乳腺癌围手术期健康教育路径制定、实施与评价的研究
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摘要
目的：乳腺癌患者作为女性肿瘤患者的特殊人群,其生存质量已成为全社会关注的问题。国内外研究表明患者健康教育是提高生存质量的一个有效途径,而健康教育路径的开展满足了患者从入院到出院的健康知识需求。本研究旨在以护理健康教育理论为指导,采用循证的方法完善和制定乳腺癌围手术期健康教育路径相关内容,通过临床实施进行效果评价、变异分析和反馈,探讨健康教育路径实施效果及影响。
方法：本研究分两个阶段进行。第一阶段：采用文献回顾,分析归纳法、专家会议法和专家咨询法完善乳腺癌围手术期健康教育路径内容,制定路径实施效果的评价指标和标准以及临床实施流程,采用层次分析法量化指标权重；设计乳腺癌围手术期健康教育实施效果评价问卷。第二阶段：于2010年7-12月对符合条件并且愿意参加研究的乳腺癌围手术期患者共102例,分为对照组和实验组进行临床研究(两组患者人口学资料具有可比性)。对照组给予常规乳腺癌围手术期健康教育护理,实验组按乳腺癌围手术期健康教育路径实施护理,对两组实施效果进行评价和比较,探讨路径实施对患者健康教育效果以及影响。
结果：第一部分：乳腺癌围手术期健康教育路径文本和实施流程等相关内容的完成。专家咨询积极性系数均为100%,权威程度大于0.8,协调程度经Kendall检验(p<0.05),集中程度较高。咨询结果具有一定的科学性和可实施性。第二部分：实验组患者并发症发生率低于对照组,患者在身体一般状况KPS评分、癌症患者生活质量评分、上肢肌力、术后功能锻炼等方面评价得分高于对照组；在健康教育实施效果评价问卷知、信、行方面得分以及生存质量测评均高于对照组,两者比较差别具有统计学意义(p<0.05)；路径实施反馈提示今后仍需加强患者术前心理,综合指导,特殊护理以及出院后活动等相关内容的指导。
结论：本次研究完善了乳腺癌围手术期健康教育路径,制定了乳腺癌围手术期路径实施评价指标和标准,设计了乳腺癌围手术期健康教育实施效果评价问卷,为乳腺癌围手术期健康教育的进一步研究提供一定的基础：同时,通过研究发现乳腺癌围手术期健康教育路径的实施可规范临床健康教育程序,提高健康教育效果,提升围手术期护理质量；促进患者术后康复、提高患者生存质量；有利于提高患者对护理工作的满意度,更能体现现代护理的人文关怀。
Objective:Female patients with breast cancer as special patients, whose quality of life had become a social concern. Domestic and international researches showed that health education was an effective way to improve these patients'quality of life, and it also showed that health education path could meet the health information needs to the patient who was in hospital.This study was on the basis of the nursing health education theory to build the evaluation of health education path about perioperative breast cancer approaching by evidence-based, then did the evaluation, variation analysis and feedback through the clinical implementation in order to improve the content path and explore the effect of health education path.
Methods:The study had conducted into two phases. PartⅠ:Used literature review, analysis induction, expert meetings and Delphi to complete the content of perioperative breast cancer health education path, make the evaluation indicators and criterion and clinical process and so on. Used AHP to quantify weights. Design the health education evaluation questionnaire. PartⅡ:Did the clinical study on total of 102 patients, who meeted the conditions of the perioperative breast cancer path and were willing to participate in the study.They were divided into two groups:control and experimental groups with comparable demographic data during July to December in the year of 2010.Control group had received routine breast health education of perioperative care, experimental group received the health care and education according to the perioperative breast cancer path, then did the evaluation and comparison to explore the effects and influences of this health education path.
Results:Part I:The text and executive process of the perioperative breast health education path had been completed. The positive factor of expert advice were 100%, the authority were greater than 0.8, the degree of coordination by the Kendall test was meanful(p<0.05),the concentration was higher. The consultation results was scientific and enforceability.PartⅡ:The incidences of complication in the experimental group was lower than the control group. The experimental group got the higher evaluation scores of general condition in body KPS score, upper limb muscle strength, exercise and other aspects of postoperative functional and the assessment scores about the experimental group in the know, believing and the quality of life were higher in the health education evaluation questionnaire with a statistically significant difference in the comparison (p<0.05); It still needs to strengthen the guidance of preoperative medication, preoperative psychological and the activities after discharge from hospital, which were obtained from the feedbacks.
Conclusion:The study improved the perioperative breast health education path, developed the evaluation and standards to the path, designed the perioperative breast cancer health education evaluation questionnaire to provide a basis for further study. At the same time, through research we found that the implementation of the path could standardized the clinical health education program and improved the effects of the health education.It also could improve the quality of perioperative nursing and promote the postoperative rehabilitation as well as the patients'quality of life.It could improve the patient's care and job satisfaction and reflect the modern humanistic nursing care better.
方法：本研究分两个阶段进行。第一阶段：采用文献回顾,分析归纳法、专家会议法和专家咨询法完善乳腺癌围手术期健康教育路径内容,制定路径实施效果的评价指标和标准以及临床实施流程,采用层次分析法量化指标权重；设计乳腺癌围手术期健康教育实施效果评价问卷。第二阶段：于2010年7-12月对符合条件并且愿意参加研究的乳腺癌围手术期患者共102例,分为对照组和实验组进行临床研究(两组患者人口学资料具有可比性)。对照组给予常规乳腺癌围手术期健康教育护理,实验组按乳腺癌围手术期健康教育路径实施护理,对两组实施效果进行评价和比较,探讨路径实施对患者健康教育效果以及影响。
结果：第一部分：乳腺癌围手术期健康教育路径文本和实施流程等相关内容的完成。专家咨询积极性系数均为100%,权威程度大于0.8,协调程度经Kendall检验(p<0.05),集中程度较高。咨询结果具有一定的科学性和可实施性。第二部分：实验组患者并发症发生率低于对照组,患者在身体一般状况KPS评分、癌症患者生活质量评分、上肢肌力、术后功能锻炼等方面评价得分高于对照组；在健康教育实施效果评价问卷知、信、行方面得分以及生存质量测评均高于对照组,两者比较差别具有统计学意义(p<0.05)；路径实施反馈提示今后仍需加强患者术前心理,综合指导,特殊护理以及出院后活动等相关内容的指导。
结论：本次研究完善了乳腺癌围手术期健康教育路径,制定了乳腺癌围手术期路径实施评价指标和标准,设计了乳腺癌围手术期健康教育实施效果评价问卷,为乳腺癌围手术期健康教育的进一步研究提供一定的基础：同时,通过研究发现乳腺癌围手术期健康教育路径的实施可规范临床健康教育程序,提高健康教育效果,提升围手术期护理质量；促进患者术后康复、提高患者生存质量；有利于提高患者对护理工作的满意度,更能体现现代护理的人文关怀。
Objective:Female patients with breast cancer as special patients, whose quality of life had become a social concern. Domestic and international researches showed that health education was an effective way to improve these patients'quality of life, and it also showed that health education path could meet the health information needs to the patient who was in hospital.This study was on the basis of the nursing health education theory to build the evaluation of health education path about perioperative breast cancer approaching by evidence-based, then did the evaluation, variation analysis and feedback through the clinical implementation in order to improve the content path and explore the effect of health education path.
Methods:The study had conducted into two phases. PartⅠ:Used literature review, analysis induction, expert meetings and Delphi to complete the content of perioperative breast cancer health education path, make the evaluation indicators and criterion and clinical process and so on. Used AHP to quantify weights. Design the health education evaluation questionnaire. PartⅡ:Did the clinical study on total of 102 patients, who meeted the conditions of the perioperative breast cancer path and were willing to participate in the study.They were divided into two groups:control and experimental groups with comparable demographic data during July to December in the year of 2010.Control group had received routine breast health education of perioperative care, experimental group received the health care and education according to the perioperative breast cancer path, then did the evaluation and comparison to explore the effects and influences of this health education path.
Results:Part I:The text and executive process of the perioperative breast health education path had been completed. The positive factor of expert advice were 100%, the authority were greater than 0.8, the degree of coordination by the Kendall test was meanful(p<0.05),the concentration was higher. The consultation results was scientific and enforceability.PartⅡ:The incidences of complication in the experimental group was lower than the control group. The experimental group got the higher evaluation scores of general condition in body KPS score, upper limb muscle strength, exercise and other aspects of postoperative functional and the assessment scores about the experimental group in the know, believing and the quality of life were higher in the health education evaluation questionnaire with a statistically significant difference in the comparison (p<0.05); It still needs to strengthen the guidance of preoperative medication, preoperative psychological and the activities after discharge from hospital, which were obtained from the feedbacks.
Conclusion:The study improved the perioperative breast health education path, developed the evaluation and standards to the path, designed the perioperative breast cancer health education evaluation questionnaire to provide a basis for further study. At the same time, through research we found that the implementation of the path could standardized the clinical health education program and improved the effects of the health education.It also could improve the quality of perioperative nursing and promote the postoperative rehabilitation as well as the patients'quality of life.It could improve the patient's care and job satisfaction and reflect the modern humanistic nursing care better.
引文
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