【作者】 王敏；

【导师】 罗彩凤；

【作者基本信息】 江苏大学 ， 护理学（专业学位）， 2023， 硕士

【摘要】 目的1.了解肠造口患者社会疏离感现状及影响因素,探索患者真实疏离感体验。2.探讨基于理情行为疗法健康教育方案对肠造口患者疏离感、歧视知觉、社会参与及社会关系质量的影响。方法本研究共包括两个部分:1.第一部分——肠造口患者社会疏离感现状及影响因素:采用解释性时序设计⑴量性研究阶段:采用便利抽样法,选取镇江市某三级甲等医院胃肠外科和伤口造口门诊225名行肠造口术患者进行调查。采用一般资料调查表、一般疏离感量表(General Alienation Scale,GSA)和社会影响量表(Social Impact Scale,SIS),了解肠造口患者社会疏离感现状及影响因素。⑵质性研究阶段:基于目的抽样法,选取方便抽样和最大差异法抽样,从量性研究阶段选择访谈对象,对纳入的14名患者进行半结构访谈,采用主题分析法挖掘肠造口患者日常生活的真实感受,充分了解患者疏离感体验。2.第二部分——肠造口患者社会疏离感干预方案构建及应用⑴根据前期量性与质性研究结果、文献查阅及筛选合适的干预技术策略,经课题组头脑风暴形成干预方案初稿,随后根据预实验和课题组成员讨论形成最终干预方案。⑵采用类实验研究,于2022年1月—2022年6月,选取镇江市某三级甲等医院胃肠外科和伤口造口门诊就诊的70名肠造口患者为研究对象,对照组和试验组各35例。两组患者均接受肠造口患者常规健康教育,试验组在常规健康教育基础上接受基于理情行为疗法的干预方案。分别于基线、干预后1个月和干预后3个月比较两组患者一般疏离感、歧视知觉、社会参与及社会关系质量的变化情况。结果1.肠造口患者社会疏离感现状及影响因素:⑴量性研究阶段:共纳入225例肠造口患者,疏离感得分(39.26±3.55)分,疏离感程度较高;不同婚姻状况、文化程度、职业情况和造口时间的患者疏离感得分差异具有统计学意义(P<0.05)。⑵质性研究阶段:通过对14名肠造口患者深度访谈及综合分析,得到不同水平肠造口患者在社会参与、人际关系及设立目标方面的疏离感体验。2.肠造口患者社会疏离感干预方案构建及应用:以理情行为疗法作为干预方案框架,对肠造口患者实施个体化健康教育干预策略。干预前两组患者基线可比,一般资料比较无统计学意义(P>0.05)。干预1个月及3个月时,试验组患者社会疏离感总分降低,与对照组相比具有统计学意义(P<0.05);试验组患者歧视知觉总分较高,与对照组差异具有统计学意义(P<0.05);试验组患者社会参与各维度及总分下降,表明社会参与效果良好,室外自主参与、社会生活和社会关系及总分差异具有统计学意义(P<0.05),室内自主参与和家庭角色自主参与差异无统计学意义(P>0.05);试验组社会关系质量随时间延长明显改善,与对照组差异具有统计学意义(P<0.05)。结论1.肠造口患者社会疏离感问题亟待临床关注,根据肠造口患者在社会参与、人际关系及设立目标方面的疏离感体验。医护人员应实施针对性措施,增强社会支持,有效缓解其疏离感,促进患者健康结局。2.基于理情行为疗法构建的干预方案有助于改善肠造口患者疏离感现状、降低歧视知觉水平及提高社会关系质量,但在社会参与方面效果有待进一步探讨。更多还原

【Abstract】 Objectives1.To understand the current situation and factors influencing social isolation in patients with enterostomies and to explore patients’ real experience of isolation.2.To investigate the effects of a health education program based on rational emotive behavior therapy on isolation,perception of discrimination,social participation and quality of social relationships in patients with enterostomies.MethodsThis study consists of two parts:1.Part I-the current situation of social isolation and the factors influencing it in patients with enterostomy: an explanatory time series design was used.(1)Quantitative research: 225 patients who underwent enterostomy surgery in a tertiary level A hospital in Zhenjiang City were selected for the survey using convenience sampling method.The General Information Questionnaire,General Isolation Scale(GSA)and Social Impact Scale(SIS)were used to understand the current situation of social isolation and the factors influencing social isolation in patients with enterostomy.(2)Qualitative research: With the purposive sampling method,convenience sampling and maximum difference method sampling,interview subjects from the quantitative research,semi-structured interviews were conducted with the 14 patients included,and thematic analysis was used to uncover the true feelings of daily life of patients with enterostomies to fully understand the patients’ experience of isolation.2.Part II-Construction and application of an intervention program for social alienation in patients with enterostomies.(1)Based on the results of the preliminary quantitative and qualitative studies,literature review and screening of appropriate intervention technology strategies,the group brainstormed to form the first draft of the intervention plan,and then formed the final intervention plan based on pre-experiments and discussions among the group members.(2)Using a class experimental study,70 patients attending the gastrointestinal surgery and wound stoma clinic of a tertiary care hospital in Zhenjiang City were selected for the study from January to June 2022,with 35 cases each in the control and experimental groups.Patients in both groups received conventional health education for patients with intestinal stoma,and the experimental group received an intervention program based on rational emotive behavior therapy on this basis.Changes in general isolation,perception of discrimination,social participation and quality of social relationships were compared between the two groups at baseline,1 month after the intervention and 3 months after the intervention,respectively.Results1.Current status of social isolation in patients with enterostomies and factors influencing it:(1)Quantitative research: 225 enterostomal patients were included,with isolation score(39.26±3.55),with a high degree of isolation;the differences in their isolation scores were statistically significant(P<0.05)among patients with different marital status,education level,occupational status and duration of stoma.(2)Qualitative research: In-depth interviews and comprehensive analysis of 14 patients with enterostomies to obtain the experience of isolation in social participation,interpersonal relationships and goal setting for patients with different levels of enterostomies.2.Construction and application of an intervention program for social isolation in patients with enterostomies:Rational emotional behavioral therapy was used as the framework of the intervention program,and individualized health education intervention strategies were implemented for patients with enterostomies.The two groups of patients were comparable at baseline before the intervention,and the comparison of general information was not statistically significant(P>0.05).At 1 month of intervention and3 months of intervention,the overall total score of isolation of patients in the test group improved,and the difference with the control group was statistical significance(P < 0.05);the total score of social influence of patients in the test group was higher,and the difference with the control group was statistically significant(P < 0.05);the dimensions of social participation and the total score of patients in the test group decreased,indicating that social participation was effective,and the differences of outdoor autonomous participation,social life and Social relationship and total score differences were statistically significant(P < 0.05),indoor autonomous participation and family role autonomous participation differences were not statistically significant(P > 0.05);the quality of social relationship in the test group improved significantly over time,and the differences with the control group were statistically significant(P <<0.05).Conclusions1.The issue of social isolation in patients with an intestinal stoma requires urgent clinical attention,and the experience of isolation varies among patients with different marital status,educational level,occupational status,and duration of stoma.Health care professionals should implement targeted measures to enhance social support,effectively alleviate their sense of isolation,and promote healthy patient outcomes.2.The intervention program based on rational emotive behavior therapy can help improve isolation,reduce the level of discrimination perception and improve the quality of social relationships in patients with enterostomies,but the effect on social participation needs to be further explored.更多还原