登革熱住院病人症狀與護理診斷之相關研究

The Relationship Between Symptoms and Nursing Diagnoses in Hospitalized Patients With Dengue Fever

背景：登革熱臨床處置以支持性療法為主，了解症狀及所需護理診斷可作為護理人員提供個別性照護的參考，但目前無相關研究，故進行本研究。目的：了解登革熱住院病人的症狀，並探討與護理診斷之一致性。方法：採回溯性描述性研究設計，資料庫為高雄兩家區域醫院符合疾病診斷碼之住院病人電子病歷，於2014年至2016年間共萃取105位病人資料。運用IBM SPSS Statistics v22，以平均數、百分比進行病人屬性及登革熱症狀之描述性統計，以卡方檢定及Kappa一致性係數進行症狀與住院天數、護理診斷之推論性統計。結果：住院病人平均51.0±27.3歲，平均住院6.1±3.6天，常見症狀為發燒及頭痛；分析護理診斷與症狀之一致性達45.4％，含體溫過高、急性疼痛、噁心、潛在危險性胃腸灌流失效、潛在危險性出血；無一致性佔27.3％：焦慮、體液容積缺失、潛在危險性跌倒；有症狀卻無護理診斷佔27.3％：腹瀉、潛在危險性感染、口腔黏膜障礙。結論／實務應用：臨床症狀與護理診斷不符之可能原因是對登革熱及護理診斷教育不足，導致護理人員在臨床上缺乏經驗或判斷力，建議加強繼續教育並善用「登革熱症狀查檢表」，以提供個別性照護。

Background: Supportive care is a primary method for treating dengue fever. Understanding the symptoms of dengue fever and its related nursing diagnosis is crucial for nurses as references for individual care. This research study was motivated by the few literature reviews available on this topic. Purpose: This study was developed to elucidate the symptoms experienced by hospitalized patients with dengue fever and to compare the consistency between symptoms and nursing diagnoses. Methods: A retrospective descriptive research method was employed. The data were collected from the electronic medical records of patients in the data pools of two regional hospitals in Kaohsiung City. A total of 105 patient records were acquired covering the period 2014–2016. IBM SPSS Statistics v22 was used to examine the descriptive statistics of patient attributes and symptoms of dengue fever using averages and percentages and the inferential statistics of symptoms, hospitalization days, and nursing diagnosis using the Chi-square test and Kappa consistency coefficient. Results: The average age of inpatients was 51.0 ± 27.3 years and the average length of hospital stays was 6.1 ± 3.6 days. The common symptoms were fever and headache. The consistency between nursing diagnosis and symptoms ranged up to 45.4%, including hyperthermia, acute pain, nausea, risk of ineffective gastrointestinal perfusion, and risk of bleeding. Inconsistency of nursing diagnosis was found to be 27.3%, including anxiety, deficient fluid volume, and risk of falls. The rate of undiagnosed symptoms was found to be 27.3%, including diarrhea, risk of infection, and impaired oral mucous membrane. Conclusions/ Implications for Practice: The reasons for the inconsistency between symptoms and nursing diagnoses may relate to insufficient nursing knowledge of dengue fever and inadequate nursing diagnosis education resulting in insufficient clinical experience/ poor judgment amongst nursing staff. The findings of this study suggest the need for continuity of education to make the use of a dengue-fever-symptom checklist more widespread in patient care.