直肠癌永久性结肠造口患者出院前压力与应对方式、社会支持的相关性研究
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摘要
目的：1.探讨直肠癌永久性结肠造口患者出院前的压力源；
2.描述直肠癌永久性结肠造口患者出院前压力水平、应对方式及社会支持水平；
3.描述直肠癌永久性结肠造口患者出院前的应对方式、社会支持与压力的关系；
4.探讨直肠癌永久性结肠造口患者出院前压力的影响因素；
方法：本课题采用流行病学横断面调查研究方法,对出院前的直肠癌永久性结肠造口患者进行研究。采用整群抽样的方法在湖南省长沙市四所三级甲等医院抽取符合条件的患者完成调查问卷。调查问卷包括一般资料问卷、结肠造口患者压力量表、压力应对量表和领悟社会支持量表(PSSS),分别用来调查患者的人口学资料、造口相关因素、患者的压力源及压力、应对方式和社会支持。选用SPSS13.0软件进行数据的统计分析。
结果：1.结肠造口患者压力量表回译的结果与原量表无影响理念的分歧,专家评定结果满意,内容效度指数(CVI)为0.88。
2.量表的内部一致性分析显示：结肠造口患者压力量表总的Cronbach'sα系数0.92,各分量表的Cronbach'sα为0.76-0.88,表明此量表具有较好的内部一致性。
3.本研究前五项压力源依次是担心疾病复发、担心我的引流装置会意外脱落、不知道如何护理我的结肠造口并发症、由于需要护理造口,家庭成员的负担日益加重、担心运动和体力活动对结肠造口造成不良影响。主要是来自“身体状况改变导致的压力”及“结肠造口护理导致的压力”,“自我概念改变导致的压力”排在第三位,“与家人的相互作用发生改变导致的压力”排在第四位。
4.出院前患者总的压力水平为中度(2.30±0.70),18.86%的患者属于高度压力水平,47.54%属于中度压力水平,26.28%属于轻度压力水平,仅有7.38%的患者没有压力。
5.将一般资料与患者的压力水平作相关分析,结果显示性别、年龄、居住地、工作状态、与家人的关系、家庭收入、术前是否知道行造口、所在科室是否有造口师与压力水平均有相关性(p<0.05)。
6.直肠癌永久性结肠造口患者均采用问题指向的及情感值向两种应对方式,问题指向得分为2.46±0.67,情感指向应对方式得分为2.01±0.61,但患者主要采用问题指向的应对方式,差异有统计学意义(p<0.05)；患者得到社会支持总分为63.91±7.86,得分由高到低依次是家庭支持、其他人支持和朋友支持,且差异有统计学意义(p<0.01)；患者压力与应对方式、社会支持的相关分析结果显示,患者的压力与问题指向的应对方式呈负相关(p<0.05),与情感指向社会支持呈正相关(p<0.01),与社会支持总分呈负相关(p<0.01)。
7.作多元回归分析,结果表明,家庭收入、问题指向的应对方式、年龄、术前是否知道行造口、社会支持总得分及情感指向应对方式纳入以压力为依变量的回归方程(F=3.296,p=0.000)
结论1.出院前直肠癌永久性结肠造口患者的压力源主要来自身体状况改变和结肠造口护理。
2.64.09%的直肠癌永久性结肠造口患者出院前的压力水平为中度以上
3.直肠癌永久性结肠造口患者主要采用问题指向的应对方式,问题指向的应对方式与压力水平呈负相关,情感指向的应对方式与压力水平呈正相关；直肠癌结肠永久性造口患者的社会支持与其压力水平呈负相关,来自家庭的支持最多,来自朋友的支持最少。
4.直肠癌永久性结肠造口患者的压力水平受年龄、家庭收入、术前是否知道行造口、应对方式及社会支持等因素的影响。
Objectives 1. To explore the major stressors among pre-discharged Rectal Cancer Patients with Permanent Colostomy;
2. To identify the level of stress and Social Support and major coping strategies among pre-discharged Rectal Cancer Patients with Permanent Colostomy;
3. To examine the relationship between stress and major coping strategies and the relationship between stress and Social Support;
4. To explore the predicted factors of stress;
Methods English version'the Stress of Colostomy Patients Scale'was translated, and back-translated, andrevised.Five experts were evaluated for the content validity.A pilot study was taken for making sure the feasibility of the questionnaire,estimating the sample size,and testing validity and reliability。It was a cross-sectional survey。The target population was Rectal Cancer Patients with Permanent Colostomy。Five state-own tertiary hospitals in Changsha, Hunan, were chosen by cluster sampling。They were three affiliated hospital of central south university, hunan Cancer hospital and hunan people's hospital。The Stress of Colostomy Patients Scale, Jalowiec coping scale, and Social Support Scale were used to measure the stressors, Stress, Coping and Social Support among pre-discharged Rectal Cancer Patients with Permanent Colostomy.The data were analyzed with software SPSS13.0.
Results 1. The Chinese version of The Stress of Colostomy Patients Scale was consistent with the original version and the result from the invited experts'assessment was satisfactory.The content validity index (CVI) was 0.88.
2. Internal consistency analysis showed that the overall Conbach's a of The Stress of Colostomy Patients Scale was 0.92,and the Conbach's a of the subscales were from 0.76-0.88,and this scale has a better internal coherency.
3. The five major stressors were'I worry about the recurrence of the disease';'I worry that my drainage appliance will drop out unexpectedly';'I don't know how to care for my colostomy complications';'My family members have increasing burdens from my colostomy care'; and'I worry that exercise and physical activities are harmful to the colostomy'.The stressors comes'Stressors from change in physical status'and'Stressors from colostomy care'
4. Colostomy patients before discharge had a moderate level of stress (2.30±0.70), while 18.86% patients had a high level of stress; 47.54% patients had a moderate level of stress; 26.28% patients had a low level of stress; and only 7.38% had no stress.
5. Demographic data of patients patients such as sex different, age, residence, working position,family relationship,family income, uninformed to stoma surgery and whether there were stoma therapy nurse had significant influence on the stress of colostomy patients(p<0.05).
6. The colostomy patients used both of problem-focused coping and emotion-focused coping,but they mainly used problem-focused coping; The score of problem-focused coping was 2.46±0.67, the score of emotion-focused coping was 2.01±0.61.But the colostomy patients mainly used problem-focused coping(P<0.01).The score of social support was 63.91±7.86,patients receiving the most support from their family, followed by other people(1eaders, relatives and colleagues) and friends(P<0.01). Problem-focused coping was negatively correlated with theirstress(P<0.05),and emotion-focused coping was positively correlated with their stress(P<0.01).The social support of colostomy patients was negatively correlated with stress(P<0.01).
7. Stepwise regression analysis revealed that stress related family income, problem-focused coping, age,whether they konw stoma surgery, social support,and emotion-focused coping were included to the regression equations in which the stress was as dependent variables.
Conclusion 1. The main stressor was'Stressors from change in physical status',followed'Stressors from colostomy care'.
2.64.09% of the colostomy patients before discharge had a moderate level of stress.
3. The colostomy patients mainly used problem-focused coping, Problem-focused coping was negatively correlated with theirstress,and emotion-focused coping was positively correlated with their stress. Patients receiving the most support from their family, followed by other people(1eaders, relatives and colleagues) and friends. The social support of colostomy patients was negatively correlated with stress.
4. Demographic data of patients patients such as age,family income,whether they know stoma surgery,coping and social support and so on.
2.描述直肠癌永久性结肠造口患者出院前压力水平、应对方式及社会支持水平；
3.描述直肠癌永久性结肠造口患者出院前的应对方式、社会支持与压力的关系；
4.探讨直肠癌永久性结肠造口患者出院前压力的影响因素；
方法：本课题采用流行病学横断面调查研究方法,对出院前的直肠癌永久性结肠造口患者进行研究。采用整群抽样的方法在湖南省长沙市四所三级甲等医院抽取符合条件的患者完成调查问卷。调查问卷包括一般资料问卷、结肠造口患者压力量表、压力应对量表和领悟社会支持量表(PSSS),分别用来调查患者的人口学资料、造口相关因素、患者的压力源及压力、应对方式和社会支持。选用SPSS13.0软件进行数据的统计分析。
结果：1.结肠造口患者压力量表回译的结果与原量表无影响理念的分歧,专家评定结果满意,内容效度指数(CVI)为0.88。
2.量表的内部一致性分析显示：结肠造口患者压力量表总的Cronbach'sα系数0.92,各分量表的Cronbach'sα为0.76-0.88,表明此量表具有较好的内部一致性。
3.本研究前五项压力源依次是担心疾病复发、担心我的引流装置会意外脱落、不知道如何护理我的结肠造口并发症、由于需要护理造口,家庭成员的负担日益加重、担心运动和体力活动对结肠造口造成不良影响。主要是来自“身体状况改变导致的压力”及“结肠造口护理导致的压力”,“自我概念改变导致的压力”排在第三位,“与家人的相互作用发生改变导致的压力”排在第四位。
4.出院前患者总的压力水平为中度(2.30±0.70),18.86%的患者属于高度压力水平,47.54%属于中度压力水平,26.28%属于轻度压力水平,仅有7.38%的患者没有压力。
5.将一般资料与患者的压力水平作相关分析,结果显示性别、年龄、居住地、工作状态、与家人的关系、家庭收入、术前是否知道行造口、所在科室是否有造口师与压力水平均有相关性(p<0.05)。
6.直肠癌永久性结肠造口患者均采用问题指向的及情感值向两种应对方式,问题指向得分为2.46±0.67,情感指向应对方式得分为2.01±0.61,但患者主要采用问题指向的应对方式,差异有统计学意义(p<0.05)；患者得到社会支持总分为63.91±7.86,得分由高到低依次是家庭支持、其他人支持和朋友支持,且差异有统计学意义(p<0.01)；患者压力与应对方式、社会支持的相关分析结果显示,患者的压力与问题指向的应对方式呈负相关(p<0.05),与情感指向社会支持呈正相关(p<0.01),与社会支持总分呈负相关(p<0.01)。
7.作多元回归分析,结果表明,家庭收入、问题指向的应对方式、年龄、术前是否知道行造口、社会支持总得分及情感指向应对方式纳入以压力为依变量的回归方程(F=3.296,p=0.000)
结论1.出院前直肠癌永久性结肠造口患者的压力源主要来自身体状况改变和结肠造口护理。
2.64.09%的直肠癌永久性结肠造口患者出院前的压力水平为中度以上
3.直肠癌永久性结肠造口患者主要采用问题指向的应对方式,问题指向的应对方式与压力水平呈负相关,情感指向的应对方式与压力水平呈正相关；直肠癌结肠永久性造口患者的社会支持与其压力水平呈负相关,来自家庭的支持最多,来自朋友的支持最少。
4.直肠癌永久性结肠造口患者的压力水平受年龄、家庭收入、术前是否知道行造口、应对方式及社会支持等因素的影响。
Objectives 1. To explore the major stressors among pre-discharged Rectal Cancer Patients with Permanent Colostomy;
2. To identify the level of stress and Social Support and major coping strategies among pre-discharged Rectal Cancer Patients with Permanent Colostomy;
3. To examine the relationship between stress and major coping strategies and the relationship between stress and Social Support;
4. To explore the predicted factors of stress;
Methods English version'the Stress of Colostomy Patients Scale'was translated, and back-translated, andrevised.Five experts were evaluated for the content validity.A pilot study was taken for making sure the feasibility of the questionnaire,estimating the sample size,and testing validity and reliability。It was a cross-sectional survey。The target population was Rectal Cancer Patients with Permanent Colostomy。Five state-own tertiary hospitals in Changsha, Hunan, were chosen by cluster sampling。They were three affiliated hospital of central south university, hunan Cancer hospital and hunan people's hospital。The Stress of Colostomy Patients Scale, Jalowiec coping scale, and Social Support Scale were used to measure the stressors, Stress, Coping and Social Support among pre-discharged Rectal Cancer Patients with Permanent Colostomy.The data were analyzed with software SPSS13.0.
Results 1. The Chinese version of The Stress of Colostomy Patients Scale was consistent with the original version and the result from the invited experts'assessment was satisfactory.The content validity index (CVI) was 0.88.
2. Internal consistency analysis showed that the overall Conbach's a of The Stress of Colostomy Patients Scale was 0.92,and the Conbach's a of the subscales were from 0.76-0.88,and this scale has a better internal coherency.
3. The five major stressors were'I worry about the recurrence of the disease';'I worry that my drainage appliance will drop out unexpectedly';'I don't know how to care for my colostomy complications';'My family members have increasing burdens from my colostomy care'; and'I worry that exercise and physical activities are harmful to the colostomy'.The stressors comes'Stressors from change in physical status'and'Stressors from colostomy care'
4. Colostomy patients before discharge had a moderate level of stress (2.30±0.70), while 18.86% patients had a high level of stress; 47.54% patients had a moderate level of stress; 26.28% patients had a low level of stress; and only 7.38% had no stress.
5. Demographic data of patients patients such as sex different, age, residence, working position,family relationship,family income, uninformed to stoma surgery and whether there were stoma therapy nurse had significant influence on the stress of colostomy patients(p<0.05).
6. The colostomy patients used both of problem-focused coping and emotion-focused coping,but they mainly used problem-focused coping; The score of problem-focused coping was 2.46±0.67, the score of emotion-focused coping was 2.01±0.61.But the colostomy patients mainly used problem-focused coping(P<0.01).The score of social support was 63.91±7.86,patients receiving the most support from their family, followed by other people(1eaders, relatives and colleagues) and friends(P<0.01). Problem-focused coping was negatively correlated with theirstress(P<0.05),and emotion-focused coping was positively correlated with their stress(P<0.01).The social support of colostomy patients was negatively correlated with stress(P<0.01).
7. Stepwise regression analysis revealed that stress related family income, problem-focused coping, age,whether they konw stoma surgery, social support,and emotion-focused coping were included to the regression equations in which the stress was as dependent variables.
Conclusion 1. The main stressor was'Stressors from change in physical status',followed'Stressors from colostomy care'.
2.64.09% of the colostomy patients before discharge had a moderate level of stress.
3. The colostomy patients mainly used problem-focused coping, Problem-focused coping was negatively correlated with theirstress,and emotion-focused coping was positively correlated with their stress. Patients receiving the most support from their family, followed by other people(1eaders, relatives and colleagues) and friends. The social support of colostomy patients was negatively correlated with stress.
4. Demographic data of patients patients such as age,family income,whether they know stoma surgery,coping and social support and so on.
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52.胡爱玲.结肠造口患者的适应与自我护理能力、社会支持相关性研究：[硕士学位论文].广州：中山大学,2008.
53.曹晓霞.急诊科护士压力源、压力与应对关系的研究：[硕士学位论文].中南大学护理学院,2007.
54.刘朝杰.问卷的信度与效度评价.中国慢性病预防与控制,1997,5：174.
55. Lazarus RS.Folkmen S.Stress appraisal and coping.New York Springer, 1984:11-21.
56. Readding LA. Hospital to home:smoothing the journey for the new ostomist. Br J Nurs.2005,14(16):16-20.
57. Eveno C. Lamblin A. Mariette C.etal. Sexual and urinary dysfunction after proctectomy for rectal cancer. Journal of Visceral Surgery,2010,147:21-30.
58. Oakley, A. Housewife. Middlesex:Penguin Books,1974..
59. Connell, RW. A really good husband. Work/life balance, gender equity and social change. Australian Journal of Social Issues,2005,40(3):369-383.
60. Szczepkowski M.Do we need a permanent colostomy in XXIst century. Acta Chir Iugosl,2002,49(2):45-55.
61. Rozmovits, L.,& Ziebland, S. Expressions of loss of adulthood in the narratives of colorectal cancer patients. Qualitative Health Research,2004,14:187-203.
62. Simmons KL, Smith JA, Bobb KA, Liles LL. Adjustment to colostomy:stoma acceptance, stoma care self-efficacy and interpersonal relationships. J Adv Nurs. 2007,60(6):627-635.
63. Devlin HB, Plant JA, Griffin N. Aftermath of surgery for anorectal cancer. BMJ,1971,3(771):413-418.
64. Gloria O'Connor, Vivien Coates, Siobhan O'Neill. Exploring the information needs of patients with cancer of the rectum. European Journal of Oncology Nursing,2010,(14):271-277
65. Wong VK, White MA. Family dynamics and health locus of control in adults with ostomies. J Wound Ostomy Continence Nurs.2002,29(1):37-44.
66. Edwards B,Clarke V. The psychological impact of a cancer diagnosis on families: the influence of family functioning and patients'illness characteristics on depression and anxiety. Psycho-oncology,2004,13:562-576.
67. Cotrim, Graca Pereira. Impact of colorectal cancer on patient and family: Implications for care. European Journal of Oncology Nursing,2008,12:217-226.
68. Smith DM,Langa KM, Kabeto MU. Health, wealth, and happiness:Wnancial resources buVer subjective well-being after the onset of a disability. Psychological Science,2005,16(9):663-666.
69. Coons SJ, Chongpison Y, Wendel CS, et al. Overall quality of life and difficulty paying for ostomy supplies in the VA Ostomy Health-Related Quality of Life Study: an exploratory analysis. Med Care,2007,45:891-895.
70. Furlani R, Ceolim MF. Living with a permanent intestinal stoma:changes told by stoma patients.Rev Bras Enferm.2002,55(5):586-591.
71. Chaudhri S,Brown L,Hassan I.etal.Preoperative Intensive,Community-Based vs. Traditional Stoma Education:A Randomized, Controlled Trial.Diseases of the Colon & Rectum,2005,48(3):504-509.
72. Kiecolt-Glaser JK, Page GG, Marucha PT,et al.Psychological influences on surgical recovery.Perspectives from psychoneuroimmunology. Am Psychol 1998,53 (11):1209-1218.
73. Sisk, R. Caregiver burden and health promotion. International Journal of Nursing Studies,2000,37:37-43.
74. Carol Emslie, Susan Browne,Una MacLeod.'Getting through'not'going under' A qualitative study of gender and spousal support after diagnosis with colorectal cancer. Social Science & Medicine,2009, (68):1169-1175.
75. Coe M,Kluka S.Concerns of clients and spouses regarding ostomy surgery for cancer.J Enterostomal Therapy,1988,15(6):232-239.
[1]喻德洪.结肠造口术与术后效能的提高[J].中国实用外科杂志1997,17(5)：263-265.
[2]Bekkers M,Van Knippenberg FCE,Van Dulmen AM,et al.Survival and psychosocial adjustment to stoma surgery and nonstoma bowel resection:A 4-year follow-up[J]. Journal of Psychosomatic Research,1997,42(3):235-244.
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[5]张华,李峥.肠造口患者的分期护理[J].护理研究,2004,18(19)：1700.
[6]周玉洁,路潜,庞冬,等.直肠癌结肠造口患者生活质量调查分析[J].护理学杂志,2003,18(7)：88-490.
[7]张秀美,孔月菊.直肠癌结肠造口患者压力调查及护理对策[J].中华当代医学,2005,3(2)：70-71.
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[9]Trainor MA.Acceptance of ostomy and the visitor role in a self-help group for ostomy patients[J].Nurs Res,1982,31(2):102-106.
[10]白燕.结肠造口术后康复期患者生活质量调查及护理对策[J].广东医学,2009,30(8)：1035-1037.
[ll]Tseng H,Wang H,Hsu Y,et al.Factors related to stress in outpatients with permanent colostomies[J].The Kaohsiung Journal of Medical Sciences,2004,20(2): 70-76.
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[13]Norton C, Burch J, Kamm MA.Patients'Views of a Colostomy for Fecal Incontinence[J].Diseases of the Colon & Rectum,2005,48(5):1062-1068.
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[16]路潜,郭蕾蕾,王静.直肠癌结肠造口患者生活质量的研究[J].中华护理杂志,2002,37(9)：648-651.
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[20]Lazarus RS.Folkmen S.Stress appraisal and coping[J].New York Springer,1984: 11-54.
[21]Wade BE. Colostomy patients:psychological adjustment at 10 weeks and 1 year after surgery in districts which employed stoma-care nurses and districts which did not[J].J Adv Nurs,1990,15(11):1297-1304.
[22]郑美春,周志伟,万德森.直肠癌永久性肠造口患者术前术后的心理特点分析及对策[J].大肠肛门病外科杂志,2004,10(2)：95-97.
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23. Bekkers M,Van Knippenberg FCE,Van Dulmen AM,et al.Survival and psychosocial adjustment to stoma surgery and nonstoma bowel resection:A 4-year follow-up.Journal of Psychosomatic Research,1997,42(3):235-244.
24.张秀美,孔月菊.直肠癌结肠造口患者压力调查及护理对策.中华当代医学,2005,3(2)：70-71.
25.郑美春,周志伟,万德森.直肠癌永久性肠造口患者术前术后的心理特点分析及对策.大肠肛门病外科杂志,2004,10(2)：95-97.
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28. Admi H.Nursing Students'Stress during the Initial Clinical Experience.Journal of Nursing Education,1997,36(7):323.
29.张华,李峥.肠造口患者的分期护理.护理研究,2004,18(19)：1700.
30.周玉洁,路潜,庞冬,等.直肠癌结肠造口患者生活质量调查分析.护理学杂志,2003,18(7)：88-490.
31. Nugent KP,Daniels P,Stewart B,Patankar R,et al.Quality of life in stoma patients.Dis Colon Rectum 1999,42(12):1569-1574.
32. Trainor MA.Acceptance of ostomy and the visitor role in a self-help group for ostomy patients.Nurs Res,1982,31 (2):102-106.
33. Tseng H,Wang H,Hsu Y,et al.Factors related to stress in outpatients with permanent colostomies.The Kaohsiung Journal of Medical Sciences,2004,20(2): 70-76.
34. Norton C, Burch J, Kamm MA.Patients'Views of a Colostomy for Fecal Incontinence.Diseases of the Colon & Rectum,2005,48(5):1062-1068.
35. Dow KH,Lafferty P.Quality of life,survivorship,and psychosocial adjustment of young women with breast cancer after breast-conserving surgery and radiation therapy.Oncol Nurs Forum,2000,27(10):1555-1564.
36.王晓晖.结肠造口病人自我护理的调查分析.中国民康医学,2009,21(2)：162,211.
37. Gutman H,Reiss R.Postoperative course and rehabilitation achievements of colostomates.Dis Colon Rectum 1985,28(10):777-781.
38.路潜,郭蕾蕾,王静.直肠癌结肠造口患者生活质量的研究.中华护理杂志,2002,37(9)：648-651.
39. Vujnovich A.Pre and post-operative assessment of patients with a stoma.Nursing Standard,2008,22(19):50-56.
40. Smith DM,Loewenstein G,Rozin P.Sensitivity to disgust, stigma, and adjustment to life with a colostomy. Journal of Research in Personality,2007,41(4):787-803.
41. Lazarus RS.Folkmen S.Stress appraisal and coping.New York Springer,1984: 11-54.
42. Wade BE. Colostomy patients:psychological adjustment at 10 weeks and 1 year after surgery in districts which employed stoma-care nurses and districts which did not.J Adv Nurs,1990,15(11):1297-1304.
43.汪向东,王希林,马弘.心理卫生评定量表手册.北京：中国心理卫生杂志社,1999.
44.刘晓红.护理心理学.上海：第二军医大学出版社,1998.
45. Seale C.Gender accommodation in online cancer support groups.Health,2006, 10(3),345-360.
46. Stanton AL,Kirk SB,Cameron CL,et al.Coping through emotional approach:scale construction and validation.J Pers Soc Psychol 2000,78(6):1150-1169.
47. Holahan CJ,Moos RH.Risk,resistance,and psychological distress:alongitudinal analysis with adults and children.J Abnorm Psychol 1987,96(1):3-13.
48. Heilburn AB.Cognitive defenses and life stress:an information-process analysis.PsycholRep,1984,54(l):3-17.
49. Cobb,S.Social support as a moderator of life stress. Psychosomatic Medicine, 1976,38(5):300-313.
50. Piwonka,MA,Merino JM. A multidimensional modeling of predictors influencing the adjustment to a colostomy.Journal of Wound,Ostomy and Continence Nurses Society,1999,11:298-305.
51.高晓敏,万敏雀,段艳侠等.结肠造口术患者社会支持与术前焦虑的相关性研究.护理学杂志,2005,20(16)：5-7.
52.胡爱玲.结肠造口患者的适应与自我护理能力、社会支持相关性研究：[硕士学位论文].广州：中山大学,2008.
53.曹晓霞.急诊科护士压力源、压力与应对关系的研究：[硕士学位论文].中南大学护理学院,2007.
54.刘朝杰.问卷的信度与效度评价.中国慢性病预防与控制,1997,5：174.
55. Lazarus RS.Folkmen S.Stress appraisal and coping.New York Springer, 1984:11-21.
56. Readding LA. Hospital to home:smoothing the journey for the new ostomist. Br J Nurs.2005,14(16):16-20.
57. Eveno C. Lamblin A. Mariette C.etal. Sexual and urinary dysfunction after proctectomy for rectal cancer. Journal of Visceral Surgery,2010,147:21-30.
58. Oakley, A. Housewife. Middlesex:Penguin Books,1974..
59. Connell, RW. A really good husband. Work/life balance, gender equity and social change. Australian Journal of Social Issues,2005,40(3):369-383.
60. Szczepkowski M.Do we need a permanent colostomy in XXIst century. Acta Chir Iugosl,2002,49(2):45-55.
61. Rozmovits, L.,& Ziebland, S. Expressions of loss of adulthood in the narratives of colorectal cancer patients. Qualitative Health Research,2004,14:187-203.
62. Simmons KL, Smith JA, Bobb KA, Liles LL. Adjustment to colostomy:stoma acceptance, stoma care self-efficacy and interpersonal relationships. J Adv Nurs. 2007,60(6):627-635.
63. Devlin HB, Plant JA, Griffin N. Aftermath of surgery for anorectal cancer. BMJ,1971,3(771):413-418.
64. Gloria O'Connor, Vivien Coates, Siobhan O'Neill. Exploring the information needs of patients with cancer of the rectum. European Journal of Oncology Nursing,2010,(14):271-277
65. Wong VK, White MA. Family dynamics and health locus of control in adults with ostomies. J Wound Ostomy Continence Nurs.2002,29(1):37-44.
66. Edwards B,Clarke V. The psychological impact of a cancer diagnosis on families: the influence of family functioning and patients'illness characteristics on depression and anxiety. Psycho-oncology,2004,13:562-576.
67. Cotrim, Graca Pereira. Impact of colorectal cancer on patient and family: Implications for care. European Journal of Oncology Nursing,2008,12:217-226.
68. Smith DM,Langa KM, Kabeto MU. Health, wealth, and happiness:Wnancial resources buVer subjective well-being after the onset of a disability. Psychological Science,2005,16(9):663-666.
69. Coons SJ, Chongpison Y, Wendel CS, et al. Overall quality of life and difficulty paying for ostomy supplies in the VA Ostomy Health-Related Quality of Life Study: an exploratory analysis. Med Care,2007,45:891-895.
70. Furlani R, Ceolim MF. Living with a permanent intestinal stoma:changes told by stoma patients.Rev Bras Enferm.2002,55(5):586-591.
71. Chaudhri S,Brown L,Hassan I.etal.Preoperative Intensive,Community-Based vs. Traditional Stoma Education:A Randomized, Controlled Trial.Diseases of the Colon & Rectum,2005,48(3):504-509.
72. Kiecolt-Glaser JK, Page GG, Marucha PT,et al.Psychological influences on surgical recovery.Perspectives from psychoneuroimmunology. Am Psychol 1998,53 (11):1209-1218.
73. Sisk, R. Caregiver burden and health promotion. International Journal of Nursing Studies,2000,37:37-43.
74. Carol Emslie, Susan Browne,Una MacLeod.'Getting through'not'going under' A qualitative study of gender and spousal support after diagnosis with colorectal cancer. Social Science & Medicine,2009, (68):1169-1175.
75. Coe M,Kluka S.Concerns of clients and spouses regarding ostomy surgery for cancer.J Enterostomal Therapy,1988,15(6):232-239.
[1]喻德洪.结肠造口术与术后效能的提高[J].中国实用外科杂志1997,17(5)：263-265.
[2]Bekkers M,Van Knippenberg FCE,Van Dulmen AM,et al.Survival and psychosocial adjustment to stoma surgery and nonstoma bowel resection:A 4-year follow-up[J]. Journal of Psychosomatic Research,1997,42(3):235-244.
[3]Admi H.Nursing Students'Stress during the Initial Clinical Experience[J] Journal of Nursing Education,1997,36(7):323.
[4]Carabajal B.Practical points in the care of patients recovering from a colostomy[J] Journal of Peri Anesthesia Nursing,1997,12(3):188-190.
[5]张华,李峥.肠造口患者的分期护理[J].护理研究,2004,18(19)：1700.
[6]周玉洁,路潜,庞冬,等.直肠癌结肠造口患者生活质量调查分析[J].护理学杂志,2003,18(7)：88-490.
[7]张秀美,孔月菊.直肠癌结肠造口患者压力调查及护理对策[J].中华当代医学,2005,3(2)：70-71.
[8]Nugent KP,Daniels P,Stewart B,Patankar R,et al.Quality of life in stoma patients[J].Dis Colon Rectum 1999,42(12):1569-1574.
[9]Trainor MA.Acceptance of ostomy and the visitor role in a self-help group for ostomy patients[J].Nurs Res,1982,31(2):102-106.
[10]白燕.结肠造口术后康复期患者生活质量调查及护理对策[J].广东医学,2009,30(8)：1035-1037.
[ll]Tseng H,Wang H,Hsu Y,et al.Factors related to stress in outpatients with permanent colostomies[J].The Kaohsiung Journal of Medical Sciences,2004,20(2): 70-76.
[12]Metcalf C.Stoma care:empowering patients through teaching practical skills[J]. Br Nurs J 1999,8(9):593-600.
[13]Norton C, Burch J, Kamm MA.Patients'Views of a Colostomy for Fecal Incontinence[J].Diseases of the Colon & Rectum,2005,48(5):1062-1068.
[14]Dow KH,Lafferty P.Quality of life,survivorship,and psychosocial adjustment of young women with breast cancer after breast-conserving surgery and radiation therapy[J].Oncol Nurs Forum,2000,27(10):1555-1564.
[15]Gutman H,Reiss R.Postoperative course and rehabilitation achievements of colostomates[J].Dis Colon Rectum 1985,28(10):777-781.
[16]路潜,郭蕾蕾,王静.直肠癌结肠造口患者生活质量的研究[J].中华护理杂志,2002,37(9)：648-651.
[17]Vujnovich A.Pre and post-operative assessment of patients with a stoma[J]. Nursing Standard,2008,22(19):50-56.
[18]Cottrell CA,Neuberg SL.DiVerent emotional reactions to diVerent groups:a sociofunctional threat-based approach to "prejudice" [J].Journal of Personality and Social Psychology,2005,88(5):770-789.
[19]Smith DM,Loewenstein G,Rozin P.Sensitivity to disgust, stigma, and adjustment to life with a colostomy[J] Journal of Research in Personality,2007,41(4):787-803.
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