Construction of VTE nursing training system based on post competence and its application in the prevention of PICC-related venous thrombosis in patients with lung cancer
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摘要:
目的 探究基于岗位胜任力的静脉血栓栓塞症(VTE)护理培训体系的建设, 以及该体系对护理队伍建设和预防肺癌患者PICC相关性静脉血栓的应用效果。 方法 以2019年4月—2020年4月西南交通大学附属医院成都市第三人民医院外科收治的132例肺癌患者及配备的36名护理人员为研究对象，将所有患者及护理人员按随机数字表法分为对照组和观察组，对照组护理人员经VTE常规培训，观察组护理人员则接受基于岗位胜任力的VTE培训。观察2组患者的临床症状，记录血液指标，评估护理人员的VTE知识知晓率和医院的VTE监测指标。 结果 经培训和护理后，观察组患者的深静脉血栓、肺血栓栓塞症和PICC相关性静脉血栓发生率均明显低于对照组(均P < 0.05)；观察组患者的D-二聚体、纤维蛋白原降解产物、内生肌酐清除率水平明显低于对照组患者，白蛋白水平明显高于对照组患者，差异有统计学意义(均P < 0.05)；观察组VTE的评估准确率、预防正确率、基础预防率、物理预防率、药物预防率均高于对照组(均P < 0.05)；观察组护理人员的考核评分和知识知晓评分明显高于对照组[(83.48±7.39)分、(82.48±7.42)分vs. (67.92±5.03)分、(67.46±6.38)分，t=7.385、6.512，均P < 0.001]。 结论 建设基于岗位胜任力的VTE护理培训体系，有利于提高医院风险质量管理能力，降低医院PICC相关性静脉血栓等VTE事件发生率，提升医护人员的综合素质，拓宽其知识面，为肺癌患者临床症状改善和血液功能的恢复带来有利条件。 Abstract:Objective This study aims to explore the construction of post competency-based VET nursing training system and its application effect on nursing team construction and PICC-associated venous thrombosis in patients with lung cancer. Methods A total of 132 patients with lung cancer and 36 nursing staff admitted to the Department of Surgery in the Third People' s Hospital of Chengdu, Affiliated Hospital of Southwest Jiaotong University from April 2019 to April 2020 were selected as the research objects. All patients and nursing staff were divided into the control group and observation group using the random number table method. Nursing staff in the control group received routine VTE training. The nursing staff in the observation group received VTE training based on post competency. The clinical symptoms in the two groups of patients were observed; the blood indexes were recorded, and the VTE awareness rate of the nursing staff and VTE monitoring indexes of the hospital were evaluated. Results After training and nursing, the incidence of deep vein thrombosis, pulmonary thromboembolism and PICC-related venous thrombosis in the observation group was significantly lower than that in the control group (all P < 0.05). The levels of D-dimer, fibrinogen degradation products and endogenous creatinine clearance in the observation group were significantly lower than those in the control group, whereas the levels of albumin were significantly higher than those in the control group, with statistical significance (all P < 0.05). The assessment accuracy, prevention accuracy, basic prevention rate, physical prevention rate and drug prevention rate of VTE in the observation group were higher than those in the control group (all P < 0.05). The assessment score and knowledge score of nursing staff in the observation group were significantly higher than those in the control group [(83.48±7.39) points, (82.48±7.42) points vs. (67.92±5.03) points, (67.46±6.38) points, t=7.385, 6.512, both P < 0.001]. Conclusion The construction of the VTE nursing training system based on post competency is conducive to improving the risk quality management ability of hospitals, reducing the incidence of PICC-associated VTE events, improving the comprehensive quality of medical staff, broadening their scope of knowledge and bringing favourable conditions for the improvement of clinical symptoms and the recovery of blood function in patients with lung cancer. -
Key words:
- Post competence /
- Venous thromboembolism /
- Nursing training /
- System construction /
- Lung cancer
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表 1 2组肺癌患者VTE发生情况比较[例(%)]
Table 1. The comparison of hemodynamic indexes between incidence of VTE in the two groups of lung cancer patients[cases (%)]
组别 例数 DVT PTE PICC相关性静脉血栓 对照组 66 12(18.18) 10(15.15) 8(12.12) 观察组 66 5(7.58) 4(6.06) 2(3.03) χ2值 5.007 4.358 5.901 P值 0.025 0.037 0.015 
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表 2 2组肺癌患者血液指标比较(x±s)
Table 2. Comparison of blood indexes between the two groups of lung cancer patients(x±s)
组别 例数 D-二聚体
(μg/mL)FDP
(μg/mL)Ccr
(mL/min)白蛋白
(g/L)对照组 66 0.36±0.07 5.76±1.11 92.36±8.86 31.59±4.39 观察组 66 0.28±0.03 4.28±1.07 78.97±6.41 36.57±4.90 t值 8.534 7.799 9.947 6.150 P值 < 0.001 < 0.001 < 0.001 < 0.001
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表 3 2组肺癌患者医院VTE监测指标比较(%)
Table 3. Comparison of VTE monitoring indexes in hospitals in two groups of lung cancer patients (%)
组别 例数 评估和预防 预防执行 评估准确率 预防正确率 基础预防率 物理预防率 药物预防率 对照组 66 69.38 37.41 48.29 42.49 45.38 观察组 66 92.39 75.38 89.20 77.39 86.92 χ2值 17.122 29.314 38.947 25.363 38.531 P值 < 0.001 < 0.001 < 0.001 < 0.001 < 0.001
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表 4 2组护理人员培训效果比较(x±s，分)
Table 4. Comparison of training effects between the two groups of nursing staff (x±s, scores)
组别 例数 短期考核 长期考核 总成绩 理论知识 实践技能 理论知识 实践技能 对照组 18 38.97±3.65 32.98±3.73 34.45±3.56 33.64±3.50 67.92±5.03 观察组 18 46.21±4.11 42.75±4.21 43.64±4.05 45.53±4.63 83.48±7.39 t值 5.588 7.369 7.231 8.691 7.385 P值 < 0.001 < 0.001 < 0.001 < 0.001 < 0.001
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表 5 2组护理人员VTE知识知晓情况比较(x±s，分)
Table 5. Comparison in VTE knowledge among nursing staff of the two groups (x±s, scores)
组别 例数 风险评估 防治指南 预防措施 案例分析 总分 对照组 18 18.49±2.49 17.74±2.14 16.39±2.43 15.38±2.20 67.46±6.38 观察组 18 21.75±2.94 20.49±2.84 20.94±2.89 20.49±2.87 82.48±7.42 t值 3.590 3.281 5.113 5.995 6.512 P值 0.001 0.002 < 0.001 < 0.001 < 0.001
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