基于计划行为理论的健康教育联合阶梯式护理模式对肺癌化疗患者的应用效果

Effect of health education based on theory of planned behavior combined with stepped care model on patients with lung cancer undergoing chemotherapy

目的探讨基于计划行为理论的健康教育联合阶梯式护理模式对肺癌化疗患者负性情绪、心理弹性及生命质量的影响。方法选取2020年10月至2021年12月潍坊医学院附属医院肺癌术后,且医院焦虑抑郁量表(HADS)中焦虑或抑郁维度评分>7分的化疗患者108例为研究对象,使用随机数字表法分为观察组和对照组各54例。排除各种原因脱落的病例,最终观察组纳入46例,对照组纳入48例。对照组实施常规护理,观察组实施基于计划行为理论的健康教育联合阶梯式护理模式的护理干预。每4周使用HADS评估患者的负性情绪,负性情绪缓解的患者停止下一阶段护理干预,未缓解的患者继续进行下一阶段更高强度的护理干预。采用HADS、心理弹性量表(CD-RISC)、肺癌治疗功能量表(FACT-L)对2组患者进行评价,并对结果进行比较。结果干预前,2组患者负性情绪、心理弹性和生命质量各维度得分与总分比较差异均无统计学意义(均P>0.05)。干预后,观察组患者负性情绪各维度得分及总分明显低于对照组,差异均有统计学意义(t=4.86、3.19、4.53,均P<0.05)。干预后,观察组患者心理弹性与生命质量各维度得分及总分均高于对照组,差异均有统计学意义(t值为-6.01~-2.89,均P<0.05)。干预后,观察组临床观察阶段与同期对照组的负性情绪缓解率相比,差异无统计学意义(P>0.05)。而观察组指导性自助、问题解决疗法、心理或药物治疗3个阶段及合计负性情绪缓解率分别为38.46%(15/39)、33.33%(8/24)、6/16、78.26%(36/46),均高于对照组,差异均有统计学意义(χ^(2)值为7.04~13.80,均P<0.05)。结论基于计划行为理论的健康教育联合阶梯式护理模式能有效缓解肺癌化疗患者的负性情绪,提高心理弹性和生命质量水平。

Objective To explore the effect of health education based on theory of planned behavior combined with stepped care model on negative emotion,psychological flexibility and quality of life in patients with lung cancer undergoing chemotherapy.Methods From October 2020 to December 2021,108 chemotherapy patients who underwent lung cancer surgery in Affiliated Hospital of Weifang Medical College and had anxiety or depression that scores was greater than 7 in any dimension of the Hospital Anxiety and Depression Scale(HADS)were selected as the study subjects.The study subjects were divided into observation group(n=46)and control group(n=48)by random digits table method.Routine care was implemented in the control group.The observation group implemented health education based on the theory of planned behavior combined with stepped care model intervention.The HADS scale was used every 4 weeks to assess negative emotion in both groups.In observation,patients with negative emotion relief stop the next stage of nursing intervention,and patients without relief continue the next stage of higher intensity nursing intervention.Results Before the intervention,there were no significant difference in the scores of negative emotion,psychological flexibility and quality of life between the two groups(P>0.05).After intervention,the scores of all dimensions of negative emotion and the total score in the observation group were significantly lower than those in the control group,and the differences had statistical significance(t=4.86,3.19 and 4.53,all P<0.05).After the intervention the scores of psychological flexibility and quality of life dimensions and the total score in the observation group were higher than those in the control group,the differences had statistical significance(t values were-6.01--2.89,all P<0.05).After the intervention,there was no significant difference in the remission rate of negative emotions between the clinical observation stage of the observation group and the concurrent control group(P>0.05).The remission rates of guided self-help,problem-solving therapy,psychological or drug therapy and total negative emotions in the observation group were 38.46%(15/39),33.33%(8/24),6/16 and 78.26%(36/46),respectively,which were higher than those in the control group,and the differences had statistical significance(χ^(2) values were 7.04-13.80,all P<0.05).Conclusions Health education based on the theory of planned behavior combined with stepped care model can effectively alleviate the negative emotions of lung cancer patients undergoing chemotherapy and improve psychological flexibility and quality of life.