Williams M A, Holloway J R, Winn M C, Wolanin M O, Lawler M L, Westwick C R, Chin M H
Nurs Res. 1979 Jan-Feb;28(1):25-35.
Confusion in 91 hospitalized patients over 60 years of age who had sustained hip fracture and undergone subsequent surgical repair was examined in seven hospitals in five states. The relationship of nursing activities, patient, surgical, and environmental variables to the extent of confusion apparent in the sample was explored. Data were gathered by record review, patient testing, observation, and interview. Patient testing and interview were carried out on the first, third, and fifth postoperative days; the patient's caregiver on those days was also interviewed. The major dependent variables used in multiple regression analysis were memory (immediate and recent), observed behavior, and patient's self-report of mental clarity. Results showed that the most consistent predictors of postoperative confusion were the presence of confusion on admission to the hospital or confusion during the preoperative period. Greater postoperative mobility and freedom from urinary problems resulted in less confusion. Being male and of increased age were risk factors. The presence of timepieces and patients' use of television were associated with higher levels of mental clarity. Patients in private rooms tended to do better on memory testing than patients in rooms shared with others. Nursing personnel's major action in response to patient confusion was that of conscious attention to orientation, explanation, or reassurance. Use of restraints was relatively frequent.
在五个州的七家医院对91名60岁以上因髋部骨折住院并接受后续手术修复的患者的精神错乱情况进行了调查。探讨了护理活动、患者、手术及环境变量与样本中明显的精神错乱程度之间的关系。通过病历审查、患者测试、观察和访谈收集数据。在术后第一天、第三天和第五天进行患者测试和访谈；在这些日子里，患者的护理人员也接受了访谈。多元回归分析中使用的主要因变量是记忆（即刻记忆和近期记忆）、观察到的行为以及患者对精神清晰度的自我报告。结果显示，术后精神错乱最一致的预测因素是入院时存在精神错乱或术前出现精神错乱。术后活动能力增强和没有泌尿系统问题会减少精神错乱。男性和年龄增长是危险因素。有钟表以及患者使用电视与较高的精神清晰度水平相关。住在单人病房的患者在记忆测试中的表现往往比与他人合住病房的患者更好。护理人员应对患者精神错乱的主要措施是有意识地关注定向、解释或安抚。约束措施的使用相对频繁。
