【作者】 汪璐；

【导师】 崔焱； 顾平； 许勤；

【作者基本信息】 南京医科大学 ， 护理学， 2008， 硕士

【摘要】 背景子宫切除术作为妇科手术中的一种基本手术,已应用于妇产科临床有数百年的历史,可为众多妇科疾病尤其是良性疾病患者解除痛苦。国内外许多医疗和护理工作者针对子宫切除术作了大量研究。国内研究者多采用量的研究方法从自己的职业角度探讨子宫切除给患者带来的影响,国外学者运用质的研究方法从患者、配偶等视角深入探讨手术所引起的所思所想较多,有助于读者对子宫切除女性的深入理解。本研究尝试以质的研究方法探讨罹患子宫良性疾病的女性经历腹式子宫切除手术的术前决策经历和术后住院期康复体验。目的1、描述研究对象的术前决策过程和心理状态,分析影响决策过程的因素。2、描述研究对象术后住院期康复体验。3、探讨研究对象的决策经历和康复体验对临床实践的启示。方法本研究主要采用了质的研究(qualitative research)方法。以8名罹患子宫良性疾病而行腹式子宫切除手术的患者为研究对象,通过深度访谈、参与观察以及Zung焦虑自评量表等方法收集资料,经过对资料的分析和归纳,获得研究结果。结果1、罹患子宫良性疾病而行腹式子宫切除手术的8位研究对象术前决策过程包括①获取疾病相关信息;②尝试各种保守治疗;③最终确定切除子宫。最终确定切除子宫是病情严重程度、生育状况、医务人员的建议、社会支持状态和工作性质等诸多因素综合考虑的结果。2、患者术前决策过程中的心理状态包括负性心理状态、矛盾心理和正性的心理状态。负性心理状态包含三个方面,即不公平感、不确定感与焦虑、恐惧。全子宫切除患者术前面临宫颈是否保留时存在决策冲突的矛盾心理。正性心理状态为期待。3、患者术后住院期康复体验包含负性体验和正性体验。负性体验包含:疼痛、情境性自尊低下、悲伤和遗憾;正性体验包含两个方面,即顺利感和幸福感。结论1、罹患子宫良性疾病而行腹式子宫切除手术患者术前决策存在许多未知,医务人员、患者及其家属作为决策主体如何科学决策,获得满意的决策结果,亟需医患双方共同努力,相互理解。2、患者的康复需要医患双方共同的支持。配偶的支持是不可替代的精神力量。医护专业人员和家庭提供持续有效的支持可以促进患者术后康复。更多还原

【Abstract】 BackgroundAs a basic gynecological operation, hysterectomy has been applied to clinical practice for centuries, relieving pains from patients suffering from gynecological diseases, especially benign uterine diseases. Many doctors and nurses home and abroad have made a lot of studies on hysterectomy. While most researchers in our country adopt quantitative research methods to study the effects of hysterectomy on patients from their own professional standpoints, their counterparts abroad widely use qualitative research approaches to study the feelings of the patients and their spouses about hysterectomy, thus helping readers understand the patients more deeply.This study attempted to apply qualitative research methods to explore the pre-operational decision-making process and post-operational hospital recovery experience of the patients who have abdominal hysterectomy because of benign uterine diseases.Objectives1. To describe pre-operational decision-making process and psychological state of the research subject, and analyze the factors that influence the decision-making process.2. To describe the post-operational recovery experience in hospital of the research subject3. To study the enlightenment of the subjects’ decision-making experience and post-operational recovery experience in hospital to clinical practice.MethodsQualitative research method was conducted in this study. Eight patients with benign uterine diseases undergoing abdominal hysterectomy were chosen as research subjects. In-depth interviews, participant observation and the Zung self-rating anxiety scale were used for purpose of data collection. The final results were obtained through analysis and synthesis of the obtained information.Results1. The pre-operational decision-making processes for eight patients undergoing abdominal hysterectomy because of benign uterine diseases comprise:①getting information about the disease;②Trying conservative treatments;③Making the final decision of hysterectomy. The final decision results from comprehensive consideration of different factors including severity of disease, childbirth status, recommendations from medical professionals, social support and patient’s job.2. Patients showed negative, contradictory and positive psychological states in pre-operational decision-making process. Patients in negative psychological state represented senses of unfairness, uncertainty, anxiety and fear. Patients undergoing uterus removal operation exhibited contradictory feeling when it came to decide whether to keep cervix or not. Patients in positive psychological state were mainly characterized by expectation for surgery.3. Patients’ post-operational hospital rehabilitation feelings include negative and positive aspects. Negative feelings include: pain, situational low self-esteem, grief and regret; while patients with positive feelings showed happiness in the smooth rehabilitation progress.Conclusion1. As for the patients with benign uterine diseases, there are many uncertainties in their decision-making before hysterectomy. Since the medical professionals, the patients and their families are all subjects in the decision making process, all of them should urgently have more mutual understanding and make more common efforts to make a scientific decision.2. Recovery of the patients need supports from both medical professionals and families. Supports from their spouses are indispensable mental power. Consistent effective supports from both medical professionals and families can improve the recovery of the patients.更多还原