【作者】 王莹；

【导师】 李艳丽；

【作者基本信息】 天津医科大学 ， 护理学， 2015， 硕士

【摘要】 【目的】(1)描述妇科癌症患者成人依恋、社会支持和创伤后成长水平。(2)探讨妇科癌症患者成人依恋、社会支持与创伤后成长之间的关系。(3)分析妇科癌症患者创伤后成长水平的影响因素,为护理工作者个体化干预患者创伤后成长水平提供理论依据。【方法】本研究采用便利抽样的方法选取经临床确诊为妇科癌症并于2013年11月至2014年8月入住天津某两所三级甲等医院的169例患者为研究对象,采用一般资料调查表、亲密关系经历量表、社会支持评定量表、创伤后成长量表对患者进行问卷调查。患者一般资料及各量表分析采用频数、构成比、均数±标准差描述,采用Person相关的方法进行相关性分析,影响因素分析采用单因素方差分析和多重线性回归分析。采用SPSS17.0软件对数据进行统计分析。【结果】(1)妇科癌症患者成人依恋两维度条目均分为依恋回避(3.20±0.90),依恋焦虑(3.92±0.80);依恋类型分布为:迷恋型依恋类型所占比例35.5%、恐惧型依恋占34.3%、安全型依恋占17.8%、冷漠型依恋占12.4%。(2)妇科癌症患者社会支持总分为(39.21±8.13),各维度得分分别为:客观支持(8.80±2.64)、主观支持(23.73±5.46)、对支持利用度(6.67±2.10)。(3)妇科癌症患者创伤后成长总得分为创伤后成长总分为(52.91±16.32),单条目得分最高的维度是个人力量维度(3.20±0.88),精神改变维度得分最低,为(1.89±1.14)。(4)依恋类型可影响患者创伤后成长水平(F=6.654~126.058,P<0.01),采用SNK方法进行两两比较显示,安全型依恋与其他三种依恋类型在创伤后成长水平上比较差异具有显著性(P<0.05)。(5)妇科癌症患者成人依恋中依恋回避维度与创伤后成长呈负相关关系(r=-0.199~-0.288,P<0.01),依恋焦虑维度与创伤后成长呈负相关关系(r=-0.244~-0.421,P<0.01);社会支持与创伤后成长成正相关关系(r=0.208~0.306,P<0.01)。（6)多重线性回归分析表明妇科癌症患者创伤后成长水平影响因素为:医疗费用支付方式、主观支持、依恋类型。【结论】(1)妇科癌症患者在患病过程中依恋系统被激活,其分布与健康人群不同;尚未能获得较多的社会支持,存在一定程度的创伤后成长。(2)医疗费用支付方式、主观支持、迷恋型、恐惧型、冷漠型依恋类型可影响患者创伤后成长水平,提示护理工作者在工作过程中应及时地评估患者依恋类型,采取个体化的干预措施有效地促进患者创伤后成长。更多还原

【Abstract】 Objectives(1)To analyze the status of adult attachment, social support and posttraumatic growth in gynecological cancer patients.(2)To analyze the influence of the attachment styles on gynecological cancer patients with social support and posttraumatic growth.(3)To analyze the influence factors of posttraumatic growth in gynecological cancer patients and to provide theoretical basis for individualized intervention of posttraumatic growth for clinical workers.Method A descriptive and relative research carried out in two level 3 first-class hospitals in Tianjin by using questionnaires, which including general data survey scale、the Posttraumatic Growth Inventory(PTGI) 、 Social Support Questionnaire and Experiences in Close Relationship(ECR).Convenience sampling method was used to select 169 objects, whose clinical diagnosis was gynecological cancer, who were living in hospitals during November 2013 to August 2014.The general data and the analysis of scales were described by frequency, percentage, mean and standard deviation, the Person related methods were used for Correlation analysis, the influence factors were analyzed by using single factor analysis of variance and multiple linear regression analysis.SPSS17.0 software package was used for statistical analysis.Results(1)The average score of adult attachment’s two dimensions of gynecological cancer patients were: attachment avoidance(3.20 ±0.90), attachment anxiety(3.92 ±0.80);Distribution of attachment styles were:35.5% preoccupied、34.3% fearful、17.8% secure and 12.4% dismissing.(2)The overall score of social support of gynecological cancer patients was(39.21±8.13) and the score of objective、subjective and availability of social supports were(8.80±2.64)、(23.73±5.46)、(6.67±2.10)respectively.(3)The overall score of posttraumatic growth of gynecological cancer patients was(52.91±16.32),among different dimensions, the highest average score was personal strength(3.20±0.88),while the lowest score was spiritual change(1.89±1.14).(4) Attachment styles had a significantly influence(P < 0.05) on the total level of posttraumatic growth in patients(P <0.01), pairwise comparisons showed that security attachment compared with other attachment styles on the level of posttraumatic growth was significant difference(P < 0.05).(5)The posttraumatic growth was negatively correlated with attachment avoidance(r=-0.199~-0.288,P<0.01) and attachment anxiety(r=-0.244~-0.421,P<0.01); Social support are positively correlated with posttraumatic growth(r = 0.208 ~ 0.208, P < 0.208)(6) Multiple linear regression analysis showed that the influence factors of posttraumatic growth of gynecologic cancer patients were: payment of medical expenses, subjective support and attachment styles.Conclusion(1) The attachment system of gynecologic cancer patients is activated during illness and difference with healthy people,the patients could not get more social support, have a certain degree of posttraumatic growth.(2) Payment of medical expenses, subjective support, preoccupied attachment styles, fearful attachment styles, dismissing attachment styles can affect patients’ posttraumatic growth level, social support plays a positive role to promote the patients with posttraumatic growth, which prompting clinical workers should be timely assess the attachment types of patients and take individual interventions depending on the attachment style, as a consequence, to promote the posttraumatic growth of patients effectively.更多还原