叙事护理结合同伴支持干预对结肠癌术后腹壁造口适应水平及病耻感的影响

Narrative nursing combined with peer support intervention on the adaptation level and stigma of abdominal stoma with intestinal obstruction caused by colon cancer

目的探讨叙事护理结合同伴支持干预对结肠癌术后腹壁造口适应水平及病耻感的影响。方法选择本院2018年7月至2020年7月收治的结肠癌术后腹壁造口患者230例,随机分为观察组和对照组各115例。对照组实施常规护理,观察组在对照组基础上增加叙事护理结合同伴支持干预,分别在干预前、干预结束时和干预后1个月应用造口适应量表(OAI-20)评价患者造口适应水平,应用社会影响量表(SIS)评价患者病耻感情况。结果两组干预结束时和干预后1个月积极生活态度、接受、持续担忧与造口适应水平总分升高,且观察组高于对照组(P<0.05);和干预前比较,干预结束时和干预后1个月社会隔离、内在羞耻、经济歧视、社会排斥及病耻感总分均降低,干预结束时两组相关数值比较差异无统计学意义(P>0.05),干预后1个月观察组数值低于对照组(P<0.05)。结论对结肠癌术后腹壁造口患者应用叙事护理结合同伴支持干预能够提升患者的造口适应水平,降低患者病耻感,值得临床推广应用。

Objective To explore the effect of narrative nursing combined with peer support intervention on the adaptation level and stigma of abdominal stoma with intestinal obstruction caused by colon cancer.Methods A total of 230 patients with abdominal stoma caused by colon cancer from July 2018 to July 2020 were randomly divided into observation group and control group,with 115 cases in each group.The patients in the control group received routine nursing,and the patients in the observation group received narrative nursing combined with peer support intervention.The stoma Adaptation Scale(OAI-20)was used to evaluate the stoma adaptation level before,at the end of and 1 month after the intervention,and the social impact scale(SIS)was used to evaluate the stigma of the patients.Results At the end of the intervention and one month after the intervention,the total scores of positive life attitude,acceptance,continuous worry and stoma adaptation increased,and the observation group was higher than the control group(P<0.05).At the end of the intervention and one month after the intervention,the total scores of social isolation,internal shame,economic discrimination,social exclusion and stigma decreased.There was no significant difference between the two groups at the end of the intervention(P>0.05).The value of the observation group was significantly lower than that of the control group one month after the intervention(P<0.05).Conclusion Narrative nursing combined with peer support intervention can improve the stoma adaptation level of patients with intestinal obstruction caused by colon cancer and reduce the sense of stigma,which is worthy of clinical application and promotion.