【作者】 刘伟伟；

【导师】 高伟；

【作者基本信息】 山东大学 ， 护理（专业学位）， 2019， 硕士

【摘要】 目的:本研究应用质性研究和量性研究两种方法调查结直肠癌肠造口患者自我感受负担的现状及其相关的影响因素,了解自我感受负担与医学应对方式、病耻感、造口自我效能之间的相关性,为使患者自我感受负担得到降低,制定有效的干预措施提供可参考的理论依据。方法:本研究分为两部分。1.第一部分质性研究应用的是现象学的方法。拟定访谈提纲,应用半结构式访谈法对15名结直肠癌肠造口患者访谈,应用Noivo11软件对访谈结果编码整理,应用Colaizzi七步法分析资料,提炼主题,总结结直肠癌肠造口患者的真实感受。2.第二部分量性研究采用问卷调查的方法。抽取山东省济南市四家三级甲等医院2018年5月至2018年12月结直肠癌肠造口的165名患者作为研究对象。调查问卷内容包括肠造口患者的一般人口学资料及临床疾病资料、自我感受负担、医学应对方式、病耻感、造口自我效能感。资料应用SPSS22.0软件和R软件统计和分析,包括描述性的资料分析、单因素方差分析、独立样本t检验、Pearson相关性分析、多元线性回归分析中的后退分析法和中介效应的分析法。结果:1.质性访谈提炼出六大主题:日常不便及窘态,经济压力大,复杂的心理感受,知识缺乏,自我价值感降低,体验到的积极因素。2.结直肠癌肠造口患者自我感受负担总分是(31.15±9.01)分,其中身体负担得分为(5.93±2.15)分,情感负担得分为(18.68±5.69)分、经济负担得分为(6.48±2.27)分。3.结直肠癌肠造口患者医学应对方式中面对得分(18.58±3.04)分,回避得分(15.56±2.63)分,屈服得分(10.80±2.87)分。4.结直肠癌肠造口患者病耻感总分是(48.05±7.69)分,处于中度水平,其中社会排斥得分是(16.63±3.09)分,经济歧视得分是(7.11±2.02)分,内在羞耻得分是(7.80±1.88)分,社会隔离得分是(16.43±3.34)分。5.结直肠后肠造口患者自我效能感得分是(74.11±20.02)分,处在中等护理水平,造口照护自我效能是(38.12±10.25)分,社交自我效能是(21.73±7.68)分,饮食选择得是(2.81±1.08)分,性生活效能为(2.07±1.09)分,性满意度为(2.02±1.07)分,是分数最低的一项,重体力为(2.47±1.17)分,保持活力为(2.56±1.11)分,是分数最高的一项,造口自理为(2.55±1.07)分。6.单因素分析的结果:患者家庭月收入、手术方式、支付方式、肠造口能否还纳及还纳的时间、患者与医护交流等因素对自我感受负担的影响有意义(P<0.05),年龄有趋势(0.05<P<0.1)。7.相关性分析提示患者的自我感受负担与面对呈负相关(P<0.05),与屈服正相关(P<0.05),与病耻感正相关(P<0.05),与造口自我效能负相关(P<0.005)。8.多元回归结果:年龄、性别、医患交流、手术方式、屈服、社会排斥、经济歧视可解释造口患者自我感受负担的52.44%。9.中介效应检验结果:屈服的应对方式在造口自我效能与自我感受负担中的中介效应为-0.118,效应比为50.43%。病耻感在造口自我效能与自我感受负担中的中介的中介效应=-0.176,效应比=75.21%。结论:1.临床医护人员应该高度重视结直肠癌肠造口患者自我感受负担相关的真实体验,做好健康宣教以及延续护理。2.结直肠癌肠造口的患者的自我感受负担很大部分处在中度及以上水平。3.结直肠癌肠造口患者的自我感受负担的水平受其性别、家庭月收入、医患交流、手术方式、支付方式、肠造口能否还纳及还纳的时间等因素的影响。4.医学应对方式、造口自我效能、病耻感也可影响结直肠癌肠造口患者的自我感受负担,面对应对、自我效能高患者自我感受负担就低,屈服应对、病耻感高患者自我感受负担就高。5.病耻感、屈服应对方式在造口自我效能与自我感受负担之间存在中介作用。更多还原

【Abstract】 Objective:This study used qualitative and quantitative research to investigate the status of self-perception burden and its related influencing factorsin colorectal cancer patients with enterostomy,to explore the relationship among self-feeling burden,medical coping methods,stigma of diseases,and stoma self-efficacy,to provide a theoretical basisfor reducing the patient’s self-feeling burden and developing effective interventions.Methods:This study is divided into two parts.1.The first part of this study is also said the qualitative study which applied the phenomenological approach.After outlining an interview,semi-structured interviewswould be used when interviewing 15 colorectal cancerpatients with enterostomy.Noivo11 software would be used to code the interview results,and Colaizzi’s seven-step methodwould be usedto analyze the data,refine the theme,and suimmarize the real feelingsof colorectal cancer patients with enterostomy.2.The second part of this study iscalled the quantitative study which used the method of questionnaire survey.165 colorectal cancer patients with enterostomy in four tertiary hospitals in Jinan,Shandong Province were enrolledfrom May to December 2018.The questionnaire included general demographic data and clinical results such as self-feeling burden,medical coping methods,diseases stigma,and enterostomy self-efficacy.SPSS22.0 software and R software were used to analysis related data including descriptive data analysis,one-way ANOVA,independent sample t test,Pearson correlation analysis,multiple linear regression analysis and mediation effect analysis.ResultS:1.The qualitative interviews extracted six major themes:daily inconvenience and embarrassment,high economic pressure,complex psychological feelings,lack of knowledge,reduced self-worth and positive factors experienced.2.The total self-receptive burden of colorectal cancer patients with enterostomywas(31.15±9.01),including body burden score(5.93±2.15),emotional burden score(18.68±5.69),and economic burden score(6.48±2.27)points.3.In the medical coping style of colorectal cancerpatients withenterostomy,the scores were(18.58±3.04),the avoidance score(15.56±2.63),and the yield score(10.80±2.87).4.The total score of disease stigma in colorectal cancer patients with enterostomy was(48.05±7.69)points,which was at a moderate level.The social exclusion score was(16.63±3.09)points,the economic discrimination score was(7.11±2.02)points,and internal shamescore was(7.80±1.88)points and the social isolation score was(16.43±3.34)points.5.The self-efficacy score of patients with colorectal post-enteral stoma was(74.11±20.02),at the level of secondary care,the self-efficacy of ostomy care was(38.12±10.25),and the social self-efficacy was(21.73±7.68)points.The choice was(2.81±1.08),the sexual life performance was(2.07±1.09),the sexual satisfaction was(2.02±1.07),which was the lowest score,and the heavy physical strength was(2.47±1.17)points.The vitality is(2.56±1.11)points,which is the highest score,and the ostomy is(2.55±1.07)points.6.The results of univariate analysis showed that the monthly income of the patient,the surgical method,the payment method,the time of retraction of the enterostomy and Doctor-patient communicationcould significantly influence the self-perception burden(P<0.05).In addition,the age was trend to influence the self-perception burden(0.05<P<0.1).7.Correlation analysis showed that the patient’s self-feeling burden was negatively correlated with the faceand enterostomy self-efficacy(all P<0.05),and positively correlated with yield and diseases stigma(all P<0.05).8.Multiple regression results showed that age,gender,doctor-patient communication,surgical methods,surrender,social exclusion,and economic discrimination can explain 52.44%of the self-perception burden of enterostomy patients.9.The mediating effect test results showed that the mediating effect of the response mode of yielding on the stoma self-efficacy and self-feeling burden is-0.118,and the Risk ratio is 50.43%.The mediating effect of enterostomy in the self-efficacy and self-feeling burden were-0.176,and the effect ratio was 75.21%.In conclusion:1.Clinical health care workers should attach great importance to the real experience related to the self-feeling burden of colorectal cancer patients with enterostomy,and do some work in health education and continuing care.2.The self-feeling burden of colorectal cancerpatients with enterostomywere largely at moderate and above levels.3.The level of self-experience burden of colorectal cancer patients with enterostomy would be affected by gender,family monthly income,doctor-patient communication,surgical methods,payment methods,and the time of retraction of the enterostomy.4.Medical coping methods,enterostomy self-efficacy,and diseases stigma could also affect the self-experience burden of colorectal cancer patients with enterostomy.Patients with higher level of face of coping and self-efficacy would have lower self-feeling burden,while patients with higher yield of coping and diseases stigmawould have higherself-feeling burden.5.There is a mediating effect between diseasesstigma or yielding of coping andenterostomy self-efficacy or self-feeling burden.更多还原