全程优化护理联合归因分析指导下正念心理支持对肝功能衰竭患者救治态度、死亡恐惧及生活质量的影响

Effects of whole-course optimization nursing combined with attribution analysis-guided mindfulness-based psychological support on treatment attitude,fear of death and quality of life in patients with liver failure

目的:探究遵循全程优化护理联合归因分析指导下正念心理支持对肝功能衰竭患者救治态度、死亡恐惧及生活质量的影响。方法:选取2021年7月至2022年6月某院就诊的80例肝功能衰竭患者。随机数字表法分为对照组(n=40例)及研究组(n=40例),对照组接受肝衰竭常规护理,研究组接受遵循全程优化护理联合归因分析指导下正念心理支持干预。比较两组干预前及干预1周时的救治态度[生命意义感量表汉化版(C-MLQ)、医学应对方式问卷(MCMQ)]、死亡恐惧[死亡态度描绘量表(DAP-R)、疾病进展恐惧简化量表(FoP-Q-SF)]及生活质量[生活质量量表(SF-36)]。结果:两组干预前的C-MLQ量表生命意义体验及生命意义寻求评分比较差异无统计学意义(t=1.281,0.296;P>0.05);干预1周时两组上述评分较干预前明显升高,且研究组高于对照组(t=2.434,3.060;P<0.05)。两组干预前的MCMQ量表各维度评分比较差异无统计学意义(t=0.311,1.073,1.472;P>0.05);干预1周时两组回避、屈服评分较干预前明显降低,面对评分较干预前明显提高,且以研究组较为显著(t=5.502,5.116,4.717;P<0.05)。两组干预前的DAP-R量表各维度评分比较差异无统计学意义(t=0.946、0.612、1.403、0.399、0.754,P>0.05);干预1周时两组死亡逃避、死亡恐惧、逃避接受评分较干预前明显降低,趋近接受及自然接受评分较干预前明显升高,且以研究组较为显著(t=7.585,2.679,4.533,2.426,5.071;P<0.05)。两组干预前的FoP-Q-SF量表评分及恐惧死亡例数比较差异无统计学意义(t=0.378,χ^(2)=0.464,P>0.05);干预后上述指标较干预前明显降低,且研究组低于对照组(t=4.836,χ^(2)=4.943,P<0.05)。两组干预前的SF-36量表生理健康及心理健康评分比较差异无统计学意义(t=0.491,1.252;P>0.05):干预1周时的上述评分较干预前明显升高,且研究者高于对照组(t=4.312,6.806;P<0.05)。结论:给予肝衰竭患者遵循全程优化护理联合归因分析指导下正念心理支持干预可帮助患者积极寻求生命的价值,采取科学的应对态度,降低死亡恐惧,改善生活质量。

Objective:To explore the effects of whole-course optimization nursing combined with attribution analysis-guided mindfulness-based psychological support on treatment attitude,fear of death and quality of life in patients with liver failure.Methods:A total of 80 patients with liver failure who were treated in the hospital from July 2021 to June 2022 were selected and divided into control group(n=40)and study group(n=40)by the random number table method.The control group received routine nursing of liver failure,and the study group received whole-course optimization nursing combined with attribution analysis-guided mindfulness-based psychological support.Before intervention and at 1 week of intervention,the treatment attitude[Chinese Meaning in Life Questionnaire(C-MLQ),Medical Coping Modes Questionnaire(MCMQ)],fear of death[Death Attitude Profile-Revised(DAP-R),Fear of Progression Questionnaire-Short Form(FoP-Q-SF)]and quality of life[36-Item Short-Form Health Survey(SF-36)]were compared between the two groups.Results:There were no statistically significant differences in the scores of life meaning experience and life meaning seeking of C-MLQ scale between the two groups before intervention,and the above scores in the two groups at 1 week of intervention were significantly enhanced compared with those before intervention,and the scores in study group were higher than those in control group(t=2.434,3.060;P<0.05).Before intervention,there were no statistical differences in the scores of dimensions of MCMQ scale between the two groups.At 1 week of intervention,the scores of avoidance and yielding in both groups were significantly reduced compared to before intervention while the facing score was significantly enhanced compared to before intervention,and the scores were more significant in study group(t=5.502,5.116,4.717;P<0.05).There were no statistical differences in the scores of dimensions of DAP-R scale between the two groups before intervention.At 1 week of intervention,the scores of death escape,fear of death and acceptance of escape were significantly decreased in both groups while the scores of approach acceptance and natural acceptance were significantly increased compared with those before intervention,the above scores in study group were more significant(t=7.585,2.679,4.533,2.426,5.071;P<0.05).The score of FoP-Q-SF scale and the number of cases with fear of death showed statistical differences between the two groups before intervention,and the above two indicators after intervention were significantly lower than those before intervention,and the indicators were lower in study group than those in control group(t=4.836,χ^(2)=4.943;P<0.05).There were no statistically significant differences in the scores of physical health and mental health scores of SF-36 scale between the two groups before intervention,and the above scores at 1 week of intervention were significantly elevated compared with those before intervention,and the scores were higher in study group compared to control group(t=4.312,6.806;P<0.05).Conclusion:Whole-course optimization nursing combined with attribution analysis-guided mindfulness-based psychological support for patients with liver failure can help to actively seek the value of life,adopt a scientific coping attitude,reduce the fear of death and improve the quality of life.