全方位焦点解决模式护理对白血病化疗患儿的影响

Effect of Comprehensive Solution-focused Nursing on Children with Leukemia Undergoing Chemotherapy

目的:探讨全方位焦点解决模式护理对化疗期间白血病患儿感染情况、不良反应、癌因性疲乏、心理状态、生活质量的影响。方法:回顾性选取2022年1月1日~2023年2月28日白血病化疗患儿86例,采用随机数字表法分为常规护理组和焦点模式护理组各43例。常规护理组实施常规护理干预,焦点模式护理组在常规干预基础上采取全方位焦点解决模式护理;比较两组化疗期间感染、不良反应发生情况及干预前后营养指标[包括血清白蛋白(ALB)、视黄醇结合蛋白(RBP)、前白蛋白(PA)、三角肌皮褶厚度、上臂围],采用多维疲乏量表(PedsQLTMMFS)、儿童焦虑性情绪障碍筛查量表(SCARED)、儿童抑郁障碍自评量表(DSRSC)、特质应对方式问卷(TCSQ)、Herth希望量表(HHI)、儿童普适性生活质量量表(PedsQL 4.0)进行比较。结果:焦点模式护理组感染发生率低于常规护理组(P<0.05),恶心呕吐、高尿酸血症、静脉炎等不良反应发生率低于常规护理组(P<0.05);干预后,焦点模式护理组营养指标、PedsQLT-MMFS各维度评分均高于干预前和常规护理组(P<0.05,P<0.01);干预后,两组PedsQL 4.0各维度评分均高于干预前(P<0.05),且焦点模式护理组(除社会功能维度)高于常规护理组(P<0.01);干预后,两组DSRSC、SCARED评分、主要照护者TCSQ及HHI评分均优于干预前(P<0.05),且焦点模式护理组优于常规护理组(P<0.01)。结论:全方位焦点解决模式护理可进一步减少感染和不良反应的发生,改善患儿的营养状况,降低病情恶化的风险,同时可缓解患儿癌因性疲乏和不良情绪,提升其生活质量,还能提高主要照护者希望水平,促进其积极应对,有助于改善白血病患儿预后。

Objective:To investigate the effect of comprehensive solution-focused nursing on infection,adverse reactions,cancer-related fatigue,psychological state and quality of life in children with leukemia during chemotherapy.Methods:A total of 86 children with leukemia undergoing chemotherapy from January 1,2022 to February 28,2023 were retrospectively selected and divided into a routine nursing group and a solution-focused nursing group according to the random number table method,with 43 cases in each group.The children in the routine nursing group were given routine nursing intervention,and the children in the solution-focused nursing group were provided comprehensive solution-focused nursing on the basis of routine intervention.The incidence of infection and adverse reactions during chemotherapy,nutritional indicators[including serum albumin(ALB),retinol binding protein(RBP),prealbumin(PA),deltoid skinfold thickness,upper arm circumference],PedsQLTMMFS,SCARED and DSRSC,TCSQ and HHI,PedsQL 4.0 were used for comparison.Results:The incidence of infection in the solurion-focused nursing group was lower than that in the routine nursing group(P<0.05),and the incidence of adverse reactions such as nausea and vomiting,hyperuricemia and phlebitis was lower than that in the routine nursing group(P<0.05).After the intervention,the nutritional indexes and the scores of all dimensions of PedsQLTMMFS in the solurion-focused nursing group were higher than those before intervention and those in the routine nursing group(P<0.05,P<0.01).The scores of all dimensions of PedsQL 4.0 in the two groups were higher after intervention than those before intervention(P<0.05),and the scores of the solurion-focused nursing group(except for the dimension of social function)were higher than those in the routine nursing group(P<0.01).After intervention,the DSRSC and SCARED scores,TCSQ and HHI scores of main caregivers in the two groups were better than those before intervention,and the scores in the solution-focus nursing group was better than the routine nursing group(P<0.01).Conclusion:The comprehensive solution-focused nursing can further reduce the incidence of infection and adverse reactions,improve the nutritional status of children and reduce the risk of disease deterioration.At the same time,it can relieve cancer-related fatigue and negative emotions of children and improve their quality of life and the hope level of the main caregivers,which is helpful to improve the prognosis of children with leukemia.