叙事护理对乳腺癌患者疾病适应结局的影响

Effect of narrative nursing on disease adaptation outcome of patients with breast cancer

目的 探讨叙事护理对乳腺癌患者创伤后成长、癌因性疲乏、心理社会适应、患肢功能及淋巴水肿等疾病适应结局的影响.方法 采用便利抽样法,选取2015年8月-2016年2月于哈尔滨医科大学附属第一医院肿瘤科就诊的乳腺癌患者76例.采用随机数字表法将其分成观察组和对照组,每组各38例.对照组接受常规乳腺癌治疗以及常规心理护理,观察组在对照组基础上,进行叙事护理干预.选用创伤后成长评定量表（PTGI）、癌症疲乏量表（BFI）、疾病心理社会适应量表（PAIS-SR）评估并比较两组患者的疾病适应情况,比较两组患者干预后上肢功能恢复及淋巴水肿情况.结果 干预1个月后,观察组患者人际关系、个人力量、精神变化、欣赏生活及创伤后成长总分均高于对照组,差异有统计学意义（P〈0.05）;观察组患者躯体疲乏、认知疲乏及疲乏总分均高于对照组,差异有统计学意义（P〈0.05）;除家庭环境和社会环境维度外,观察组患者疾病心理社会适应各维度得分及总分均高于对照组,差异有统计学意义（P〈0.05）;观察组患者上肢功能恢复优于对照组,淋巴水肿发生率低于对照组,差异有统计学意义（P〈0.05）.结论 叙事护理可以改善乳腺癌患者创伤后成长、癌因性疲乏、心理社会适应、患肢功能恢复及淋巴水肿等疾病适应结局,值得在乳腺癌或更大疾病群体中推广.

Objective To explore the effect of narrative nursing on disease adaptation outcome of patients with breast cancer such as posttraumatic growth, cancer-related fatigue, psychosocial adaptation, limb function and lymphedema. Methods From August 2015 to February 2016, 76 breast cancer patients of the First Affiliated Hospital of Harbin Medical University were selected as the research objects by convenient sampling method. All patients were divided into observation group and control group by random number table, 38 cases with each group. Patients in the control group were given routine breast cancer treatment and psychological care. On the basis of control group, patients in the observation group received the narrative nursing intervention. The posttraumatic growth rating scale （PTGI）, short fatigue scale （BFI） and disease psychosocial adaptation scale （PAIS-SR） were used to evaluate the disease adaptation condition of patients. The upper limb lymphedema and functional recovery were compared between two groups after intervention. Results The scores of interpersonal relationship, personal strength, mental change, appreciation of life and posttraumatic growth score were higher in the observation group than that in the control group after 1-month intervention （P〈0.05）; the scores of physical fatigue, cognitive fatigue and total score of fatigue in the observation group were higher than those in the control group, the differencs were statistically significant （P〈0.05）; except the family environment and social environment dimensions, the scores of each dimension and total scores of disease psychosocial adaptation in the observation group were higher than those in the control group, the differencs were statistically significant （P〈0.05）; The function of upper limb in the observation group was better than that in the control group, and the incidence of lymphedema was lower than that in the control group, the differencs were statistically significant （P〈0.05）. Conclusions Narrative nursing can improve the disease adaptation outcome in breast cancer patients in the aspects of posttraumatic growth, cancer-related fatigue, psychosocial adaptation, limb functional recovery and lymphatic edema disease. It is worth spreading among breast cancer or more disease group.