预期性恶心的概念分析

Concept Analysis of Anticipatory Nausea

目的通过对预期性恶心的定义性特征、原因、结果、临床观察和测评方法等进行系统分析,构建预期性恶心的概念及模式,以期规范该概念在临床实践和科学研究中的应用。方法在CINAHL、PubMed、Cancerlit、PsycINFO等期刊数据库,检索1966—2010年的预期性恶心相关文献,采用Walker和Avant的概念分析方法进行分析。结果预期性恶心是指由既往不良化疗体验形成的条件反射所致的特殊生理和心理反应,通常表现为给予新一轮化疗药物前出现烦恶欲吐感及心理不适。其定义性特征包括:(1)条件反应;(2)预期;(3)呕吐感;(4)不良生理及心理反应。预期性恶心的发生与治疗因素及患者因素相关,可导致生活质量下降、并发症、日常功能失调、低依从性及治疗中断等不良后果。结论对预期性恶心的概念分析可以帮助加深对该概念的认识和理解,为相关研究和干预措施提供新思路。本研究所构建的概念和模式可用于对预期性恶心的症状管理,减少化疗不良反应的发生,减轻患者的痛苦和不适。未来的研究可进一步探讨预期性恶心的原因、结果与其特征之间的关联,探索有效的干预措施。

Objective To conduct a systematic analysis of anticipatory nausea （AN） and to develop an accurate concept of AN. Methods Systematic searches for literature about anticipated nausea from Cancerlit, CINAHL, PubMed/Medline, PsycINFO databases from 1966 to 2010 were conducted and Walker and Avant＇s concept analysis was applied to examine the concept of anticipated nausea. Results Occurring before the administration of a subsequent course of chemotherapy and typically after a previous negative experience with treatment, anticipatory nausea was an awareness of vomiting and a process of conditioned reflex as well, which was characterized by undesirable psychosocial and physical responses. Four attributes identified were conditioned reflex, anticipation, awareness of vomiting and physical and psychosocial responses. A number of treatment-related and patient-related factors were important in the development of AN. The occurrence of AN can significantly affect patients＇ quality of life, further treatment complications, daily activities, patients＇ compliance and treatment termination. Conclusion The study provides insight into anticipatory nausea and opens up new avenues for research and interventions. The definition and model presented in this article can be used by nurses that promote symptom management. Future research is needed to determine the relationships between the antecedents, attributes, and consequences of anticipatory nausea, and to develop effective interventions.