人文关怀及认知行为干预对膀胱癌全膀胱切除尿道改流术后患者护理结局的影响

The Influence of Humanistic Care and Cognitive Behavior Intervention on the Nursing Outcomes of Patients with Bladder Cancer after Total Cystectomy and Urethral Diversion

目的探讨人文关怀及认知行为干预对膀胱癌全膀胱切除尿道改流术后患者护理结局的影响效果。方法选取该院泌尿外科2017年1月-2020年6月行全膀胱切除+输尿管腹壁造口尿道改流手术的膀胱癌患者50例,按照围术期护理方法不同分为对照组(n=24)和观察组(n=26)。对照组给予泌尿外科恶性肿瘤围术期常规护理,观察组实施围术期人文关怀及认知行为干预模式。出院后随访1个月,对比两组干预后心理健康水平(SAS、SDS)、Spitzer生存质量评价指标、术后应对能力(SCSQ)、自我效能(GSES)及病耻感程度(SIS)。结果干预后:观察组SAS评分(17.32±5.88)分,显著低于对照组(25.35±5.53)分,差异有统计学意义(t=-4.964,P<0.001);观察组SDS评分(19.48±5.57)分,显著低于对照组(28.02±6.83)分,差异有统计学意义(t=-4.862,P<0.001);观察组,差异有统计学意义GSES总分及SCSQ积极应对总分均明显高于对照组,SCSQ消极应对总分及SIS各项目得分均明显低于对照组,差异有统计学意义(P<0.05);观察组Spitzer各项目得分均分别高于对照组,差异有统计学意义(P<0.001)。结论通过对膀胱癌行全膀胱切除尿道改流术患者实施围术期人文关怀及认知行为干预,患者心理健康水平明显提升,个人应对能力、自信心及生活质量得到明显改善。

Objective To investigate the effect of humanistic care and cognitive behavior intervention on the nursing outcomes of patients with bladder cancer after total cystectomy and urethral diversion.Methods Fifty patients with bladder cancer who underwent total cystectomy and ureteral abdominal wall stoma and urethral diversion from January 2017 to June 2020 in the hospital were selected from the department of urology in the hospital,and were divided into control group(n=24)and observation group(n=26)according to different perioperative nursing methods.The control group received routine perioperative nursing for urological malignant tumors,and the observation group implemented perioperative humanistic care and cognitive behavior intervention models.Follow-up for 1 month after discharge,compared the mental health level(SAS,SDS),spitzer quality of life evaluation index,postoperative coping ability(SCSQ),self-efficacy(GSES)and stigma of the two groups after intervention degree(SIS).Results After intervention:the SAS score of the observation group was(17.32±5.88)points,which was significantly lower than that of the control group(25.35±5.53)points,and the difference was statistically significant(t=-4.964,P<0.001);the SDS score of the observation group was(19.48±5.57)points,significantly lower than the control group(28.02±6.83)points,the difference was statistically significant(t=-4.862,P<0.001);the observation group GSES total score and SCSQ active response total score were significantly higher than the control group.The total score of SCSQ negative coping and the scores of SIS items were significantly lower than those of the control group,the difference was statistically significant(P<0.05);the spitzer scores of the observation group were higher than those of the control group,and the difference was statistically significant(P<0.001).Conclusion Through the perioperative humanistic care and cognitive behavior intervention for patients with bladder cancer undergoing total cystectomy and urethral diversion,the patients'mental health level has been significantly improved,and their personal coping ability,self-confidence and quality of life have been significantly improved.