信息-动机-行为技巧模型对贲门癌根治术后患者应用效果

Application effect of information-motivation-behavior skill model on patients after radical resection of cardia cancer

目的贲门癌根治手术对患者创伤性较大、所需吻合口较多、并发症发生率高。本研究探讨信息-动机-行为技巧(information-motivation-behavioral,IMB)模型在贲门癌术后患者中的应用价值。方法选取2018-06-01-2019-08-31新乡市中心医院收治的86例贲门癌患者为研究对象,均择期行根治性手术,按照入院时间及基线资料具有可比性的原则分为研究组和对照组,各43例。两组均采用常规护理干预,研究组在对照组基础上给予基于IMB模型的护理干预。比较两组术后配合行为、术后康复情况(进食时间、肠蠕动时间、下床活动时间和住院时间)、并发症发生率、护理满意度及干预前后中文版癌症自我管理效能感量表评分。结果干预后,研究组自我决策评分为(12.23±1.13)分,高于对照组的(9.26±1.54)分,t=10.196,P<0.001;正性态度评分为(53.21±5.31)分,高于对照组的(47.25±5.87)分,t=4.938,P<0.001;自我减压评分为(34.24±2.64)分,高于对照组的(28.07±2.95)分,t=10.220,P<0.001。研究组术后置管期间配合度(97.67%)、有效咳嗽配合度(95.35%)、饮食要求配合度(97.67%)、早期活动配合度(95.35%)均优于对照组,均P<0.001。研究组并发症发生率为2.33%,低于对照组的18.65%,χ2=4.468,P=0.035。研究组进食时间为(3.21±1.67)d,短于对照组的(4.63±1.52)d,t=4.124,P<0.001;肠蠕动时间为(2.78±1.54)d,短于对照组(4.21±1.46)d,t=4.419,P<0.001;下床活动时间为(2.51±1.32)d,短于对照组(3.94±1.29)d,t=5.081,P<0.001;住院时间为(9.78±1.12)d,短于对照组(11.89±1.32)d,t=7.993,P<0.001。研究组可靠性得分为(4.59±0.31)分,高于对照组的(4.16±0.29)分,t=6.642,P<0.001;有形性得分为(4.48±0.28)分,高于对照组的(4.06±0.24)分,t=7.468,P<0.001;反应性得分为(4.71±0.18)分,高于对照组的(4.33±0.21)分,t=9.009,P<0.001;移情性得分为(4.59±0.24)分,高于对照组的(4.25±0.23)分,t=6.707,P<0.001;保证性得分为(4.72±0.19)分,高于对照组的(4.31±0.20)分,t=9.746,P<0.001。结论基于IMB模型的护理干预能提高贲门癌根治术后患者自我管理效能、术后配合行为,降低并发症发生率,提高满意度,有利于术后快速康复。

OBJECTIVE Radical surgery for cardia cancer is more traumatic,requires more anastomoses,and has a high complication rate.This study explored the application value of information-motivation-behavioral(IMB)model in patients after cardia cancer surgery.METHODS A total of 86 patients with cardia cancer admitted to Xinxiang Central Hospital from June 1,2018 to August 31,2019 were selected as the research subjects,all of whom underwent elective radical surgery,and were divided into study group and control group based on the time of admission and the principle of comparability of baseline data,each with 43 cases.Both groups used conventional nursing intervention,and the study group was given nursing intervention based on the IMB model on the basis of the control group.The postoperative cooperation behavior,postoperative rehabilitation(feeding time,bowel movement time,time to get out of bed,length of stay in hospital),complication rate,nursing satisfaction,and Chinese version of cancer self-management efficacy scale before and after intervention were compared.RESULTS After intervention,the self-decision score of the study group was 12.23±1.13,which was higher than that of the control group 9.26±1.54,t=10.196,P<0.001.The positive attitude score was53.21±5.31,which was higher than that of the control group 47.25±5.87,t=4.938,P<0.001.The self-decompression score was 34.24±2.64,which was higher than that of the control group 28.07±2.95,t=10.220,P<0.001.The degree of cooperation during postoperative catheterization(97.67%),effective cough cooperation(95.35%),dietary requirements(97.67%),early activity cooperation(95.35%)in the study group were better than those of the control group,all P<0.001.The complication rate in the study group was 2.33%,which was lower than that of the control group(18.65%),2χ=4.468,P=0.035.The eating time of the study group was(3.21±1.67)d,which was shorter than that of the control group(4.63±1.52)d,t=4.124,P<0.001.The bowel movement time was(2.78±1.54)d,which was shorter than that of the control group(4.21±1.52)d,t=4.419,P<0.001.The time of getting out of bed was(2.51±1.32)d,which was shorter than that of the control group(3.94±1.29)d,t=5.081,P<0.001.The length of stay was(9.78±1.12)d,which was shorter than that of the control group(11.89±1.32)d,t=7.993,P<0.001.The reliability score of the study group was 4.59±0.31,which was higher than that of the control group 4.16±0.29,t=6.642,P<0.001.The tangibility score was 4.48±0.28,which was higher than that of the control group 4.06±0.24,t=7.468,P<0.001.The reactivity score was 4.71±0.18,which was higher than that of the control group 4.33±0.21,t=9.009,P<0.001.The empathy score was 4.59±0.24,which was higher than that of the control group 4.25±0.23,t=6.707,P<0.001.The guarantee score was 4.72±0.19,which was higher than that of the control group 4.31±0.20,t=9.746,P<0.001.CONCLUSION Nursing intervention based on the IMB model can improve the self-management efficiency and cooperating behavior of patients after radical resection of cardia cancer,reduce the incidence of complications,improve satisfaction,and facilitate rapid postoperative recovery.