慢性阻塞性肺疾病患者希望水平的现况调查及干预研究

发布时间：2018-01-09 04:21

本文关键词：慢性阻塞性肺疾病患者希望水平的现况调查及干预研究　出处：《广西医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的了解慢性阻塞性肺疾病(Chronic obstructive pulmonary disease,COPD)患者的希望水平现状,明确患者希望水平与生活质量、照顾者希望水平的关系以及影响患者希望水平的因素;通过与COPD患者进行半结构式深度访谈进一步剖析其内心的希望体验;探索能有效提高我国COPD患者希望水平与自我效能的综合护理干预模式。方法本研究包含调查、质性和干预研究三个部分。(1)调查研究:通过便利抽样选取2015年6月到2016年4月在广西医科大学第一附属医院东院和西院呼吸内科住院的COPD患者及其家庭照顾者118对,共336例作为研究对象。采用一般资料调查表、Herth希望指数量表、COPD评估测试问卷分别评估患者的一般情况、希望水平、生活质量和照顾者的一般情况、希望水平。分析COPD患者的希望水平与自身生活质量、照顾者希望水平之间的关系;通过多元逐步回归法分析影响COPD患者希望水平的因素。(2)质性研究:采用目的抽样法,在参与第一部分问卷调查的患者中选取16例有代表性的作为研究对象,通过半结构式深度访谈探讨患者内心的希望体验。(3)干预研究:选择2016年5月到2017年1月期间在广西医科大学第一附属医院东院呼吸内科一、二病区住院,同时符合纳入和排除标准的COPD患者各30例作为研究对象。二病区的患者为对照组,给予常规护理;一病区的患者为干预组,在常规护理的基础上增加综合护理干预。干预前以及干预6周后应用Herth希望指数量表和COPD自我效能量表分别对两组患者进行测评,比较评估结果,评价综合护理干预模式对提高我国COPD患者希望水平与自我效能的效果。结果(1)118例COPD患者希望水平总分为(33.69±4.66)分,其中64.4%的患者处于中等希望水平,35.6%的患者处于高等希望水平;COPD患者的生活质量总分为(22.68±5.60)分,照顾者希望水平得分(35.03±4.41)分;进行Pearson相关分析,发现COPD患者的希望水平总分与其生活质量得分呈显著负相关,与照顾者希望水平总分及各维度得分呈显著正相关;多元逐步回归分析结果显示:患者的生活质量、文化程度、是否在职、婚姻状况、医疗付费方式和照顾者的希望水平6个因素进入回归方程,共同解释了患者希望水平总变异的55.6%。(2)通过应用Colaizzi 7步分析法联合Nvivo8.0软件整理分析访谈资料,研究者最后归纳出4个主要的主题:(1)对希望的理解:希望是对未来生活的向往、希望是活好当下、希望是努力治疗;(2)阻碍希望的因素:身体不适感强烈、对疾病认知不足、负性情绪、家庭不和睦、治疗效果不佳,害怕疾病复发;(3)促进希望的因素:病情好转、外在支持、内在目标;(4)希望促使患者付出行动—改变现状:改变不良习惯、主动学习。(3)实施干预前,干预组和对照组患者的希望水平与自我效能得分比较差异无显著性(P0.05);进行综合护理干预以后,两组患者的希望水平与自我效能得分比较差异具有显著性(P0.05);在干预前后干预组患者的希望水平与自我效能得分比较具有明显差异(P0.05)。结论(1)COPD患者处于中等至高等希望水平,生活质量受到较严重影响,COPD患者家庭照顾者的希望水平亦处于中等至高等。(2)多种因素能够影响COPD患者的希望水平,其中生活质量、文化程度、是否在职、婚姻状况、医疗付费方式和照顾者希望水平6个因素是其主要影响因素。(3)通过深度访谈,揭示了COPD患者对希望的理解、促进希望的因素、阻碍希望的因素、希望能够促使患者付出行动—改变现状。研究结果较好地阐释了COPD患者保持中高希望水平的原因。能帮助医护人员更好地了解患者的需求,为下一步针对关键影响因素制定干预措施提供了科学依据。提高COPD患者的希望水平,对维持其身心健康具有重要意义。(4)综合护理干预模式能有效提高我国COPD患者的希望水平与自我效能。
[Abstract]:Objective to investigate the chronic obstructive pulmonary disease (Chronic obstructive pulmonary disease, COPD) of hope level of patients, patients with clear level of hope and quality of life, caregivers hope level and their hope level factors; through semi-structured interviews with COPD patients and analyze the inner to explore the effective experience; I want to improve in patients with COPD and the level of comprehensive nursing intervention self-efficacy model. This study contains three parts of qualitative investigation and intervention research. (1) research: by convenience sampling from June 2015 to April 2016 in the First Affiliated Hospital of Guangxi Medical University COPD patients hospitalized and Eastern Hospital Respiratory Medicine West Hospital and family care on the 118, a total of 336 cases as the research object. The general information questionnaire, Herth hope index scale, COPD assessment test respectively. In general, patients hope level, in general, the quality of life and the caregiver's level of hope. The hope level analysis of COPD patients and their caregivers to quality of life, the relationship between levels; by multivariate analysis the factors influence the hope level of patients with COPD stepwise regression method. (2): Qualitative study using purposive sampling in the first part, a questionnaire survey of patients with 16 cases selected representative as the research object, through semi-structured depth interviews to explore the patients of hope inside experience. (3) intervention study: May 2016 to January 2017 in the First Affiliated Hospital of Guangxi Medical University, Eastern Hospital wards, two, at the same time, in accordance with the inclusion and the exclusion criteria of COPD of the 30 cases of patients as the research object. In two patients as control group, were given routine nursing care; ward of the patients in routine care intervention group. Comprehensive nursing intervention based on the intervention. Before and 6 weeks after intervention by Herth hope index scale and COPD self efficacy scale were used to test two groups of patients, compare the evaluation results, the evaluation of comprehensive nursing intervention mode in China to improve the hope level of patients with COPD and self efficacy. Results 118 cases of COPD (1) the hope level of patients with total score (33.69 + 4.66), 64.4% of them were at the middle level of hope, 35.6% of patients in a higher level of hope; the scores of quality of life for patients with COPD (22.68 + 5.60), caregiver level of hope score (35.03 + 4.41); Pearson correlation analysis, found that patients with COPD hope is negatively related to the total score and life quality score was positively related to the level of the score and caregiver hope; multiple stepwise regression analysis showed that the quality of life of the patients, the degree of culture, Whether the job, marital status, medical billing and caregiver to level 6 factors into the regression equation, the common interpretation of the hope level of patients with the total variation of 55.6%. (2) by using Colaizzi 7 step method combined with Nvivo8.0 software analysis of the interview data, researchers finally summed up 4 main themes: (1) I hope to understand: hope is longing for the future life, hope is to live in the moment, the hope is to treatment; (2) factors that hinder the hope: physical discomfort, lack of knowledge about the disease, negative emotions, family harmony, poor treatment, fear of recurrence of the disease; (3) promote hope the factors: the condition improved, external support, intrinsic goals; (4) to the patients with action - Change: change the bad habits, active learning. (3) before the intervention, the score intervention group and the control group patients the level of hope and self-efficacy are relatively poor Had no significant difference (P0.05); after the intervention, the score of the two groups of patients the level of hope and self-efficacy significantly (P0.05); in the intervention group score of hope level and self efficacy compared with the significant difference (P0.05). Conclusion (1) COPD in patients with moderate to high I hope the level of quality of life have been seriously affected, the family caregivers of patients with COPD is also in the middle to high level of hope. (2) a variety of factors which can affect the COPD patients in the hope level, including the quality of life, culture degree, whether the job, marital status, medical billing and caregiver hope level 6 factors are the factors the main effect (3). Through in-depth interviews, reveals COPD patients hope for understanding, hope promoting factors, factors that hinder the hope, hope can make the patients pay action to change the status quo. Good results Explanation of the COPD patients maintain a high level of hope. The reason can help medical staff to better understand the needs of patients, to provide a scientific basis for the next step for the key factors to improve the intervention measures. Patients with COPD level of hope, health is of great significance for the maintenance of the body and mind. (4) the comprehensive nursing intervention mode can effectively improve the patients with COPD in our country the level of hope and self-efficacy.

【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R473.5

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