问题解决护理模式在肺癌化疗患者及其照顾者中的应用

Application of problem-solving nursing model in lung cancer chemotherapy patients and their caregivers

目的分析肺癌化疗患者及其照顾者应用问题解决护理模式的效果,探究对患者用药依从性、希望水平、自我管理能力、心理状态以及照顾者的照顾负担产生影响。方法选取2020年2月—2023年1月医院收治的肺癌患者及其照顾者各110例作为研究对象,按照组间基线资料具有可比性原则将110例患者分为对照组和观察组,每组55例。分组时患者及其照顾者分配到同一组,对照组实施常规护理,观察组实施常规护理+问题解决护理模式,持续干预6个月,比较两组患者干预前后的用药依从性、希望水平、心理状态以及自我管理能力,并比较两组患者照顾者干预前后的照顾负担程度。结果问题解决护理模式干预后6个月,观察组患者用药依从性优于对照组,组间比较差异有统计学意义(P<0.05)。干预前,两组患者希望水平量表(HHI)评分和90项症状清单(SCL-90)评分比较差异无统计学意义(P>0.05);干预后,观察组患者HHI评分高于对照组,SCL-90评分低于对照组,组间比较差异具有统计学意义(P<0.05)。干预前,两组患者健康自我管理行为、健康自我认知和健康自我管理环境3个分量表评分比较差异无统计学意义(P>0.05);干预后,除健康自我认知外,观察组患者健康自我管理行为、健康自我管理环境2个分量表评分评分均高于对照组,差异有统计学意义(P<0.05)。干预前,两组患者照顾者ZBI量表个人负担和责任负担评分比较差异无统计学意义(P>0.05);干预后,观察组患者照顾者两个维度评分均低于对照组,差异有统计学意义(P<0.05)。结论问题解决护理模式能为患者提供更多支持和指导,让患者更好地应对治疗过程中的困难和问题,不仅可有效提高肺癌化疗患者的用药依从性、希望水平及自我管理能力,改善其负面情绪,还可有效减轻其照顾者的照顾负担。

Objective To analyze the effects of applying a problem-solving model of care to patients undergoing chemotherapy for lung cancer and their caregivers,and to explore the impact on patients'medication adherence,hope level,self-management ability,psychological status,and caregivers'burden of care.Methods A total of 110 cases each of lung cancer patients and their caregivers admitted to the hospital from February 2020 to January 2023 were selected as the study subjects,and the 110 patients were divided into a control group and an observation group of 55 cases each according to the principle that the baseline data between the groups were comparable.The patients and their caregivers were assigned to the same group.The control group received routine care,while the observation group received routine care and problem-solving care.The intervention lasted for 6 months.The medication compliance,hope level,psychological state,and self-management ability of the two groups of patients before and after the intervention were compared.The care burden of the caregivers of the two groups of patients before and after the intervention was also compared.Results Six months after the intervention of the problem-solving nursing model,the medication adherence in the observation group was better than that in the control group,and the difference between the groups was statistically significant(P<0.05).Before the intervention,there was no significant difference in the scores of Hope Level Scale(HHI)and Symptom Checklist 90(SCL-90)between the two groups of patients(P>0.05).After the intervention,the HHI score in the observation group was higher than that in the control group,the SCL-90 score in the observation group was lower than that in the control group,and the difference between the groups was statistically significant(P<0.05).Before the intervention,there was no significant difference in the scores of the three subscales of health self-management behavior,health self-cognition and health self-management environment between the two groups of patients(P>0.05).After the intervention,except for health self-cognition,the scores of the two subscales of health self-management behavior and health self-management environment in the observation group were higher than those in the control group,and the differences were statistically significant(P<0.05).Before the intervention,there was no significant difference in the personal burden and responsibility burden scores of the ZBI scale of the caregivers of the two groups of patients(P>0.05);after the intervention,the scores of the two dimensions of the caregivers of the observation group were lower than those of the control group,and the differences were statistically significant(P<0.05).Conclusion The problem-solving nursing model can provide patients with more support and guidance,allowing them to better cope with the difficulties and problems during the treatment process.It can not only effectively improve the medication compliance,hope level and self-management ability of lung cancer chemotherapy patients,improve their negative emotions,but also effectively reduce the care burden of their caregivers.