【作者】 徐静；

【导师】 眭建；

【作者基本信息】 江苏大学 ， 护理学（专业学位）， 2019， 硕士

【摘要】 目的:旨在了解家庭保健在肠造口患者自我护理中的意义,分析肠造口患者医院-家庭过渡期间健康管理的需求情况及出院后支持计划的发展现状,探究健康信念干预对肠造口患者术后早期社会心理适应水平及生活质量的影响,为促进肠造口患者术后早期社会心理适应提供实践指导和护理对策。方法:本研究分为两个部分。(1)质性研究:运用目的抽样的方法,选取2016年11月~2017年4月在镇江市某三级甲等医院造口门诊就诊的12例肠造口患者为研究对象。访谈由两名护理研究生采用半结构式访谈的方式在一个私人安静的空间里进行,以当场记录和录音相结合的形式与患者进行面对面深入访谈,每次访谈时间约为25~40分钟,使用解释性的现象学分析,以此了解肠造口患者院后家庭保健中的健康管理需求。访谈人数以资料达到饱和状态为准。(2)干预研究:采用便利抽样的方法,选取镇江市某三级甲等医院110例因结直肠癌行结肠或回肠造口术的患者,将其随机分为对照组和试验组,其中对照组有55例,试验组有55例。对照组患者给予常规造口护理,试验组患者在常规造口护理的基础上,实施健康信念模式干预,干预周期为3个月。该干预模式主要是通过提高患者术后早期信息察觉、技能学习、需要感知等方面的能力来形成自我健康信念;以健康目标为导向,纠正不良生活习惯,进而促进积极生活态度的产生,形成健康行为。采用自行设计的一般资料情况调查表对肠造口患者的人口学和临床特征资料进行收集。在患者术后第1天、出院时、出院后3个月时采用中文版造口患者社会心理适应量表(OAI-20)和简明健康调查问卷(SF-36)对两组患者进行调查,分别评估肠造口患者社会心理适应水平及生活质量情况。采用SPSS22.0软件对数据进行统计分析,所用的统计方法主要包括:描述性分析、两独立样本t检验、单因素方差分析、四格表卡方检验等。结果:1.质性研究结果:肠造口患者过渡期身体意象、日常和社交生活活动、造口管理教育、家庭及社会支持等方面问题突出,护理需求明显。2.干预研究结果:(1)两组患者性别、年龄、造口类型、文化程度、婚姻状况、家庭月收入等一般资料差异均无统计学意义(P>0.05)。(2)两独立样本t检验结果显示:干预前试验组肠造口患者术后社会心理适应总得分为28.49±11.09分,对照组适应总得分为27.00±12.07分,患者总体处于低适应水平;出院时和出院后3个月,试验组患者术后社会心理适应总分、正性情绪得分、负性情绪得分、社会生活适应得分均明显高于对照组(P<0.05)。配对t检验结果表明:出院时和出院后3个月,试验组患者术后社会心理适应总分、正性情绪得分、负性情绪得分、社会生活适应得分均高于干预前(P<0.05)。(3)在护理干预前,两组患者生活质量各维度得分比较,差异无统计学意义(P>0.05);出院时和出院后3个月,试验组患者生活质量各维度得分均明显高于对照组(P<0.05);出院时,试验组患者生活质量各维度得分均高于干预前(P<0.05);出院后3个月,两组患者生活质量各维度得分均高于干预前(P<0.05)。(4)重复测量方差分析结果表明:两组患者术后社会心理适应总分及各维度得分、生活质量各维度得分间存在交互效应(P<0.05)。(5)在护理干预后,试验组造口并发症总发生率为16.36%,对照组造口并发症总发生率为32.73%;四格表卡方检验结果显示:两组患者造口并发症总发生率比较,差异有统计学意义(P<0.05);其中试验组患者有2例发生造口周围性皮炎,对照组患者有8例发生造口周围性皮炎,两组患者造口周围性皮炎发生率比较,差异有统计学意义(P<0.05)。结论:1.肠造口患者术后早期居家健康管理需求迫切。2.健康信念能提高肠造口患者术后早期社会心理适应水平及生活质量。3.肠造口患者术后出院后支持计划有待完善。更多还原

【Abstract】 Objective: Understanding the significance of family health care in self-care of enterostomy patients,analyzing the needs of health management during hospital-to-family transition in enterostomy patients and the development status of post-discharge support programs,exploring the effects of health belief intervention on postoperative early psychosocial adaptation and quality of life in patients with enterostomy,and providing practical guidance and nursing strategies for promoting early postoperative psychosocial adaptation in patients with enterostomy.Methods: This study was divided into two parts.(1)Qualitative research: Using the method of purpose sampling,and 12 cases of enterostomy patients from the ostomy clinic of a top-third hospital in Zhenjiang from November 2016 to April 2017 were selected as subjects.The interview was conducted by two nursing graduate students in a private and quiet space using semi-structured interviews.In-depth face-to-face interviews with patients were conducted in the form of on-the-spot recording and recording.Each interview lasted about 25 to 40 minutes.Interpretative phenomenological analysis is used to understand the health management needs of post-hospital family health care in patients with enterostomy.The number of interviewees is based on the saturation of data.(2)Intervention study: Using a convenient sampling method,a total of 110 patients with colostomy or ileostomy for colorectal cancer were selected from a top-third hospital in Zhenjiang.They were randomly divided into the control group and the experimental group,of which 55 cases were in the control group and 55 cases in the experimental group.The patients in the control group were given routine stoma care.The patients in the experimental group were enrolled in the health belief model on the basis of routine stoma care.The intervention period was 3 months.The intervention mode mainly forms self-health beliefs by improving the ability of post-operative information detection,skill learning,and need for perception.It is guided by health goals,corrects bad habits,and promotes the generation of positive attitudes to form healthy behaviors.Demographic and clinical characteristics data were collected from patients with enterostomy using aself-designed general information questionnaire.The patients of the two groups were investigated on the first day after surgery,at the time of discharge,and at the end of 3months after discharge,using the Chinese version of the Ostomy Adjustment Inventory-20 Scale(OAI-20)and the Chinese version of the Self-administration Formal-36 scales(SF-36).The psychosocial adaptation level and quality of life of patients with enterostomy were evaluated separately.Statistical analysis was performed using SPSS 22.0 software.The statistical methods used included descriptive analysis,two independent sample t-tests,one-way ANOVA,and four-square table chi-square test.Results:1.Qualitative research results:During the transitional period of enterostomy,the problems of body image,daily and social life activities,education of stoma management,family and social support are prominent,and nursing needs are obvious.2.Intervention study results:(1)There were no significant differences in gender,age,type of stoma,educational level,marital status,and family monthly income between the two groups(P>0.05).(2)The t-test results of two independent samples showed that: Before the intervention,the total score of postoperative psychosocial adaptation in the experimental group was 28.49±11.09,and the total score of the control group was27.00±12.07.The patients were generally at low adaptation level.At the time of discharge and 3 months after discharge,the total scores of psychosocial adaptation,positive emotion score,negative emotion score,and social life adaptation score of the experimental group were significantly higher than the control group(P<0.05).The results of paired t-test showed that: At the time of discharge and 3 months after discharge,the total scores of postoperative psychosocial adaptation,positive emotion score,negative emotion score,and social life adaptation were higher in the experimental group than before intervention(P<0.05).(3)Before the nursing intervention,there was no significant difference in scoresof quality of life between the two groups(P>0.05).At the time of discharge and 3months after discharge,the scores of quality of life in the experimental group were significantly higher than those in the control group(P<0.05).At the time of discharge,the scores of all dimensions of QOL of the experimental group were higher than those before the intervention(P<0.05).Three months after discharge,the scores of each dimension of quality of life of the two groups were higher than those before intervention(P<0.05).(4)Repeated measurement analysis of variance showed that: The total scores of psychosocial adaptation and scores of each dimension,the scores of each dimension of quality of life in the two groups had interactive effects(P<0.05).(5)After the nursing intervention,the total incidence of ostomy complications in the experimental group was 16.36%,and the total incidence of ostomy complications in the control group was 32.73%.The four-square table chi-square test results show:The total incidence of ostomy complications in the two groups was statistically significant(P<0.05).Among them,2 patients in the experimental group developed peristomal dermatitis,and 8 patients in the control group developed peristomal dermatitis.The incidence of peristomal dermatitis in the two groups was statistically significant(P<0.05).Conclusion:1.The early postoperative home health management needs of patients with enterostomy are urgent.2.Health beliefs can improve the level of early psychosocial adaptation and quality of life in patients with enterostomy.3.The post-discharge support programs for patients with enterostomy need to be improved.更多还原