腮腺肿瘤切除患者围术期个性化舒适护理与叙事护理干预模式的构建

Construction on intervention model of personalized comfort nursing and narrative care in perioperative period of patients with excision of parotid tumor

目的探讨在腮腺肿瘤切除患者围术期构建个性化舒适护理与叙事护理干预模式的效果。方法选择2014年1月~2017年9月中国石油天然气集团公司中心医院拟行全麻手术的腮腺肿瘤患者96例,根据随机数字表法分为常规护理护理组(对照组)和个性化舒适护理结合叙事护理组(实验组),每组各48例,对照组患者围术期实施常规护理,实验组在对照组基础上采用个性化舒适护理结合"叙事护理"的干预模式,术前、手术1周后分别使用Zung焦虑抑郁自评量表(SAS、SDS)、KPS评分和自我认同感量表对患者焦虑抑郁情况、生活质量以及自我认同感进行评估,手术1周后对患者并发症情况进行统计,于患者出院调查患者家属护理满意度。结果手术1周后,实验组SAS、SDS及自我认同感评分明显优于对照组,差异有统计学意义(P<0.05),两组SAS评分明显低于术前,差异有统计学意义(P<0.05);SDS评分,实验组较术前明显降低,差异有统计学意义(P<0.05),对照组差异无统计学意义(P>0.05);实验组KPS评分增加明显高于对照组,差异有统计学意义(P<0.05);自我认同感评分,仅实验组较术前明显升高,差异有统计学意义(P<0.05),通过信度分析,自我认同感量表克朗巴哈系数(Cronbach′sα)为0.85;术后实验组切口感染发生率明显少于对照组,差异有统计学意义(P<0.05);此外实验组患者家属总满意率明显高于对照组,差异有统计学意义(P<0.05)。结论腮腺肿瘤切除患者围术期护理过程中实施个性化舒适护理与叙事护理干预模式能明显改善患者焦虑抑郁情绪和舒适度,提高患者生活质量和自我认同感,同时降低患者术后切口感染率,此外大大提高了患者家属对护理的满意度。

Objective To investigate the effect on construction of the intervention model of personalized comfort nursing and narrative care in perioperative period of patients with excision of parotid tumor.Methods From January 2014 to September 2017,in China National Petroleum Corporation Central Hospital,96 patients undergoing elective general anaesthesia operation of parotid tumor were selected,according to the random number table method,they divided into usual ursing group （control group） and personalized comfort nursing combined with narrative care group （experiment group）,with 48 cases in each group.the control group was given with usual care during the perioperative period,based on which the experiment group was implemented with the intervention model of personalized comfort nursing combined with ＂narrative care＂ for psychological care,then Zung anxiety and depression self-rating scale （SAS and SDS）,KPS marking criterion and self-identity scale were used separately to evaluate the conditions of anxiety and depression,quality of life,sense of self-identity of all patients before and after operation 1 week,patients＇ complications after operation 1 week were conducted,the questionnaire on satisfaction to nursing was handed to the patients＇ relatives and had a statistics.Results After surgery 1 week,the scores of SAS,SDS and sense of self-identity in the experiment group were significantly better than the control group,the differences were statistically significant （P 〈 0.05）,the scores of SAS in two groups were lower than before operation,the differences were statistically significant （P 〈 0.05）;socres of SDS in the experiment group were significantly lower than before operation,the differences were statistically significant （P 〈 0.05）,there was no those statistically significant difference in the control group （P 〉 0.05）;KPS increasement point in the experiment group was obviously higher than the control group,the differences were statistically significant （P 〈 0.05）;compared with before operation,the scores of sense of self-identity only in the experiment group increased,the differences were statistically significant （P 〈 0.05）,the Cronbach＇s α of self-identity Scale was 0.85 after reliability analysis;the incision infection rate in the experiment group was lower than the control group,the difference was statistically significant （P 〈 0.05）;the satisfaction of patients＇ relatives in the experiment group was higher than the control group,the difference was statistically significant （P 〈 0.05）.Conclusion During the process of providing nursing to the patients undergoing resection of parotid tumor,the implementation of personalized comfort nursing and narrative care may significantly improve the emotion of anxiety and depression and comfort degree,as well raise the quality of life and sense of self-identity of patients,meanwhile,reduce the postoperative incision infection rate,as well as greatly enhance the satisfaction of patients＇ family members.