 Trong tong so cac ddi t u g n g nghidn euu, dieu dudng vien la n u chidm da so, trong dp luoi d u d i 34 t u l i la chinh. Ti Id didu dudng vidn trinh dp trung c l p chiem han mdt nda vdi thdm nidn cdng tdc nhd han 5 nam Id chfnh. Trong qua trinh t h y c hidn chdm sdc ngudi bgnh, han 90% dieu d u d n g vidn idm vide dge lap vdi bdc sT. Trung binh so buoi Idm ca t u 21h-7h/thang la 7,53 ngdy, Irung binh so ngudi bgnh c^am sdc/ngay la 7,32 ngudi bdnh.
NGHIEN ClJU KHOA HOC
Bang 2. Thong tln/kel qua kien thCre quy t r i n h dat kim luon
N^idung 1 TansS Tjl$
Ha huyet ap l(hdng phai la tai bien khi dat ifim ludn cho ngu^i bgnh
Dung Sai
110 38
74,3 25,7 ehlorhexidine 4% duvc ithuyen cdo khong nen si> dvng Cho tre Si non dir6>i 28 tuan tudi
Dung Sai
Khong nen dgt kim Iu6n tgi ni
£)Ong Sai
59 89
39,9 60,1 pgap
110 , i 38
74,3 25,7 Ho khuyu tay Id vj tri khong IFU ^ ^ ^ kim luon ^ Diing
Sai -J:
,5:^96
'ta
64,9 35,1 tiling con lo^hoac betadin 10% sat triing vj trf tiem, dgn kh^siiu d6 du'a kim vio mach mau
Diing Sal
5'' 95
35,8 64,2 Sau khi njt thong nong, day phan than kim ngap het long tinh mgch
Dung Sai
14 134
9,5 90,5 Sat trung da It nhit 2 lln tgi vj tri dgt kim ludn Dung
Sai
102 46
68,9 31,1 Mgt dieu dU'O'ng vien dat kim iuon di^oc toi da 2 lan Dilfe
Sal
73 75
49,3 50,7 K i t qua ve kien thdc cCia dieu dudng vien, cau hdi Sau khi rCit t h d n g n d n g , day p h i n than kim ngdp h i t l o n g tTnh mgch cd ti Id d i l u dudng vien tra idi dung thap nhat (9,5%); cdu hdi Ha h u y l t dp khdng phai la tai bien khi ddt k i m luon cho n g u d i bgnh vd cau hdi Khong ndn dat kim luon tgi n i p gap cd ti le dieu dudng vien tra Idi dung cao nhat (74,3%).
Vdi mdi cdu trd Idi dung Ihi d u g c 1 diem, d i l m k i l n thdc v l quy trinh ddt kim iuon d u g c linh bang long d i l m cua 8 cau hdi v l kien thuc eua quy trinh khi phat v l n cho 148 d i l u d u d n g vidn. Nhu vgy, tong so diem cao nhat md dieu dudng vien ed t h l dgt duge d phdn kien Ihuc ndy Id 8 diem. Thyc te khi phat v l n cdc d i l u dudng vien thi diem cao n h i t ma dieu dudng vidn dai
d u g c Id 7 vd cd 2 d i l u , d u & n g vidn khdng dugc d i l m ndo d p h i n k i l n thdc ndy. Diem Injng binh cac d i l u d u d n g vien dgt d u g c Id 4,17 diem; 41^
trung vj vdi dd Idch chuan la 1,397.
Bdng 3. T h d n g tin/ket qud kien t h u c quy trinh c h a m sdc k i m l u i n
1 Tans6 1 Till Lip lai nut kim luon ho^c thay dau nut khac n g ^ sau khi bo-m thuoc ho^c djch truyen
Dung 1 24 | 16,2 Sai 1 124 1 83,8 Khi kiim tra si^ luu thdng cija kim luon ddng loai bom tiem 1ml
Dung 1 33 1 22,3 Sai 1 115 1 77,7 N u ^ muoi sinh ly 9%ii diing de kiem tra sif }iru thdng cua kim luon
Diing 1 84 j 56,8 Sai 1 64 I 43,2 1ml djch ^0!m vdo day noi de kiem tra sir lu>u thong cua kim luon ' ^
Diing 1 93 | 62,8 Sai 1 55 1 37,2 . Khi duy tr) nhD djch, lipit, mdu khong can thilt phai thay day noi hdng ngay
Dung 1 116 1 78,4 Sai 1 32 1 21,6 Nen thay kim luon thu'vng xuyen sau 48 gicr Diing 1 22 | 14,9 Sai 1 126 1 85.1 Oku hlfu CO thit tTnh m^ch 1^ dau hl|u tai biln sOm ciia quy trinh cham s6c kim Iu6n
Diing 1 47
Sai 101 Tong 1 148
31,8 68,2 100 D o i v d i c a u h d i v e kien t h u e q u y trinh chfel) sdc kim ludn, cdu hdi K h i duy tri nhu djch, lipit, mau k h d n g can t h i e t phai thay day n l i hdng^
ngay ed 78,4 % d i l u d u d n g vidn tra ldi dung,day Id ti lg eao nhat va edu tra Idi dCing thap nhit vol 14,6% Id cdu Nen t h a y k i m Iu6n t h u d n g xuyen sau 48 g i d .
Vdi mdi cdu tra Idi dung ve k i l n thuc, dieu dudng vidn d u g c 1 diem, diem k i l n thdc v l cham sde kim luon TMNV d u g c tinh bang long dilm cua 7 edu hdi phdt v l n d i l u dudng vien. Nhu vgy,
I 32
NGHIEN CCTU KHOA HOC
cd 148 d i l u d u d n g vidn da Iham gia phdt v l n vdi s6 d i l m toi da cd t h l dgt d u g c d p h i n nay Id 7 diem. K i t qua phdt v l n cho t h i y d i l m cao n h l l dieu d u d n g vien dgi d u g c Id 5 d i l m , ed 4 dieu d u d n g vidn khdng d u g c d i l m ndo v l p h i n k i l n thuc nay. Trung binh cdc d i l u d u d n g vien dgt d u g c 2,83 d i l m , tnjng vj Id 3 d i l m vdi dp Idch chuan la 1,62.
Bang 4. S ^ tuan thu quy trinh d^t kim l u i n (n - 82)
sn
1.
a) b) c) d) a) f) 9) 2 3.
4 5 6.
7.
8.
9.
10.
11.
12.
13.
14.
N5I dung
Tin s6c6 t h ^ hl^n
Tile%
Dungcu Hpp d^rng Ijong con Nifcrc muoi sinii ly Bom tiem 5ml Bang dinti iio|c t)ang Opsite Hop cii6ng soc Ttiung dimg rac theo quy djnii Bam tiem day kin tnrac kill sir dgng Dilu dtf&ng vign m^c trang pligc theo quy dinh
Oieu dudng vien n>a tay ho^c s^l khuan nhanh
Thuc hien 5 dung Day mgt liiung d|ch qua Stirling da Ctio da viing sat tnjng khd Ngdn tro glQ tinh mach va cang be mat da tai vj tri tiem Dira kim vao mach mau Mau trao ra biu nhua Rut thong nong dan din, ding th&i day kim vao mach m^u Kim khong ng|p trong mach miu Bern) it nifcSrc mu6l 9 %a Co ^nh kim tuin
82 82 82 82 82 82 82 21 50 82 82 82 82 82 82 82 81 20 78 82
100 100 100 100 100 100 100 25,6 62,5 100 100 100 100 100 100 100 98,8 24,4 95,1 100 Bdng 4 eung d p mdt so thdng tin ve s y tudn thu quy trinh dat kim luon TMNV eua d i l u dudng vidn.
Trong t i n g so 20 phan cCia quy Irinh thi cd 15 cau p h i n lat cd d i l u dudng vidn thyc hl§n day du
Phan chuan bj dyng cy, t i t cd dieu d u d n g da c h u i n bj day dO nhung dyng cy c i n t h i l t d l t h y c hi^n quy Irinh. P h i n dieu d u d n g tuSn thu thap n h i t la "Kim khdng n g | p trong mach mdu" vdi chi
20 trong t i n g s6 82 quan sdt l u a n g ung (24,4%) Id Ihyc hi$n dOng vdi quy trinh cua b^nh vi$n.
T i l p theo Id v l n de trang phyc ciia d i l u d u d n g vien, chl cd 21 quan sat t u a n g ung 25,6%i Id I h y c hi^n dung theo quy djnh: dOi mu, deo k h i u trang vd m$c Irang phye quy djnh eua khoa h l i sdc. Han 90% d i l u d u d n g vidn rilt Ihdng ndng d i n d i n , r l i d i y kim vdo mgch mdu (98,8%), bam il n u d c mudi 9%o (95,1%) va cd han 60%.
d i l u d u d n g vidn rua lay hogc sdt k h u i n nhanh (62,5%) trong giai dogn dau khi thyc hi$n y l§nh.
Bang S. S i ^ tuan t h u q u y t r i n h c h a m sdc k i m I u 6 n ( n = 148)
STT 1 a) b) c) O) 2.
3.
4.
5.
6.
7.
8 9.
10.
11.
12.
13.
14.
16.
N$)dung
T i n s I c 6 t h ^ hi^n
TilJ%
Di^gcg Khay sach Gac v l khuin Dung djch sit trOng nhanh Thung dyng ric ttieo quy djnh Dilu dudng vi§n mac tiang phgc theo quy djnh
Thuc hi§n 5 dOng Dilu duong vien rua tay hoac sat khuin nhanh
Kilm tra bang dinh co dinh kim lu6n Kiem tra diy nil
Vung da xung quanh dat kim luin an toin (khflng sung, khflng do, khflng tim)
Sit khuin diu nut kim Dl khfl diu nut kim sau sat khuan khfl
Dilu chlnh khfla chac 3 Thio nut diu nil kim dim bio vfl khuin
Kilm tra su luu thflng a]a kim iuin Dit tic dfl miy, djch tmyln Trong khi th(pc hifln y tinh vj tri tiim khflng phing, khong ri nuac Bum nudc cit sau tifim, tmyln djch
148 63 148 148 69 148 134 148 148 148
133 133 148 42 131 148 148 124
100 42,6 100 100 46,6 100 90,5 100 100 100
89,9 89,9 100 28,4 88.5 100 100 83,8
i ^ , . * ^ DEU DUONG
N G H I E N c a u K H O A H O C
sn
16.
17.
18.
19.
Noi dung
Lap lai kim luon Thu don dung eg Rita tay Ghi ho su bfinh in
Tan so c d t h ^ hi$n
148 148 97 148
Tlle%
100 100 65,5 100 D l i vdi quy trinh cham sdc kim ludn TMNV ddt tren ngudi bgnh thi chi cd 13 phan trong quy trinh d u g c d i l u dudng vien thyc hi^n d i y du d t i l cd 148 quan sat, gan 1/3 quan sdt thao niit dau noi dam bao vd khuan (28,4%), trong khi gdn mdt nua quan sat la cd chuan bi ggc vd khuan (42,6%i). Chua d i n mdt nua quan sat didu dudng vidn mgc trang phuc khdng dung quy djnh (46,6%). Tf Id dleu d u d n g rda lay hoae sal khuan nhanh trudc khi thyc hien y lenh (90,5%)) cao han sau khi thuc hi#n y ldnh phai rda tay {65,5%).
Han 80% cac d i l u d u d n g vidn thyc hidn bam nudc c i t sau tiem, truyen dich (83,8%), kiem tra s u luu thdng eua kim iuon (88,5%), sdt k h u i n vd d l khd dau nut kim sau khi sdt khuan (89,9%).
Bang 6. Cac y e u to ca nhan lien quan den s y t u a n t h d quy t r i n h
liSTraww-
Nam Hit
Quy trinh d i t kim luin Trung
binh Gii tri .'i^S.(^F*'r^!^" r^«i?^
16,8 F = 0,74 17,1 p = 0,39
Quy trinh cham soc kim luon Trung
binh -^fi,ii &3r-T
17,9 18,7
Gia tri F.P ik.Wi -'- >-
F = 3,75 0 = 0.05 Tuli
< 34 lull 35-44 tuoi
> 45 tuoi Bang clp chuyfin Trung cap Cao ding Dai hoc tro len
16,99 F = 2,61 17,6 p = 0,11 0 mfln khi tot nghifip
16,77 F=1,72 17,72 p = 0,2 18,6
18,59 19 20 18,02 20 20,11
F = 0,98 p = 0,38
F = 35,6 0 = 0.00
Thim nifin cflng tic S5nam 5-10 nam 5 1 0 n i m
16,94 F = 0,71 17,17 p = 0,49 17,18
18,59 18,66 18,78
F = 0.11 p = 0.89
Quy trinh dat kim lu&n Trung
binh Gii trj
F,P Ly do dl ISm d i l u d u ^ n g Thfch nghe flieu dirang HQC diSu diro'ng thi lam di^u dip&ng KhOng tim dirpc ngh^ fiSo thich hpp hon Ly do khde Ki^n thirc ve quy trinh d | t kim !u6n Kien thirc vk quy trinh cham soc kim luon
16,72 F = 0,99 17,63
p = 0,23 17 118 r = 0.57 D= 0.000
Quy trinh cham soc kim luon Trung
binh Giatri
F,P
,M
17,91
19.84 F = 23.39 20
0 = 0.0011 18.6
r = 0.66 0 = 0.000 Bang 6 cho I h l y s y luan Ihu quy trinh dat kim luon khdng khde nhau giua hai nhdm nam va nO (p = 0,39) nhung s y tudn thu QTKT d i d m soc kim ludn TMNV cd s y khac bigt cd y nghla thong ke (p
= 0,05) giua nhom nam va nhdm n u . Nhung dieu d u d n g vien khi tot nghidp trudng trung cap tuan Ihu t h y c hdnh quy trinh cham sdc kim luon co s y khde bidt ed )f nghta thong kd vdi nhdm dieu dudng vidn khi tot nghigp cao dang hoae dgi hpc (p = 0,00). Nhung dieu duang vien thich nghi didu dudng tudn thu quy trinh cham sde kim luin khde biet vdi nhung nhdm cdn lai, nhdm khdng tim d u g c nghe nao thich hgp han tuan thu quy trinh cham sdc kim luon cijng khde vdi nhom lam d i l u d u d n g vi ly do khde va nhdm hgc dieu dudng thi lam d i l u d u d n g (p < 0,001). Kiln thdc ve quy Irinh ddt va cham sdc kim ludn ed m l i lidn J quan thugn den thye hdnh quy Irinh ddt kim luin vd quy Irinh eham sdc kim l u i n d muc ')/ nghTa thdng kd 95%. (p < 0,001).
Nghidn c d u khdng tim t h i y moi lien quan gii^a I h y c hanh tuan Ihu quy trinh eham sdc kim luon TMNV vdi t u l i (p = 0,38) va thdm nien cdng tac cua dieu d u d n g vidn (p = 0,89).
Cung l u a n g t u nhu vdy, nghien cdu nay chi ra rang s y tuan thu t h y c hanh d4it kim l u i n TMNV khdng ed lien quan den gidi linh (p = 0,39), tuoi (p
I 34
^.^
NGHIEN c a u KHOA HOC
= 0,11), bdng c l p chuyen mdn khi t i t nghi$p (p = 0,2), tham nidn cdng tdc (p = 0,49) vd ly do di Idm dieu d u d n g (p = 0,23) t>di cde gid Iri t h i n g kd p deu Idn h a n 0,05 d mdc y nghTa 95%.
Bang 7. Y l u to loai hinh lao dong vd khoa dieu d u d n g vien Idm vide lien quan den s u tudn thu quy trinh
Quy trinh d^t kim luon Trung
binh Gia trj F, p
Quy trinh cham soc kim luon Trung
binh Gia bi F, p Logi hinh lao dgng ,^^^ _ .,
Bienct)!
Hgp dong Khoa ' • - * Hoi si>c ngoai Ha si>c tich arc Hoi sue so sinh
17,17 F = 2.06 16.65 p = 0,15
18,76 F = 6,88 18,34 0 = 0.0^
" " ""^ " - • , . . " • , .
16.61 F= 11,57 16,97 D = 0.00 17,54
17,54 F = 35,53 18,56 0 = 0.00 19.73 Bang 7 cho thay cdc y l u Id loai hinh lao ddng (p = 0,01) vd nai d i l u d u d n g vidn Idm vide (p = 0,00) cd m l i lidn quan cd y nghTa thong kd vdi s y tudn thu quy trinh cham sdc kim l u i n TMNV ddt trdn n g u d i benh, khdng cd m i l lien quan giua cae doi t u g n g bien c h l hay hgp dong khi tuan thu QTKT dat kim l u i n TMNV (p > 0.05) d muc ^ nghTa 95%.
Bang 8. Lien quan gjua khdi luong cong viec vdi s u tuan thu quy trinh
TrungbinhsocatLr21ti-7il/
ttiang
Tnjng binii s6 ngircri bfinii d i i m soc/ngiy
Quy trinii dit kim luon r = ^).19 p = 0.08 r=.0.39 p= 0.00
Quy trinh ciiam sdc kim luon
r = ^).17 p = 0.07 r = .0.47 11= 0.00 Kiem djnh thong kd cho b i l t khdng cd du bdng Chung v l s u khac bigt cua trung binh so b u l l lam ca t u 21h-7h trong thang vdi vide tuan thu thue hanh quy trinh ddt kim l u i n (p = 0,08) vd tuan thu quy trinh cham sdc kim luon (p = 0,07).
Tmng binh so ngudi benh eham sdc trong ngay cua dieu d u d n g vien cd anh hudng d i n s u
tudn Ihu quy trinh dgt kim l u i n va eham sdc kim luon d muc y nghTa 95% (p < 0,05).
Bang 9. Cac yeu to s u ho t r a cua dong nghigp lien quan tdi tuan thu quy trinh N^i dung Quy trinh dat
kim Iu6n Trung
binh Gia tri F, p
Quy trinh cham soc kim lubn Trung
binh GidtrjF.p Gif^ d& dieu (krong vifin khde
Thufimg xuyen Thinh thoang Khong giup dO'
16,8 F = 2.10 17,67 p = 0,07
0
18,01 F = 35,96 20,04 D = 0.00
19 GKpd&, h^1P7 ciJa flieu duOng vi6n Utac Thucfng xuyen
Thinh thoang
16,65 F = 4,28 17.67 p = 0,06
17,91 F = 73,04 19.85 o = 0.0P Khi dieu d u d n g vidn thudng xuydn giup d d eae dieu d u d n g vidn khac cd lien quan d i n s y tuan thu quy trinh eham sdc kim luon TMNV so vdi nhung dieu d u d n g vien thinh thodng giup d d dieu d u d n g vidn (p < 0,001) nhung s y giup d d cdc d i l u d u d n g vidn Wide lgi khdng lidn quan d i n s y tuan thu quy Irinh dat kim l u i n TMNV (p >
0,05). Cung giong nhu khi thudng xuyen giup d d d i l u d u d n g vidn khde, nhung d i l u d u d n g vidn t h u d n g xuydn 6urgc dieu d u d n g vidn khac giup d d tuan thu quy trinh chdm sdc kim luon TMNV khde vdi nhung d i l u d u d n g vidn thinh thoang mdi d u g c d i l u d u d n g vidn khde giup d d (p <
0,001); s y giup d d cua cde dieu d u d n g vidn khde khdng anh hudng d i n s y tuan thu quy trinh ddt kim luon TMNV.
3.2. Ket qua phan tich hoi quy t u y i n tinh da bien
3.2.1. Sir tuan thu quy trinh dat kim luon TMNV
Cdc yeu to lidn quan vd y l u to cd p < 0,1 trong phan phdn tich m i l lien quan dan bien vdi s y tuan thu quy trinh dgt kim luon TMNV id: k i l n thuc ve quy trinh dat kim iuon TMNV, khoa, trung binh so ngudi bgnh cham sdc/ngdy, bang c l p khi lot nghiep.
N G H I £ N CCrU KHOA H p c
K i t qud phdn tich md hinh hoi quy cho ta I h l y cdc yeu to k i l n thuc v l quy trinh d§t kim l u i n TMNV (p = 0,00), trung binh chdm sdc s6 ngudi bdnh/ngay (p = b,03) vd bang e l p khi l i t nghidp (p = 0,00) cOa d i l u d u d n g vidn id cd lidn quan den s u tuan thu quy trinh.
Mo hinh h6i quy:
•^^^Su tuan IhCi guv trinh dat kim j g l n = 0.51 x k i l n thdc v l quy trinh + 0.16 x b^ng c l p khi t i t nqhiep - 0.14 x trung binh cham sdc s l noudi benh/nody.
Kiem djnh tinh phu hgp cCia m l hinh: F = 13,65, p = 0,00, R2= 0,34. ^
T d m0 hinh cho ta Ihay moi lidn quan cua y l u ti^ k i l n f i d e v l quy trinh vdi s y tudn thu quy trinh manh n h i t , y l u t l trung binh s l ngudi bgnh chdm sdc/ngdy cd m l i lidn quan y l u n h i f vdi s y ludn thii quy trinh. Khi k i l n thde ve quy Irinh g i i j nguyen, bang e l p t i t nghidp giu nguydn thi trung binh so ngudi bdnh cham sdc/ngdy tdng 1 thl s y tuan thii quy trinh giam di 0,14. Tuang t y nhu vdy k i l n thuc tang idn 1 thi s y tuan thu tang Idn 0,51;
khi bdng c l p tdng Idrhl thl s y luan thu tdng Idn 0,16 khi hai yeu to cdn I g i ^ u nguyen.
3.2.2. S^r tuan thu quy trinh cham s6c kim luon TMNV
Cdc y l u t l lidn quan vd yeu lo cd p < 0,1 trong p h i n phan tich m l i lien quan dan b i l n vdi s y tuan thu quy trinh eham sdc kim l u i n TMNV Id:
giup 6& cua dieu dudng vidn khde, giup d d d i l u dudng vien khde, trung binh s l ngudi b$nh cham sdc/ngay, khoa, logi hinh iao dgng, ly do di lam dieu d u d n g , bdng e l p khi tot nghidp, gidi, k i l n Ihdc ve quy trinh chdm sdc kim l u i n TMNV.
K i t qud phdn lich hoi quy da bien cho thay ede yeu to kien thuc quy trinh cham sde kim l u i n (p ^ K ^ 0,00), trung binh cham sde so ngudi b$nh/ngdy '' (p = 0,00), b i n g cap khi t i t nghigp (p = 0,02) la thye s y cd lien quan d i n s y tudn thu quy trinh chdm sdc kim l u i n TMNV.
I 38
M6 hinh hdi quy:
S u tudn thCJ QUV trinh cham sdc kim j^^p
= 0.57 X k i l n thdc v l guv trinh - 0.18 x trung hjr^^
s6 ngudi bdnh chdm sdc/nadv + 0.14 x bine ci^p khi t i t nahido.
Md hinh cd thyc d mdc F = 39,532, p = 0,000, R2 = 0,452. Md hinh cho t h i y khi 2 trong s l 3 ^ u t l lien quan gi(?Jnguydn thl: k i l n thdc v l quy trihntdng idn 1 thl s y tuan thu quy trinh tang ldn 0,57; bing e l p chuydn mdn tang idn 1 thl s y ludn Ihij quy trinh ldng ldn 0,14; mjng binh s l ngudi bdnh chSm s6c/
ngdy ldng len 1 thi s y tudn thu gidm di 0,18.
4. BAN LUAN
DO t u l i cCia cdc d i l u dudng vidn tuang dli trd, nhdm tuoi s 34 l u l l c h i l m tdi 92,6%, ti 1$ ndy eao han h i n nghien c d u ci3a Chu Anh Van nhdm t u l i s 34 tuoi chf chiem 60,3%[30].
K i t quS phdt van 148 dieu dudng vien thl c6 87,8% la n u ; 12,2% Id nam gidi. K i t qud ndy t u a n g V - v d y c I t qud v l tl 1$ n d 86,6%[21] trong nghidrf_cdu cOa Db Thj Ngpc; cd khde so vdi tl !§
nam '9% vd n d 91 % eOa Chu Anh Van[30].
Ti lg d i l u d u d n g vidn Id trung c l p chilm 69,6%.
Ti 1^ d i l u d u d n g vidn Id trung c l p chilm da s l id ti 1$ ehung nhung cung c h i l m ti 1$ t h i o han trong nhieu nghidn cdu t r u d c dd da lieh hdnh: ti l§ dilu du&ng vidn Id trung c l p trong nghidn cuu cCia Chu AniiTVan la 80,4%[3O], trong nghien cdu cQa Dfi Thj Ngpc la 75,4%[21]^ trong nghien cdu cOa Duang Thj Binh Minh Id 84,5%[201, nghidn cdu ^ cOa Nguyin T h j i Y l n Id 83,7%[32]. Cd I h l ndi dd W Id s y qudn tdm etla Ban Gidm d i e doi vdi eac d(D vi h l i sdc, lya chgn nhO'ng d i l u dudng c6 trinh dO chuyen mdn cao d l ddp dng vdi doi hdi cdna vi$c trong mdt mdi trudng eham sdc ngudi b^nh (CSNB) dgc bigt: Ngudi b§nh phg thuOc hodn lodn vdo s y cham sdc cOa dieu 'dudng vidn.
Trong so 82 quan sdt d i l u dudng vidn thyc hi$n quy trinh ddt kim l u i n TMNV thi cd 62,5% ± d i l u d u a n g vien ed rda tay hoge sdt khuin tay t r u d c khi t h y c hi^n quy trinh, t u a n g t y vdi k i t ^ qud 63,1%. dieu d u d n g vien n>a tay trudc khi
NGHt£N c a u KHOA HOC
t h y c hign tidm trong nghidn c d u cua T r i n Thj Minh P h u g n g v l Ddnh gid t h y c hign TAT tgi B$nh vi0n Da khoa Hd Ddng nam 2012[24], cao han nghien c u u cua L§ Thj Kim Oanh v l s y tuSn IhQ rua tay, sdt k h u i n lay Id 52,8%[22], 47,5% d i l u d u d n g rua tay t r u d e Wii t h y c hign CSNB I h d mdy cua d i l u d u d n g khoa ICU, B§nh vi^n C h g Ray trong khao sdi cCia O^ng Thj Van Trang[27], vd cao hgn han 15,9% d i l u d u d n g , hO sinh rua tay, sdt k h u i n tay trude khi tidm trong nghidn cdu khao sat ve TAT cua N g u y i n Thj My Linh lgi B0nh vien Phg sdn Tlen Giang[16, 17]. K i t qud rda tay sau khi t h y c hign quy trinh cham sdc kim luon TMNV dgt Iren ngudi b^nh Id 65,5%i trong 148 d i l u d u d n g vien d u g c quan sat t h y c hl#n quy trinh cao han so vdi nghidn c u u cOa Ld Thj Kim Oanh cd 62,3%i n>a tay sau khi thye hi^n quy trinh tidm[22].
K i t qua phdn tich hoi quy da b i l n cho thay ea hai quy trinh d§t kim l u i n TMNV vd chdm sdc kim l u i n TMNV dgt trdn ngudi bgnh thye s u cd lien quan thuan d i n bang d p chuydn mdn, kien thdc v l quy trinh va iien quan nghjch den trung binh eham sdc so ngudi bdnii/ngdy.
D i l u nay'Cd t h l IJ giai la do cae quy trinh d i l u d u d n g vten dang t h y c hidn hdng ngdy ma cg the han la hai quy Irinh dgt va cham sdc kim l u i n TMNV 6i£gc xdy d y n g do chfnh nhung ngudi dieu d u d n g cOa eac khoa, nhijng ngudi lam vigc trye t i l p , hieu rd cdng vide Ihudng ngdy hg v l n idm. T d nhung k i l n thuc t h y c t l dd cdng vdi s y nghidn c u u , tim tdi nhung bdng ehung khoa hgc hign dgi, cdp nh^t Iren the gidi d l dng dyng sao cho phCi hgp vdi tinh hinh eua Vidt Nam, cua B0nh vien Nhi Trung u a n g . Do vdy, nhyng d i l u d u d n g vidn ed bang c l p t i t h a n , cd kien tiiuc t i t han sd tuan thu quy trinh tot han.
Tuy nhien, s l lugng ngudi b§nh chdm sdc/
ngdy dnh h u d n g khdng nhd d i n s y tuan thCi quy trinh, ddng n g u d i b^nh cham sdc nhung van phdi ddm bao t h y c hl#n dung y l^nh, thdi gian cOa y l$nh nen vige qudn budc, bd b u d e la d i l u khd trdnh khdi.
Dya trdn k i t qud nghien euu vd bdn lu|ln.
Chung tdi dua ra m|t so k i t lugn v l s y ludn IhO quy trinh ky thugt cua (Slu d u d n g vidn eae khoa H l i sdc, Bgnh vign Nhi Trung u a n g nhu sau;
5.1. SM* t u a n t h u q u y t r i n h ky t h u g t cda d i l u d u & n g v i e n cac khoa Hoi s u e , B$nh vidn Nhi T r u n g u a n g
D i l m Irung binh s y tuan thu quy trinh dat kim l u i n TMNV Id 15,13 d i l m , d i l u d u d n g cd d i l m t h y c hdnh t h i p n h i t Id 11 d i l m , cao n h l l Id 19 d i l m , khdng cd dieu d u d n g ndo dgt ^ I m t l i da 20 d i l m . Cd 15 bude trong quy trinh t i t cd cdc d i l u d u d n g vien d u g c quan sat t h y c hien, b u d c
"Kim khdng ngdp Irong mach mdu" ed ti Id cdc d i l u d u d n g vidn tudn Ihu it nhai (24,4%i), tiep d i n Id bude " D i l u d u d n g vidn mgc trang phgc theo quy djnh" (25,6%).
D i l m frung binh s y ludn thu quy trinh cham sdc kim l u i n TMNV ddt trdn ngudi bgnh la 18,95 d i l m , d i l m Ihap n h l l Id 16 diem va diem cao n h i t Id 22 d i l m - d l l m toi da ma dieu d u d n g vien cd t h l dgt d quy trinh nay. Cd 13 b u d c trong quy trinh i l l ca eac d i l u dudng vidn thyc hien d i y dO, g i n 1/3 quan sdt thdo nut d i u n l i ddm bao vd k h u i n (28,4%)) trong khi g i n mOt nda quan sdt Id cd c h u i n bj ggc vd khuan(42,6%). Chua d i n m$l nda quan sat d i l u d u d n g vien mgc Irang phyc khdng dung quy djnh (46,6%i).
5.2. Cdc y e u t o lien quan d i n s u t u d n t h d quy t r i n h ky thudt ciJia dieu d u d n g vien cdc khoa Hoi s u e cda B d n h vign Nhi Trung u a n g
5.2.1. Boi vol quy trinh d$t kim Iu6n TMNV Nghien c u u chl ra cd m i l lidn quan giua cdc y l u l l nai d i l u d u d n g vidn idm vl$c, trung binh so ngudi bdnh eham sdc/ngdy, k i l n thuc ve quy trinh d$t kim luon TMNV vdi s y tudn thu quy Irinh d | t kim l u i n TMNV (p < 0,05).
5.2.2. D6i v&i quy trinh cham soc kim luon TMNV
r ^ h i d n cdu cho thay cd m l i lidn quan giua c a c , y l u t l gidi tfnh, bang c l p chuydn mdn khi
4 ^ '
.A-EJifiJ DUONG 37 INGHIEN ClJU KHOA Hpc
t i l nghigp, ly do di Idm dieu d u d n g , yeu to logi hinh lao dgng, nai dieu dudng vien idm vigc, doi tugng dieu dudng vien Id bien c h l hay hgp dong, trung binh s l ngudi bgnh cham sdc/ngdy, giup dd d i l u dudng vidn khde, giup d d , ho trg eua d i l u dudng vien khde cd lidn quan d i n s y tudn thu quy trinh eham sdc kim ludn TMNV ddi tren ngudi bgnh (p < 0,05).
Sau khi k i l m sodt tde dgng cCia y l u to n h i i u tiem tang, nhung y l u t l cd m i l lidn quan cd y nghTa vdi s u luan thu hai quy trinh ddt kim luon va eham sde kim luon TMNV eua d i l u dudng vien (p < 0,05) id: K i l n thdc eua dieu d u d n g vidn v l quy trinh, bdng cap ehuydn mdn cua dieu d u d n g vien vd yeu to trung binh s6 ngudi bgnh chdm sdc/ngay.
TAI LIEU THAM KHAO
1. Nguydn Thj My Linh vd edng sy. (2009),
"Khao sdt ve tidm an todn eua didu dudng - hg sinh tai Bdnh vidn Phu san Tidn Giang, nam 2008", Y hge Thanh pho Hd Chi Mmh. 13(5).
2. Duang Thj Binh Minh (2012), T h y c frang cdng tdc eham sde d i l u duang ngudi bdnh tai cac khoa lam sang Bgnh vidn Hdu Nghj, nam 2012, Thac sT quan iy bdnh vidn, Trudng Dgi hgc Y te Cong edng, Hd Ndi.
3. Dd Thj Nggc (2013), Danh gia kien thuc, ky ndng va thai do thye hidn quy trinh ky thuat chuydn mdn trong cham sdc ngudi bgnh cua cac d i l u dudng vien lam sang tre cdng tac tai Bdnh vidn E, nam 2013, Thge sTquan ly bgnh vign. Dai hgc Y t l Cdng edng, Ha Ngi.
4. Le Thj Kim Oanh (2012), Can thidp nang cao tudn thij quy trinh ky thuat tidm t m y l n cua d i l u dudng lai Bdnh vidn Bdc Thang Long, nam 2012, Thgc sT quan ly bdnh vien, Trudng Dai hpc Y t i Cdng cgng, Ha Ngi.
5. Chu Anh Van (2013), Thye trang cham sdc dinh dudng cua dieu dudng vidn cdc khoa ldm sang vd mdi s l yeu to lien quan tgi Benh vidn Nhi Tmng uang, nam 2013, Thac sT quan ly bgnh vidn, Trudng Dai hoe Y te Cdng cpng. Hd Ndi.
6. Chu Hai Y i n (2013), T h u c trgng edng tdc cham sdc lodn dign ngudi bgnh cua d i l u dudng vien khoa H l i sdc c l p cuu, Benh vign Nong nghigp, ndm 2013, Thac sT quan ly bgnh vifn, Trudng Dgi hgc Y t l Cdng cdng, Ha NOi.
7. Choi .S.P & et al (2013), A field study of the role of nurses in advocating for safe practice in hospitals, access date 25-12-2013, available from http://wvirtv.ncbi.nimnih.gov/pubmed/24251549.
8. Omorogbe .V.E & et al. (2012), Injection safety practices among nursing staff of mission hospitals in Benin City, Nigena, access date 22- 12-2013, available from http://www.ncbi.nlm.nih.
gov/pubmed/22199046
9. Jarvis .W.R (2001), "Infection controi and changing health-care delivery systems', Emerging Infectious Diseases. 7(2), pg. 170-173.
10. WHO (2002), Prevention of hospital-acquired infections, access date 29-11-2013, available from hllp://www.who.int/esr/resources/publications/
d mgresist/en/whoedscsreph200212 .pdf.
11. WHO (2009), Primary health care, including health system strengthening, access date 24-12-2013, available from http://www.who.
int/hrh/resources/A62„12_EN.pdf.
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