住院胃肠癌患者家属照顾者感受与社会支持、成人依恋的关系

发布时间：2018-11-24 11:24

【摘要】：目的：了解住院胃肠癌症患者家属照顾者感受现状,在分析成人依恋、社会支持与家属照顾者感受的基础上,进一步探讨社会支持在成人依恋影响照顾者感受关系中的中介效应。为缓解住院胃肠癌患者照顾者消极感受,增加其积极感受提供理论依据,并提出针对性相关干预措施。方法：采用横断面问卷调查法,于2014年8月至2015年8月采用方便取样,选择济南市某三级甲等医院普通外科病房胃肠癌术后住院照顾者进行问卷调查。本次调查共发放问卷237份,回收有效问卷207份。调查问卷主要包括：一般资料问卷、亲密关系体验问卷-修订版、社会支持评定量表及照顾者反应评估量表,主要用于测量患者及其照顾者一般资料、照顾者的成人依恋、社会支持及照顾者感受。使用SPSS22.0和AMOS17.0软件进行数据录入和分析。具体包括：描述性统计分析、方差分析、Pearson相关分析、逐步多元线性回归分析及结构方程模型分析等。结果：(1)住院胃肠癌症患者照顾者的消极感受平均分为(10.40±1.78),其中健康问题维度得分为(2.25±0.70),时间安排受打扰维度得分为(3.50±0.67),经济负荷维度得分为(2.80±0.92),家庭支持缺乏维度得分为(1.86±0.54)。照顾者的积极感受平均分为(4.38±0.41)。(2)人口学资料单因素分析结果显示,照顾者的消极感受在照顾者的年龄、家庭经济状况、与患者的关系以及照顾者感知到的患者情绪状态上差异有统计学意义(P0.05)。而照顾者的积极感受在照顾者的年龄、性别、文化水平、职业、家庭经济状况、与患者的关系、与患者同住、照顾患者的意愿、感知患者情绪状态以及患者的性别上差异有统计学意义(P0.05)。(3)相关分析结果显示,照顾者的消极感受与照顾者的依恋回避和依恋焦虑有显著正相关关系(r=0.268,r=0.343,P0.01)。照顾者的消极感受与客观支持,主观支持,支持利用度呈显著负相关关系(r=-0.256,r=-0.354,r=-0.411,P0.01)。照顾者的积极感受与照顾者的依恋回避有显著负相关关系(r=-0.269,P0.01),照顾者的积极感受与客观支持,主观支持,支持利用度呈显著正相关关系(r=0.197,r=0.225,r=0.256,P0.01)。另外,依恋回避与客观支持,主观支持,支持利用度有显著负相关(r=-0.162,r=-0.149,r=-0.260,P0.05),依恋焦虑与客观支持和支持利用度有显著负相关(r=-0.215,r=-0.354, P)0.01)。(4)逐步多元线性回归分析结果显示,照顾者的年龄,感知患者情绪状态,感知患者病情严重程度,家庭经济状况,照顾者文化水平,依恋回避,依恋焦虑,主观支持和支持利用度可以预测照顾者的消极感受(P0.05)。照顾者职业,与患者的关系,照顾患者意愿,文化水平,患者性别,依恋对象,依恋回避,客观支持和支持利用度可以预测照顾者的积极感受(P0.05)。(5)构建中介模型发现,社会支持可以中介成人依恋与照顾者消极感受和积极感受的关系,消极感受模型的拟合指标：CMIN/DF=1.173,GFI=0.935, AGFI=0.894,RMSEA=0.059,CFI=0.925,IFI=0.928。社会支持在照顾者依恋回避对其消极感受的中介效应量为0.209,社会支持在照顾者依恋焦虑对其消极感受的中介效应量为0.238(P0.05)。积极模型的拟合指标：CMIN/DF=1.343,GFI= 0.928,AGFI=0.895,RMSEA=0.041,CFI=0.956,IFI=0.958,社会支持在照顾者依恋回避对其积极感受的中介效应量为-0.088。社会支持在照顾者依恋焦虑对其积极感受的中介效应量为-0.105(P0.05)。结论：(1)住院胃肠癌症患者家属照顾者在照顾患者期间不仅产生消极感受,同时也会产生积极感受。(2)住院胃肠癌症患者家属照顾者感受受到多种因素的影响,照顾者的积极感受与消极感受预测因素不尽相同。成人依恋和社会支持对照顾者感受有显著预测作用,且.社会支持可以完全中介成人依恋对照顾感受的关系。(3)医务人员应更加关注依恋焦虑和依恋回避倾向高的照顾者,给予更多的支持和帮助,采取针对性的措施保证照顾者的身心健康,从而为患者提供高质量的护理,促进共同健康。
[Abstract]:Objective: To study the current situation of family care in patients with gastrointestinal cancer. Based on the analysis of adult attachment, social support and the feeling of family caregivers, this paper further discusses the intermediate effect of social support in the relationship between adult attachment and caregiver's feelings. In order to alleviate the negative feelings of the patients in the patients with gastrointestinal cancer and to increase their positive experience, this paper provides the theoretical basis and puts forward the relevant interventions. Methods: By means of cross-section questionnaire, a questionnaire was conducted from August 2014 to August, 2015, and the patients with gastrointestinal cancer in general hospital ward of a third class A hospital in Jinan were selected. A total of 237 questionnaires were issued for the survey, and 207 questionnaires were collected. The questionnaire mainly includes the general data questionnaire, the intimate experience questionnaire-revision, the social support rating scale and the caregiver response assessment scale, which is mainly used to measure the general information of the patients and their caregivers, the adult attachment of the carers, the social support and the care of the caregivers. Data entry and analysis were performed using the SPSS10.0 and AMOS6.0 software. in particular, descriptive statistic analysis, variance analysis, Pearson correlation analysis, stepwise multiple linear regression analysis and structural equation model analysis, etc. Results: (1) The negative feelings of the patients with gastrointestinal cancer were divided into (10.40 to 1.78), among which the health problems were divided into (2.25, 0.70), and the time schedule was divided into (3.50 and 0.67), and the economic load dimension was divided into (2.80, 0.92). The lack of dimension in family support is divided into (1.86 to 0.54). The positive feelings of the carers were equally divided into (4.38, 0.41). (2) The results of the single-factor analysis of the demographic data show that the negative feelings of the carers are statistically significant in the age of the carers, the family's economic status, the relationship with the patient and the emotional state of the patients perceived by the carers (P0.05). The positive feelings of the carers are the age, gender, cultural level, occupation, family and economic status of the caregiver, the relationship with the patient, the patient's will with the patient, the willingness to take care of the patient, the sense of the patient's emotional state and the difference in the patient's gender (P0.05). (3) The results of correlation analysis showed that the negative feelings of the carers were positively correlated with the attachment avoidance and attachment anxiety of the carers (r = 0.268, r = 0.343, P0.01). The negative feelings of the carers were negatively correlated with the objective support, the subjective support and the degree of support (r =-0.256, r =-0.354, r =-0.411, P0.01). There was a significant negative correlation between the positive feelings of the carers (r =-0.269, P0.01), the positive feelings of the carers and the objective support, the subjective support and the degree of support, r = 0.197, r = 0.225, r = 0.256, P0.01). There was a significant negative correlation between attachment avoidance and objective support, subjective support, and degree of support (r =-0.162, r =-0.149, r =-0.260, P0.05), and the attachment anxiety was negatively correlated with the degree of objective support and support (r =-0.215, r =-0.354, P) 0.01). (4) The results of stepwise multiple linear regression analysis show that the age of the caregiver, the sense of the patient's emotional state, the severity of the patient's condition, the family economic situation, the level of care of the caregiver, the attachment avoidance, the attachment anxiety, Subjective support and support utilization can predict the negative feelings of caregivers (P0.05). The patient's occupation, the relationship with the patient, the patient's will, the cultural level, the patient's gender, the attachment object, the attachment avoidance, the objective support and the support availability can predict the positive feelings of the carers (P0.05). (5) The relationship between the negative feelings and the positive feelings of the adult attachment and the caregivers can be mediated by the social support, and the fitting index of the negative feeling model is CMIN/ DF = 1.173, GFI = 0.935, AGFI = 0.894, RMSEA = 0.059, CFI = 0.925, P = 0.928. The effect of social support on the negative feelings of caregiver attachment avoidance was 0.209. The effect of social support on the negative feelings of caregiver attachment anxiety was 0.238 (P0.05). The fitting index of the positive model: CMIN/ DF = 1.343, GFI = 0.928, AGFI = 0.895, RMSEA = 0.041, CFI = 0.956, P = 0.958, the effect of social support on the positive feelings of the caregiver is-0.088. The effect of social support on the positive feelings of the caregiver's attachment anxiety was-0.105 (P0.05). Conclusion: (1) The family caregivers of the patients with gastrointestinal cancer have not only negative feelings during the care of the patients, but also positive feelings. (2) The feeling of family care in patients with gastrointestinal cancer is affected by a variety of factors, and the positive feelings of the carers are different from those of negative feelings. Adult attachment and social support have a significant predictor of caregivers and. Social support can fully mediate the relationship between adult attachment and care. (3) Medical personnel should pay more attention to the care of attachment anxiety and attachment avoidance, give more support and help, and take targeted measures to ensure the physical and mental health of the carers, so as to provide high-quality care for patients and promote common health.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R473.73

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