PDCA循环模式的护理干预对病人病耻感影响效果的研究

Study on the effects of nursing intervention based on PDCA cycle mode on patients′stigma

目的:探讨基于PDCA循环模式的护理干预对病人病耻感水平的影响。方法:选取2021年3月至2022年1月胃肠外科收入院的处于中重度病耻感水平的结直肠癌肠造口病人,取得其知情同意后,收集一般资料,并使用统一的量表进行基线调查;随机分为对照组和干预组,对照组采取常规护理和康复治疗,干预组在此基础上,同时实施基于PDCA循环模式的护理干预,干预前和干预后4次、干预后8次结束应用社会影响量表评价干预组与对照组病人之间及干预前后的病耻感水平。结果:干预前,2组病人病耻感总分及社会排斥、经济歧视、内在羞耻感与社会隔离维度得分差异无统计学意义(P>0.05)。干预后4次、8次,干预组病人病耻感及各维度得分低于对照组(P<0.05~P<0.01)。干预后,干预组病人病耻感总分及社会排斥、经济歧视、内在羞耻感与社会隔离维度得分均降低(P<0.05~P<0.01);而对照组病耻感总分和社会排斥有增加趋势(P<0.05)。结论:基于PDCA循环模式的综合护理干预能够有效降低肠造口病人的病耻感水平。

Objective:To investigate the effects of nursing intervention based on PDCA cycle mode on patients′stigma.Methods:The patients with moderate-to-severe levels of stigma treated with colorectal cancer enterostomy,who admitted to the gastrointestinal surgery department from March 2021 to January 2022,were selected.After obtaining their informed consent,the general data were collected,and a baseline survey was conducted using a uniform scale.The patients were divdied into the control group and intervention group.The control group was given the routine nursing and rehabilitation treatment,and the intervention group was given the nursing intervention based on the PDCA cycle mode on the basis of control group.The social impact scale was used to evaluate and compare the levels of stigma in two groups between before and after 4 and 8 times of intervention.Results:Compared with before intervention,the intervention effects and time effect of the total score of stigma and social exclusion were significant after intervention(P<0.05).The intervention effects of economic discrimination,internal shame and social isolation were significant(P<0.05).Except for there was no statistical significance in the economic discrimination dimension and interaction of time effects(P>0.05),but the differences of the interaction effects of the total score of stigma and other dimensions were statistically significant(P<0.05).There was no statistical significance in the total score of stigma and scores of social exclusion,economic discrimination,internal shame and social isolation between two groups(P>0.05).After 4 and 8 times of intervention,the scores of stigma and various dimensions in the intervention group were lower than those in the control group(P<0.05 to P<0.01).After intervention,the total score of stigma and scores of social exclusion,economic discrimination,internal shame and social isolation in the intervention group significantly decrease(P<0.05 to P<0.01).In the control group,the total score of stigma and social exclusion increased(P<0.05),while the others had no statistical significance(P>0.05).Conclusions:Comprehensive nursing interventions based on the PDCA cycle mode can effectively reduce the level of stigma in patients with enterostomies.