问题导向护理模式用于糖尿病合并胃癌化疗患者的价值

Value of Problem-Oriented Nursing Model in Patients with Diabetes and Gastric Cancer Undergoing Chemotherapy

目的 探究基于问题导向的护理模式对糖尿病合并胃癌化疗患者心理弹性、胃肠道反应和生存质量等的影响。方法 采用便利抽样法选择2019年1月至2022年1月四川大学华西医院腹部肿瘤科收治的糖尿病合并胃癌化疗患者87例作为研究对象,按简单随机法分为对照组(n=43)与试验组(n=44),对照组患者采用常规护理干预,试验组在此基础上采用基于问题导向的护理干预,比较两组患者干预前后的心理弹性、自我管理效能、营养状况、胃肠道反应及生存质量。结果 干预后,两组心理弹性量表(CD-RISC)的坚韧性、力量性、乐观性维度得分及自我管理效能感量表(C-SUPPH)的自我决策、缓解压力、正性态度得分均较干预前增加(P<0.05),试验组CD-RISC各维度得分、C-SUPPH各维度得分均高于对照组(P<0.05);干预前两组血红蛋白、清蛋白与总蛋白水平差异无统计学意义(P>0.05),干预后两组上述营养因子均较干预前降低(P<0.05),且干预后试验组营养因子水平均高于对照组(P<0.05);干预期间,试验组恶心呕吐和食欲减退发生率为38.64%、29.55%,低于对照组的60.47%、51.62%(P<0.05);干预后,两组欧洲癌症治疗与研究组织开发的生命质量测定量表(EORTCQLQ-ST022)各维度得分均较同组干预前降低(P<0.05),且试验组各维度得分低于对照组(P<0.05)。结论 基于问题导向的护理干预,有助于提高糖尿病合并胃癌化疗患者心理弹性,提高患者自我管理效能水平,并降低胃肠道不良反应发生率,提升患者生存质量。

Objective To explore the effect of problem-oriented nursing intervention on psychological resilience,gastrointestinal reaction and quality of life in patients with diabetes mellitus complicated with gastric cancer undergoing chemotherapy.Methods A total of 87 patients with diabetes mellitus complicated with gastric cancer undergoing chemotherapy admitted to the department of abdominal oncology of West China Hospital from January 2019 to January 2022 were selected as the research subjects by convenience sampling method.They were divided into control group(n=43)and experimental group(n=44)according to simple random method.Patients in the control group were given routine nursing intervention,while patients in the experimental group were given problem-oriented nursing intervention on the basis of routine nursing intervention.Psychological resilience,self-management efficacy,nutritional status,gastrointestinal reaction and quality of life before and after intervention were compared between the two groups.Results After intervention,the scores of tenacity,strength and optimism in Connor-Davidson Resilience Scale(CD-RISC)and the scores of self-decision making,stress relief,and positive attitude in Chinese-version of Strategies Used by People to Promote Health(C-SUPPH)in both groups increased compared with those before intervention(P<0.05),and the scores of CD-RISC and C-SUPPH in the experimental group were higher than those in the control group(P<0.05).Before intervention,there was no significant difference in the levels of hemoglobin,albumin and total protein between the two groups(P>0.05).After intervention,the above-mentioned nutritional factors in both groups were lower than those before intervention(P<0.05).After intervention,the levels of nutritional factors in the experimental group were higher than those in the control group(P<0.05).During intervention,the incidence of nausea and vomiting and loss of appetite in the experimental group were 38.64%and 29.55%,which were lower than 60.47%and 51.62%in the control group(P<0.05).After intervention,the scores of all dimensions of the Quality of Life Questionnaire for Patients with Stomach Cancer developed by European Organization for Research and Treatment of Cancer(EORTC QLQ-STO22)were lower than those before intervention(P<0.05),and the scores of all dimensions in the experimental group were lower than those in the control group(P<0.05).Conclusion Problem-oriented nursing intervention is helpful to improve the psychological resilience of patients with diabetes complicated with gastric cancer undergoing chemotherapy,improve their level of self-management efficacy,reduce the incidence of gastrointestinal adverse reactions,and improve their quality of life.