系统自我护理干预对喉癌病人生存质量影响的研究
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摘要
为了研究有效提高喉癌术后病人生存质量的护理干预方法,将Orem自我护理理论同临床护理实践相结合,制定出系统自我护理干预措施应用于喉癌术后病人。本研究采用实验性研究设计,将2006年12月-2007年12月吉林大学第二医院耳鼻喉科住院手术治疗的共计76例喉癌病人随机分为干预组和对照组,对照组病人实施喉癌术后常规护理,干预组病人实施能改善自我护理能力的系统自我护理干预措施,主要包括能改善健康知识水平、自我概念、自护责任感和自我护理技能四个方面的认知教育和行为训练,通过自我护理理论的三大系统即完全补偿性、部分补偿性系统及支持教育完成。病人出院后每月定期电话随访或家访,至出院后3个月干预结束。采用个人一般资料调查表、自我护理能力测定量表(ESCA)、欧洲癌调查治疗组织生存质量中心调查表(EORTC QLQ-C30)、欧洲癌调查治疗组织头颈癌生存质量问卷(EORTC QLQ-H&N35)进行调查。数据采用SPSS14.0软件进行统计分析。研究结果显示,喉癌病人的自我护理能力总均分为98.12士14.32,呈现低等水平;喉癌病人的生存质量EOR-TC QLQ-C30总均分为95.57±10.63,呈现中低等水平;EORTCQLQ-H&N35总均分为20.37±11.05,呈现中低等水平;喉癌病人的自我护理能力与生存质量之间存在中等程度的正相关(r=0.40,P=0.01);干预组自我护理能力比对照组明显增强,自我护理干预可明显提高喉癌病人自我护理能力(P<0.05);系统自我护理干预能明显提高喉癌病人的生存质量(P<0.05)。结果表明,系统自我护理干预是提高喉癌病人生存质量的行之有效的方法。对预防喉癌病人术后及远期并发症的发生,提高喉癌病人独立生活的能力,减轻家庭和社会负担,促进病人康复,提高护理质量和服务质量具有现实意义。
Objectives:(1)To describe the self-care agency in patients with larynx carcinoma. (2)To Describe the quality of life.(3)To find out the relationship between the self-care agency and quality of life.(4) To explore the effects in patients with larynx carcinoma of systemic self-care management interventions on self-care agency. (5)To explore the effects of systemic self-care management interventions on quality of life in patients with larynx carcinoma.Methods:The study used an experimental design. The 76 patients who came from the ENT Institute inpatient department of the Second Clinical Hospital of Jilin University from Dec 2006 to Dec 2007 were randomly allocated to a control or intervention group.The patients in the control group received routine nursing care.The intervention group received systemic self-care management interventions which included improvement of self–care ability, self-care responsibility, self-esteem and health knowledge. The intervention time was four months. Four questionnaires were used for data collection:a general information sheet of patients,the exercise of Self-care Agency(ESCA), EORTC QLQ-C30 and EORTCQLQ-H&N35 questionnaires.The statis -tical software SPSS for windows version 14.0 was used for data analysis. Results:(1)ESCA scores of All larynx carcinoma was patients 98.12士14.32,perceived a low level of self-care agency. Only 7.89%patients perceived a high level of self-care agency. Factors that can influence significantly self-care agency,used by Linear Regression,were educational level, profession, operating manner and family relationship. (2) EOR-TCQLQ-C30 quality of life scores of all patients was95.57±10.63,EORTCQLQ-H&N35 quality of life scores of all patients was20.37±11.05.patients perceived a middle level of quality of life.(3 )Findings from the present study revealed that there are a significant positive relationship between the self-care agency and quality of life in patients with larynx carcinoma. (4) Systemic self-care management interventions improved self-care agency(P<0.05). (5)Systemic self-care management interventions were significantly improved larynx carcinoma quality(P<0.05). Conclusions: From the results of this study it can be concluded that larynx carcinoma patients perceived a low level of self-care agency and quality of life. There are a significant positive relationship between the self-care agency and quality of life inpatients with larynx carcinoma .Self-care education could improve the self-care agency,enhance quality of life.
Objectives:(1)To describe the self-care agency in patients with larynx carcinoma. (2)To Describe the quality of life.(3)To find out the relationship between the self-care agency and quality of life.(4) To explore the effects in patients with larynx carcinoma of systemic self-care management interventions on self-care agency. (5)To explore the effects of systemic self-care management interventions on quality of life in patients with larynx carcinoma.Methods:The study used an experimental design. The 76 patients who came from the ENT Institute inpatient department of the Second Clinical Hospital of Jilin University from Dec 2006 to Dec 2007 were randomly allocated to a control or intervention group.The patients in the control group received routine nursing care.The intervention group received systemic self-care management interventions which included improvement of self–care ability, self-care responsibility, self-esteem and health knowledge. The intervention time was four months. Four questionnaires were used for data collection:a general information sheet of patients,the exercise of Self-care Agency(ESCA), EORTC QLQ-C30 and EORTCQLQ-H&N35 questionnaires.The statis -tical software SPSS for windows version 14.0 was used for data analysis. Results:(1)ESCA scores of All larynx carcinoma was patients 98.12士14.32,perceived a low level of self-care agency. Only 7.89%patients perceived a high level of self-care agency. Factors that can influence significantly self-care agency,used by Linear Regression,were educational level, profession, operating manner and family relationship. (2) EOR-TCQLQ-C30 quality of life scores of all patients was95.57±10.63,EORTCQLQ-H&N35 quality of life scores of all patients was20.37±11.05.patients perceived a middle level of quality of life.(3 )Findings from the present study revealed that there are a significant positive relationship between the self-care agency and quality of life in patients with larynx carcinoma. (4) Systemic self-care management interventions improved self-care agency(P<0.05). (5)Systemic self-care management interventions were significantly improved larynx carcinoma quality(P<0.05). Conclusions: From the results of this study it can be concluded that larynx carcinoma patients perceived a low level of self-care agency and quality of life. There are a significant positive relationship between the self-care agency and quality of life inpatients with larynx carcinoma .Self-care education could improve the self-care agency,enhance quality of life.
引文
[1]田勇泉,孙爱华.耳鼻咽喉-头颈外科学[M],北京人民卫生出版社,2006:216-220.
[2]刘秀莲,王秋芹,冯桂玲.护理干预对喉癌术后病人生存质量的影响.护理学杂志,2006,21(4):48-49.
[3]刘慧莲,涂英,毛君晓.Orem自理模式在喉癌手术病人中的应用.赣南医学院学报,2005,4:518-520.
[4]Orem,D.E.Nursing:Concept of practice.New York: Mc Gmwy,1991.
[5]Gantz S. B .Self-care:perspectives from six disciplines. H olistic nursing practices.1900,4(2),1-12.
[6]张立强,栾信庸,潘新良等.喉切除术后病人生存质量的评估.中华耳鼻咽喉科杂志,2002,37:11-14.
[7]吕式缓.护理程序与主要的护理学说.国外医学护理学分册, 1983,4(5):205.
[8]Mc Bride S H. Comparative analysis of three instruments designed to measure self-care agency.Nurs Res,1991,40(1): 12-16.
[9]HansonB ,BickelL .Development and testing of the ques-tionnaire on perception of self-care agency.In J.Riehl Sisca (Ed.),1985,13:272-278.
[10]MinekoY amashita. The exercise of self-care agency sca -le.Western Journal of nursing research,1998,20(3):370- 381.
[11]Hsiu-HungWang,Shirley C,Lafrey.Preliminary develop- ment and testing of instruments to measure self-care agency and social support of women in TaiWan Kaohsiungy Med Sci,2000,16:459-467.
[12]Hannele Lukkarinen,Maijahentinen.Self-care agency and factors related to this agency among patients with coronary heart disease.Int JNurs.Stud,1997,34(4):295-233.
[13]ConellyC E.Self-care and the chronically ill patient nursing clinics of North American.1987,22(3):621-628.
[14]Dodd MJ, Dibble SL. Predictors of Self-care:A Test of Orem Model.DODD-VOL,1993,20(6):895-901.
[15]Hanucharumkul S,Social support,self-care,and quality of life in cancer patients receivng radio therapy in Thailand.Un- published doctoral dissertation,College of Nursing, Wayne State University,Detroit,1988.
[16]王岚.自我护理在消化科实施效果的调查.现代护理,2004,10(6):518.
[17]颜江瑛,刘筱娴.生命质量—健康评价的发展方向.国外医学社会医学分册,1999,16(1):7-9.
[18]Flanagan JC. A ressearch approach to improving our quality of life.Am Psvchol.1978,33:138-147.
[19]World Health Organization. Report of the WHO meeting on the assessment of quality of life in health care,Geneva: WHO,1991.
[20]Gotay CC, korn EL, McCabe MS,et al. Quality of life research in oncology,past achievements and future priorites inoncology,past achievements and future priorities Cancer. 1991,67:839.
[21]Shen W, Kotsanos JG Huster WJ, etal, Devlopment and validation of thediabetes quality of life clinical trial question- naire. Med Care, 1999,37(4suppl):45-46.
[22]Michael V,Jennefer J,Wang SR, et al. Cross-sectional study of quality of lifeand symptoms in chronic renal disease patients:The modifecation of diet inrenal disease study. Am JKidney Dis, 1997,29(6):888-896.
[23]Finary AY. Quality of life assessment in dematology. Semin Cutan MedSurg,1998,17(4):291-296.
[24]Rssthoven JJ, Osoba D, Butts CA,et al. The impact of post chemotherapy nausea and vomiting on quality of life afer moderately emetogenic chemotherapy.Support Cure Cancer,1998,6(4):389-395.
[25]Fletcher AE, Hunt BM, Bulpitt CJ. Evaluation of quality of life in clinical trials of cardiovascular disease. J Chronic Dis, 1987,40(6):557-569.
[26]许四平,薛立娟,潘耀东.生存质量及其影响因素.国外医学护理学分册,1997,16(5):207-208.
[27]方积乾,万崇华,郝元涛.健康有关生存质量的研究概况.中国康复医学杂志,2002,15(1):40-43.
[28]Maria M. Lotempio MD, Kevin H. Comparison of quality of life outcomes in laryngealcancer patients following che- moradiation vs. total laryngectomy. Presented at the Annual Meeting of the Am-erican Academy of Otolaryngology–Head and Neck Surgery, New York, NY.2004,9:19-22.
[29]Luna-Ortiz K,Nunz-Valencia ER,Tamez-Velarde M. Quality of life and functional evaluation after supracricoid partial laryngec-tomy with cricohyoidoepiglottopexy in Mexican patients. J lary-ngolotol.2004,118(4): 284-288.
[30]Lee-Preston V,Steen IN,Dear A,Kelly CG etal.Optimizing the assessment of quality of life after laryngeal cancer treatment. J Laryngol Otol.2004,18(6):432-438.
[31]尚耀东,周永青,陶振峰等.48例喉全切除气管食管断端膜样部食管吻合分流发音重建术长期疗效观察.中华耳鼻咽喉科杂志,2002,37 (1):2-6.
[32]鲁才红,丁洪琼,乐建新等.头颈部癌症病人术后生存质量的研究.护理研究,2004,18(1):5-7.
[33]方渭清,陈晓云.晚期喉癌病人的生存质量与其个性特征和应对方式的相关性研究.中华耳鼻咽喉科杂志,2004,39(4):227-231.
[34]张立琴,杨新月.奥瑞姆自理模式在我国护理实践中的应用中国护理管理,2007,7(7):40-43.
[35]钟玲.对佩带喉套管病人实施全程自我护理教育训练的方法.护士进修杂志,2001,16(3):210-211.
[36]Hanucharumkul,S.Predictors of self-care in cancer patients receiving radio therapy. Cancer Nursing, 1989, 12(1).
[37]Marilyn B L. Power, self-care and health in women living in urban squater settlements in Karachi,Pakistan: a test of Orem' theory Journal of Advanced Nursing,1999,30(1):248- 259.
[38]Stroll W, Lo B, Chales C. Do patients want to participate in medicaldecision making.Jam Med Assoc,1984,252(21): 2990-2994.
[39]Thompson SC,Pitts JS,Schwankovsky L.Preference for in –volvement in medical decision-making:situational and demo- graphic influences.Pat Educ Couns,1993,22(3):133- 140.
[40]Gloria A, Hagopian.The efects of information alaudiotapes on Knowledge and self-care behaviors of patients undergoing radiation therapy .H AGO-PIAN,1996,23 (4):697-700.
[41]Orem DE.Nursing:Concepts of practice. NewYork: Mc Grawy,2000.
[42] Irvine EJ.Development and subsequent refinement of the inflammatory bowel disease questionnaire:a quality-of-life instrument for adult patients with inflammatory boweldisease.J Pediatr Gastroenterol Nutr,1999,28(4):23-27
[43]万崇华.生命质量研究中一些重要问题的探讨(二).中国行为医学科学.1999,8(2):155-156.
[44]Oldridge N,Gottlieb M,Guyatt G,et al.Predictors of health related quality of life with cardiac rehabilitation after acute myocardial infarction.J Cardiopulm Rehabil.1998,18(2):95- 103.
[45]Dodd M J. Measuring informational intervention for chemotherapy knowledge and self-care behavior Research Nursing Health,1984,7:43-50.
[2]刘秀莲,王秋芹,冯桂玲.护理干预对喉癌术后病人生存质量的影响.护理学杂志,2006,21(4):48-49.
[3]刘慧莲,涂英,毛君晓.Orem自理模式在喉癌手术病人中的应用.赣南医学院学报,2005,4:518-520.
[4]Orem,D.E.Nursing:Concept of practice.New York: Mc Gmwy,1991.
[5]Gantz S. B .Self-care:perspectives from six disciplines. H olistic nursing practices.1900,4(2),1-12.
[6]张立强,栾信庸,潘新良等.喉切除术后病人生存质量的评估.中华耳鼻咽喉科杂志,2002,37:11-14.
[7]吕式缓.护理程序与主要的护理学说.国外医学护理学分册, 1983,4(5):205.
[8]Mc Bride S H. Comparative analysis of three instruments designed to measure self-care agency.Nurs Res,1991,40(1): 12-16.
[9]HansonB ,BickelL .Development and testing of the ques-tionnaire on perception of self-care agency.In J.Riehl Sisca (Ed.),1985,13:272-278.
[10]MinekoY amashita. The exercise of self-care agency sca -le.Western Journal of nursing research,1998,20(3):370- 381.
[11]Hsiu-HungWang,Shirley C,Lafrey.Preliminary develop- ment and testing of instruments to measure self-care agency and social support of women in TaiWan Kaohsiungy Med Sci,2000,16:459-467.
[12]Hannele Lukkarinen,Maijahentinen.Self-care agency and factors related to this agency among patients with coronary heart disease.Int JNurs.Stud,1997,34(4):295-233.
[13]ConellyC E.Self-care and the chronically ill patient nursing clinics of North American.1987,22(3):621-628.
[14]Dodd MJ, Dibble SL. Predictors of Self-care:A Test of Orem Model.DODD-VOL,1993,20(6):895-901.
[15]Hanucharumkul S,Social support,self-care,and quality of life in cancer patients receivng radio therapy in Thailand.Un- published doctoral dissertation,College of Nursing, Wayne State University,Detroit,1988.
[16]王岚.自我护理在消化科实施效果的调查.现代护理,2004,10(6):518.
[17]颜江瑛,刘筱娴.生命质量—健康评价的发展方向.国外医学社会医学分册,1999,16(1):7-9.
[18]Flanagan JC. A ressearch approach to improving our quality of life.Am Psvchol.1978,33:138-147.
[19]World Health Organization. Report of the WHO meeting on the assessment of quality of life in health care,Geneva: WHO,1991.
[20]Gotay CC, korn EL, McCabe MS,et al. Quality of life research in oncology,past achievements and future priorites inoncology,past achievements and future priorities Cancer. 1991,67:839.
[21]Shen W, Kotsanos JG Huster WJ, etal, Devlopment and validation of thediabetes quality of life clinical trial question- naire. Med Care, 1999,37(4suppl):45-46.
[22]Michael V,Jennefer J,Wang SR, et al. Cross-sectional study of quality of lifeand symptoms in chronic renal disease patients:The modifecation of diet inrenal disease study. Am JKidney Dis, 1997,29(6):888-896.
[23]Finary AY. Quality of life assessment in dematology. Semin Cutan MedSurg,1998,17(4):291-296.
[24]Rssthoven JJ, Osoba D, Butts CA,et al. The impact of post chemotherapy nausea and vomiting on quality of life afer moderately emetogenic chemotherapy.Support Cure Cancer,1998,6(4):389-395.
[25]Fletcher AE, Hunt BM, Bulpitt CJ. Evaluation of quality of life in clinical trials of cardiovascular disease. J Chronic Dis, 1987,40(6):557-569.
[26]许四平,薛立娟,潘耀东.生存质量及其影响因素.国外医学护理学分册,1997,16(5):207-208.
[27]方积乾,万崇华,郝元涛.健康有关生存质量的研究概况.中国康复医学杂志,2002,15(1):40-43.
[28]Maria M. Lotempio MD, Kevin H. Comparison of quality of life outcomes in laryngealcancer patients following che- moradiation vs. total laryngectomy. Presented at the Annual Meeting of the Am-erican Academy of Otolaryngology–Head and Neck Surgery, New York, NY.2004,9:19-22.
[29]Luna-Ortiz K,Nunz-Valencia ER,Tamez-Velarde M. Quality of life and functional evaluation after supracricoid partial laryngec-tomy with cricohyoidoepiglottopexy in Mexican patients. J lary-ngolotol.2004,118(4): 284-288.
[30]Lee-Preston V,Steen IN,Dear A,Kelly CG etal.Optimizing the assessment of quality of life after laryngeal cancer treatment. J Laryngol Otol.2004,18(6):432-438.
[31]尚耀东,周永青,陶振峰等.48例喉全切除气管食管断端膜样部食管吻合分流发音重建术长期疗效观察.中华耳鼻咽喉科杂志,2002,37 (1):2-6.
[32]鲁才红,丁洪琼,乐建新等.头颈部癌症病人术后生存质量的研究.护理研究,2004,18(1):5-7.
[33]方渭清,陈晓云.晚期喉癌病人的生存质量与其个性特征和应对方式的相关性研究.中华耳鼻咽喉科杂志,2004,39(4):227-231.
[34]张立琴,杨新月.奥瑞姆自理模式在我国护理实践中的应用中国护理管理,2007,7(7):40-43.
[35]钟玲.对佩带喉套管病人实施全程自我护理教育训练的方法.护士进修杂志,2001,16(3):210-211.
[36]Hanucharumkul,S.Predictors of self-care in cancer patients receiving radio therapy. Cancer Nursing, 1989, 12(1).
[37]Marilyn B L. Power, self-care and health in women living in urban squater settlements in Karachi,Pakistan: a test of Orem' theory Journal of Advanced Nursing,1999,30(1):248- 259.
[38]Stroll W, Lo B, Chales C. Do patients want to participate in medicaldecision making.Jam Med Assoc,1984,252(21): 2990-2994.
[39]Thompson SC,Pitts JS,Schwankovsky L.Preference for in –volvement in medical decision-making:situational and demo- graphic influences.Pat Educ Couns,1993,22(3):133- 140.
[40]Gloria A, Hagopian.The efects of information alaudiotapes on Knowledge and self-care behaviors of patients undergoing radiation therapy .H AGO-PIAN,1996,23 (4):697-700.
[41]Orem DE.Nursing:Concepts of practice. NewYork: Mc Grawy,2000.
[42] Irvine EJ.Development and subsequent refinement of the inflammatory bowel disease questionnaire:a quality-of-life instrument for adult patients with inflammatory boweldisease.J Pediatr Gastroenterol Nutr,1999,28(4):23-27
[43]万崇华.生命质量研究中一些重要问题的探讨(二).中国行为医学科学.1999,8(2):155-156.
[44]Oldridge N,Gottlieb M,Guyatt G,et al.Predictors of health related quality of life with cardiac rehabilitation after acute myocardial infarction.J Cardiopulm Rehabil.1998,18(2):95- 103.
[45]Dodd M J. Measuring informational intervention for chemotherapy knowledge and self-care behavior Research Nursing Health,1984,7:43-50.
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