全人照护管理模式在改善青春期白血病儿童生存质量中的应用研究
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摘要
目的:探索全人照护管理模式在改善化疗期间青春期白血病儿童生存质量中的应用效果。方法:采用自身前后对照,选取某大学附属儿童医院97例接受化学治疗的青春期白血病儿童为研究对象,比较全人照护管理模式实施前后其生存质量的变化,在干预前采用课题组自行研制的《不同年龄阶段白血病儿童生存质量评价量表》,并结合半结构式访谈对儿童的生存质量现状及存在问题进行调查,根据调查结果制定以全人照护模式为框架的干预方案,并在实施3个月后观察干预后生存质量各项指标的变化。结果:干预前后患儿的生存质量总分及各领域得分均有明显提高(P<0.05),且干预前后的心理情感领域与社会交往领域改善最明显;各维度干预前后除学校表现以外均有显著差异(P<0.05)。干预前后部分条目,如学校活动中跟不上同龄人、因身体不适必须去看病或住院而缺课、医疗保险等无显著差异(P>0.05)。结论:全人照护管理模式能有效缓解化疗期间青春期白血病儿童的焦虑、抑郁情绪,并明显提高其生存质量,帮助白血病儿童尽早回归社会。
Objective:To understand the implementation effects on the quality of life of the adolescent leukemia children in chemotherapy under the humanistic nursing management model,improve the prognosis and the quality of life. Methods:As a casecontrol study,97 adolescent children receiving chemotherapy from the Affiliated Children's Hospital of a Medical University were enrolled. The changes of the quality of life before and after the intervention of holistic nursing management model were compared.The current quality of life and the problems of the adolescent leukemia children in chemotherapy was investigated before intervention through the survey using self-designed scale(the quality of life scale for leukemia children of different ages)combined with the semistructured interviews on children's quality of life. The holistic nursing management model is applied according to the results and all the indicators of the quality of life were examined after 3 months. Results:The total score and scores in all fields of the leukemia children before and after the intervention were significantly improved(P <0.05). Among them,the mental emotion and social interaction improved most evidently. And there is no obvious difference(P <0.05) before and after the intervention in the school performance in all fields. And there was no obvious difference in parts of the factors(P >0.05) including the weaker performance of the leukemia children in the school activity than the peers,the absence from class due to the illness,the great help of the medical insurance in relieving the economical burden. Conclusion:The holistic nursing management model can relieve anxiety and depression in children with leukemia chemotherapy,significantly improve the quality of life and let leukemia children return to society as soon as possible.
Objective:To understand the implementation effects on the quality of life of the adolescent leukemia children in chemotherapy under the humanistic nursing management model,improve the prognosis and the quality of life. Methods:As a casecontrol study,97 adolescent children receiving chemotherapy from the Affiliated Children's Hospital of a Medical University were enrolled. The changes of the quality of life before and after the intervention of holistic nursing management model were compared.The current quality of life and the problems of the adolescent leukemia children in chemotherapy was investigated before intervention through the survey using self-designed scale(the quality of life scale for leukemia children of different ages)combined with the semistructured interviews on children's quality of life. The holistic nursing management model is applied according to the results and all the indicators of the quality of life were examined after 3 months. Results:The total score and scores in all fields of the leukemia children before and after the intervention were significantly improved(P <0.05). Among them,the mental emotion and social interaction improved most evidently. And there is no obvious difference(P <0.05) before and after the intervention in the school performance in all fields. And there was no obvious difference in parts of the factors(P >0.05) including the weaker performance of the leukemia children in the school activity than the peers,the absence from class due to the illness,the great help of the medical insurance in relieving the economical burden. Conclusion:The holistic nursing management model can relieve anxiety and depression in children with leukemia chemotherapy,significantly improve the quality of life and let leukemia children return to society as soon as possible.
引文
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[14]Olson K,Amari A.Self-reported pain in adolescents with leukemia or a brain tumor:a systematic review[J].Cancer Nurs,2015,38(5):E43-53.
[15]Braam KI,van der Torre P,Takken T,et al.Physical exercise training interventions for children and young adults during and after treatment for childhood cancer[J].Cochrane Database Syst Rev,2013(4):CD008796.
[16]Tremolada M,Taverna L,Bonichini S,et al.Self-esteem and academic difficulties in preadolescents and adolescents healed from paediatric leukaemia[J].Cancers(Basel),2017,9(6):55.
[17]Rajii F,Oskouie F,Shoghi M.Caring for a child with cancer:impact on mother’s health[J].Asian Pan J Cancer Prev,2014,15(4):1731-1738.
[18]林晓霞,陈燕惠,陈珊,等.社会支持对学龄期白血病患儿及其家长的影响[J].中国儿童保健杂志,2016,24(12):1241-1244.
[19]张洁文.儿童生存质量癌症模块量表中文版Peds QL3.0信度、效度分析及其初步应用[D].广州:中山大学,2009.
[20]Ackard DM,Neumark-Sztainer D.Health care information sources for adolescents:age and gender differences on use,concerns,and needs[J].J Adolesc Health,2001,29(3):170-176.
[21]周英凤,王颖.白血病住院患儿领悟社会支持状况调查分析[J].护理学杂志,2003,18(10):741-742.
[22]王园园,王婧婷,俞苏燕,等.确诊初期急性淋巴细胞性白血病患儿父母需求的质性研究[J].解放军护理杂志,2016,33(4):6-10
[2]吴双.1 241例白血病流行特征及直接经济负担评价[D].兰州:兰州大学,2014.
[3]马金香,雷毅雄,叶铁真,等.广东省儿童青少年白血病流行特征分析[J].中国预防医学杂志,2008,9(4):245-247.
[4]Whitehead TP,Metayer C,Wiemels JL,et al.Childhood leukemia and primary prevention[J].Curr Probl Pediatr Adolesc Health Care,2016,46(10):317-352.
[5]Metayer C,Dahl G,Wiemels J,et al.Childhood leukemia:a preventable disease[J].Pediatrics,2016,138(s1):S45-55.
[6]胡亚美,江载芳.诸福棠实用儿科学[M].8版.北京:人民卫生出版社,2015.
[7]Essig S,Li QZ,Chen Y,et al.Risk of late effects of treatment in children newly diagnosed with standard-risk acute lymphoblastic leukemia:a report from the Childhood Cancer Survivor Study cohort[J].Lancet Oncol,2014,15(8):841-851.
[8]黄建美,蔡若吟,林旭妮,等.白血病急性期住院患儿的行为特点及护理对策[J].南方护理学报,2005,12(5):8-10.
[9]朱宏锐,吕晓凡,鲁丰华,等.晚期癌症患者灵性照护的研究进展[J].解放军护理杂志,2015,32(17):32-35.
[10]陈丽云,伍杏修.社区服务对慢性病患者生存质量的影响[J].现代康复,2000,4(8):1146-1147.
[11]裴艳,吴蓓雯,袁长蓉,等.乳腺癌病人全人照护模式的发展与思考[J].护理研究,2014,28(16):1926-1928.
[12]王紫娟,莫霖,刘洋,等.我国不同年龄阶段白血病儿童生存质量评价量表的初步研制[J].护理学杂志,2016,31(9):24-27.
[13]Wang Y,Huang J,Rong L,et al.Impact of age on the survival of pediatric leukemia:an analysis of 15083 children in the SEER database[J].Oncotarget,2016,7(50):83767-83774.
[14]Olson K,Amari A.Self-reported pain in adolescents with leukemia or a brain tumor:a systematic review[J].Cancer Nurs,2015,38(5):E43-53.
[15]Braam KI,van der Torre P,Takken T,et al.Physical exercise training interventions for children and young adults during and after treatment for childhood cancer[J].Cochrane Database Syst Rev,2013(4):CD008796.
[16]Tremolada M,Taverna L,Bonichini S,et al.Self-esteem and academic difficulties in preadolescents and adolescents healed from paediatric leukaemia[J].Cancers(Basel),2017,9(6):55.
[17]Rajii F,Oskouie F,Shoghi M.Caring for a child with cancer:impact on mother’s health[J].Asian Pan J Cancer Prev,2014,15(4):1731-1738.
[18]林晓霞,陈燕惠,陈珊,等.社会支持对学龄期白血病患儿及其家长的影响[J].中国儿童保健杂志,2016,24(12):1241-1244.
[19]张洁文.儿童生存质量癌症模块量表中文版Peds QL3.0信度、效度分析及其初步应用[D].广州:中山大学,2009.
[20]Ackard DM,Neumark-Sztainer D.Health care information sources for adolescents:age and gender differences on use,concerns,and needs[J].J Adolesc Health,2001,29(3):170-176.
[21]周英凤,王颖.白血病住院患儿领悟社会支持状况调查分析[J].护理学杂志,2003,18(10):741-742.
[22]王园园,王婧婷,俞苏燕,等.确诊初期急性淋巴细胞性白血病患儿父母需求的质性研究[J].解放军护理杂志,2016,33(4):6-10