【作者】 郭颖；

【导师】 刘照旭；

【作者基本信息】 山东大学 ， 护理学， 2015， 硕士

【摘要】 目的：探讨自我效能联合自我护理干预对食管癌放疗患者生活质量的影响,并根据干预效果评价干预措施的临床应用前景,以制定切实可行的护理干预模式,提高食管癌患者的生活质量。方法：本研究为干预性研究,采用便利抽样的方法,选择2013年6月-2014年12月在山东省某肿瘤医院放疗病区接受根治性放射治疗的88例食管癌患者为研究对象,其中将2013年6月-2013年12月接受食管癌根治性放疗的44例患者作为对照组,2014年1月-2014年12月收治的44例食管癌根治性放疗患者作为实验组。对照组患者给予食管癌放疗常规护理,实验组患者在此基础上实施提高自我效能感和自我护理能力的联合干预。两组患者均在放疗前一天、结束后1个月采用一般自我效能感量表(GSES)、自我护理能力测定量表(ESCA)、欧洲癌症患者生命质量测定量表(EORTCQLQ-C30)进行组间干预效果比较；实验组尚在放疗结束当天进行同样调查,以考察随时间变化,干预措施对食管癌患者自身的影响。数据采用SPSS 17.0软件进行统计学分析。结果：1.实验组食管癌患者的自我效能感有40.48%处于高等水平,54.76%处于中等水平,4.76%处于低等水平；对照组食管癌患者的自我效能感有77.27%处于中等水平,20.46患者处于低等水平,2.27%患者处于高等水平。实验组食管癌患者的自我护理能力有80.95%处于高等水平,19.05%处于中等水平,无1例处于低等水平；对照组的自我护理能力有6.82%处于高等水平,90.91%处于中等水平,2.27%处于低等水平。2.实验组患者的自我效能感、自我护理能力和生活质量较对照组均有显著改善(P<0.01)。3.实验组患者的自我效能感、自我护理能力得分均随着时间的推移而升高(P<0.01),患者的生活质量得分在放疗前一天、放疗结束当天及干预结束后两两比较差异均有统计学意义(P<0.01)。4.食管癌放疗患者的自我效能感与自我护理能力及各维度之间均呈高度正相关(P<0.01)；自我效能感与生活质量及各功能领域之间均呈高度正相关(P<0.01),与症状领域及单项条目中的疲倦、疼痛、食欲下降、便秘呈负相关(P<0.01)；自我护理能力及各维度与生活质量及各功能领域间两两均呈高度正相关(P<0.01),症状领域及单项条目中的疲乏、疼痛、失眠、食欲下降、便秘均与自我护理能力及各个维度呈负相关(P<0.01)。5.对食管癌患者放疗后生活质量影响因素进行多元逐步回归分析,筛选出影响放疗后生活质量的四个主要因素：病变位置(B=-8.633,P<0.01)、自我护理能力(B=0.127,P<0.01)、疾病分期(B=-4.124,P<0.01)、自我效能(B=0.502,P<0.01)。结论：1.对照组患者的自我效能感和自我护理能力处于中等水平,而实验组患者的自我效能感和自我护理能力处在高等水平。2.自我效能联合自我护理干预有效增强了患者的自我效能感,提高了自我护理能力。并且随着放疗推进,自我效能感和自我护理能力是逐步升高的。3.对患者实施自我效能及自我护理的综合干预方法是提高食管癌患者放疗后生活质量的有效方法。患者放疗结束时的生活质量低于放疗前,应该着重加强放疗期间的护理干预。4.食管癌患者的自我效能感、自我护理能力与生活质量两两之间均呈显著正相关。5.病变位置、自我护理能力、临床分期和自我效能感是影响食管癌患者放疗后生活质量的重要因素。其中病变位置和自我护理能力是主要因素。更多还原

【Abstract】 Objective:To explore the influence of self-efficacy and self-care joint intervention on the quality of life of esophageal carcinoma (EC) patients who are receiving radiation and evaluate the prospect of clinical application based on the effect of intervention in order to draw up feasible nursing intervention model, and improve the quality of life of EC patients.Methods:The research was an interventional study, and used the method of convenience sampling to select 88 EC patients receiving definitive radiotherapy who came from the radiology department of one cancer hospital in Shandong from Jun 2013 to Dec 2014. Among of them,44 patients with EC from Jun 2013 to Dec 2013 were ranked control group, and 44 EC patients from Jan 2014 to Nov 2014 were ranked experimental group. The patients in the control group received EC routine nursing, while the experimental group received joint nursing intervention which improved self-efficacy and self-care ability on the basis of routine nursing care. The interventional effect of those two groups were compared with each other, using questionnaires included general self-efficacy scale (GSES), the exercise of self-care agency (ESCA), the European quality of life instrument for cancer patients-esophageal cancer (EORTCQLQ-C30) on the day before radiation and in one month after the completion of radiation. The patients in experimental group were also evaluated in the same way on the very day of radiation so that the change of interventions effect over time can be studied for EC patients. The statistical software SPSS for windows version 17.0 was used for data analysis.Results:1.40.48% EC patients perceived higher levels,54.76% patients perceived medium levels and 4.76% patients perceived lower levels of self-efficacy in experimental group; while 77.27% patients perceived medium levels,20.46% patients perceived lower levels and 2.27% perceived higher levels in the control group. In addition, in experimental group,80.95% patients perceived higher levels, 19.05% patients perceived medium levels and none perceived lower levels of self-care ability; while in the control group,6.82% patients perceived higher levels, 90.91% patients perceived medium levels, and 2.27% perceived lower levels.2. Comparing the self-efficacy of two groups, both self-care ability and quality of life in the experimental group were significantly improved (P<0.01).3. The scores of self-efficacy, self-care ability and quality of life in the experimental group all improved over time (P<0.01). The life quality scores of patients were statistically different between the pre-radiation, the very day of radiation and after the intervention (P<0.05).4. Self-efficacy, self-care ability and its dimension scores had a significant positive relationship (P<0.01); self-efficacy, quality of life and its functional areas scores had a significant positive relationship (P<0.01); Self efficacy and the symptoms of fatigue, pain, loss of appetite, constipation were negatively correlated (P<0.01).self-care ability and its dimension and quality of life and functional areas were highly positive correlation (P<0.01), symptoms and individual items of fatigue, pain, insomnia, loss of appetite, constipation and self-care ability and all dimensions were negatively correlated (P<0.01).5. According to the stepwise multiple regression analysis of the influencing factors related to the quality of life of patients with esophageal carcinoma after radiotherapy were lesion location OB=-8.633, P<0.01) with self-care ability (B=0.127, P<0.01), clinical stage (B=-4.124, P<0.01), self-efficacy (B=0.502, P<0.01)Conclusion:1. The level of self-efficacy and self-care ability of patients in control group was medium, while the level of those in experimental group was high.2. Self-efficacy and Self-care joint intervention was the effective way to improve self-efficacy, self-care ability of esophageal carcinoma patients receiving radiation. And with the advance of radiotherapy, self-efficacy and self care ability is gradually increased.3. Self-efficacy and Self-care joint intervention was the effective way to improve the quality of life of esophageal carcinoma patients receiving radiation. But the quality of life of the patients at the end of radiotherapy should be lower than that before radiotherapy, we should focus on strengthening intervention during radiotherapy.4. The relationship between the scores of self-efficacy, self-care ability and its dimensions, and the quality of life and its dimensions presented highly positive correlation.5. The main factors that affect the quality of life of patients with esophageal carcinoma after radiotherapy were lesion location,self-care ability, clinical stage, self-efficacy,among which lesion location and the self-care ability were the most important factors.更多还原