慢性鼻窦炎患者术前心理状况分析及治疗性沟通干预效果

发布时间：2018-04-02 14:35

本文选题：治疗性沟通　切入点：慢性鼻窦炎　出处：《山西医科大学》2017年硕士论文

【摘要】：目的:获得慢性鼻窦炎患者术前焦虑抑郁情绪、各种心境状态、主观症状评分和慢性病自我效能的流行病学资料,并分析其相关性及影响因素;以治疗性沟通系统(therapeutic communication system,TCS)作为干预手段,评价其对慢性鼻窦炎行鼻内镜术患者的效果;采用质性研究方法对通过治疗性沟通方法干预的患者进行半结构式访谈以获取患者对干预方案的感受、态度和建议,评价和修正沟通方案。方法:本研究分为三部分。第一部分:横断面研究。采用便利抽样的方法,抽取某三甲医院耳鼻喉头颈外科符合纳入标准的慢性鼻窦炎(chronic rhinosinusitis,CRS)患者。在入院第一天采用一般情况调查表、简明心境量表(BPOMS)、医院焦虑抑郁量表(HADS)、症状视觉评分量表(VAS)、慢性病管理自我效能量表(CDSES)收集资料。使用SPSS19.0统计软件对调查数据进行分析描述。第二部分:实验性研究。选取调查研究中愿意参与治疗性沟通系统的患者为研究对象,随机分为TCS干预组和对照组。干预组患者在一般护理的基础上采用治疗性沟通系统,对照组采用一般护理方法。用BPOMS、HADS、CDSES、护理满意度量表(NSNS)在出院前一天收集患者资料。SPSS19.0软件分析干预后两组患者在术后出院前整体心理水平、焦虑抑郁、慢性病管理自我效能和护理满意度之间的差异。第三部分:质性研究。采用现象学研究方法,立意取样选取12例在研究二中接受TCS干预的CRS手术患者。应用半结构式访谈法收集患者对TCS干预的真实感受和体验。Colaizzi的资料分析方法对资料进行分析和提炼主题。结果:1横断面研究:(1)CRS术前患者的焦虑、抑郁水平:用医院焦虑抑郁量表(HADS)对158例CRS术前患者进行调查。结果0-7分无焦虑症状的患者81例占51.3%,0-7分无抑郁的患者93例占58.9%;8-10分有可疑焦虑的患者42例占26.5%,8-10分有可疑抑郁的患者38例,占24%;11-21分确定存在焦虑的患者35例占22.2%,11-21分确定存在抑郁症状的患者27例占20.3%;以评分≥8分为症状阳性,焦虑77例占48.7%,抑郁65例占41.1%,焦虑合并抑郁54例占34.2%,单纯焦虑23例占14.6%,单纯抑郁11例占7.0%;对患者焦虑、抑郁的影响因素进行分析结果不同文化程度、居住地、家庭月收入和医疗支付方式对CRS患者术前的焦虑水平有统计学差异(P0.05);不同文化程度、居住地、家庭月收入和支付方式在CRS术前患者抑郁水平也有统计学差异(P0.05)。(2)CRS患者症状VAS评分:用慢性鼻窦炎症状VAS评分量表调查评分均分大于5分的有93例占比59%;对VAS评分进行单因素分析,症状视觉评分5的患者在焦虑、抑郁、心境评分大于症状视觉评分≤5的患者,症状视觉评分大于5的患者在症状管理自我效能评分小于症状视觉评分≤5的患者,差异均具有有统计学意义(P0.05)。(3)CRS患者术前心境评分:用简明心境量表调查的各维度得分由高到低分别是精力-活力、疲乏-迟钝、紧张-焦虑、迷乱-混沌、抑郁-沮丧、愤怒-敌意;对量表各维度得分与症状视觉评分量表、慢性病自我管理效能量表的关系分析,结果简明心境量表各维度得分与症状视觉评分量表得分之间呈正相关,除愤怒-敌意维度外各维度得分与慢性病自我管理效能量表得分呈负相关,均具有统计学意义(P0.05)。(4)CRS患者慢性病管理自我效能:自我效能总分、症状管理自我效能评分和疾病共性管理自我效能评分≥7的人数百分比分别是61.4%、65.2%、54.4%。症状管理自我效能得分与患者焦虑、抑郁、VAS得分是负相关且具有统计学意义(P0.05)。2实验性研究:(1)治疗性沟通对焦虑、抑郁的影响:干预前两组患者得分均衡具有可比性,干预后干预组焦虑、抑郁得分低于对照组差异具有统计学意义(P0.05);两组患者干预后焦虑、抑郁得分比干预前都有下降,干预组下降幅度大于对照组且差异具有统计学意义(P0.05)。(2)治疗性沟通对简明心境量表得分影响:干预前两组数据的得分均衡具有可比性,干预后两组患者简明心境量表各维度得分差异组间比较具有统计学意义(P0.05);两组患者各维度得分干预前后的差值差异均具有统计学意义(P0.05)。(3)治疗性沟通对自我效能影响:干预前两组数据的得分均衡具有可比性,干预后干预组和对照组两组患者慢性病自我管理效能量表各维度得分组间比较差异均具有统计学意义,(P0.05),干预组和对照组慢性病自我管理效能量表各维度得分干预前后的差值都有上升,但干预组上升幅度较大且具有统计学意义,(P0.05)。(3)干预后干预组患者护理满意度高于对照组且差异具有统计学意义(P0.05)3质性研究:共提炼出三个主题分别是:患者对治疗性沟通干预方法的感受;患者对治疗性沟通方法的评价;患者对治疗性沟通方法的建议。结论:CRS鼻内镜术前患者的心理问题不容忽视。术前焦虑、抑郁的发生率较高,不同文化程度、居住地、家庭月收入和医疗支付方式是CRS患者焦虑、抑郁的影响因素;CRS患者鼻窦症状的严重程度会对患者焦虑、抑郁、各维度心境造成影响;CRS患者在心境各维度精力-活力、疲乏-迟钝、紧张-焦虑、迷乱-混沌、抑郁-沮丧、愤怒-敌意方面都有负性表现;CRS患者症状严重程度和不良心境状态会降低患者对疾病的自我效能;CRS患者的疾病自我效能较低,患者的焦虑、抑郁、疾病症状严重程度影响患者对疾病的自我效能。医护人员在治疗护理过程中应关注CRS患者的焦虑、抑郁、心境状态、症状严重程度和对疾病的自我效能。治疗性沟通模式的干预方法能够改善CRS患者的焦虑、抑郁以及其他各种不良心境,增强患者对疾病的自我效能,提高患者对护理服务的满意度,具有可操作性和临床实用性,值得进一步扩大研究并在临床上推广应用。后续的治疗性沟通方案有待改进如护士态度应该更亲切,让多领域的医务工作者参与其中,注意患者的接受理解能力。
[Abstract]:Objective: to obtain the operation of patients with chronic sinusitis before anxiety and depression, mood state, the epidemiological data of subjective symptom scores and chronic disease self-efficacy, and to analyze the factors of relevance and impact; the therapeutic communication system (therapeutic communication system, TCS) as a means of intervention and evaluation of patients with chronic sinusitis treated by endoscopic sinus surgery effect using qualitative research methods; semi-structured interviews of the therapeutic methods of communication intervention patients to obtain the patients of intervention feeling, attitude and suggestions, evaluating and modifying the communication scheme. Methods: This study is divided into three parts. The first part: a cross-sectional study. By convenient sampling, extraction of a hospital of Otolaryngology Head and neck surgery in accordance with the inclusion criteria of chronic sinusitis (chronic rhinosinusitis, CRS). The patients in the first day of admission by general questionnaire, concise Mood scale (BPOMS), hospital anxiety and Depression Scale (HADS), visual symptoms rating scale (VAS), chronic disease management self-efficacy scale (CDSES). Data were collected using SPSS19.0 statistical software to analyze the description of survey data. The second part: experimental study. Select research and willing to participate in the treatment of the communication system of the patients as the research object, randomly divided into TCS group and control group. The intervention group were treated with therapeutic communication system based on general nursing, the control group with general nursing method. BPOMS, HADS, CDSES, nursing satisfaction scale (NSNS) on the day before discharge in patients with data collection.SPSS19.0 software analysis after the intervention of the two groups of patients discharged before the overall psychological level, postoperative anxiety and depression, the difference between the chronic disease management self-efficacy and nursing satisfaction. The third part: qualitative research. The research method of phenomenology, purposive sampling selection 12 cases of CRS patients receiving TCS intervention in the second study. Data analysis methods of semi-structured interviews TCS intervention were collected real feeling and experience of the.Colaizzi were analyzed and the theme of the data. Results: 1 cross-sectional studies: (1) anxiety patients, preoperative depression level: CRS the hospital anxiety and Depression Scale (HADS) in 158 cases of CRS patients were investigated. Results 81 cases of 0-7 patients without anxiety symptoms accounted for 51.3%, 0-7 of 93 patients without depression accounted for 58.9%; 8-10 points in 42 patients with suspicious anxiety accounted for 26.5%, 8-10 points with 38 suspicious patients, patients with depression accounted for 24%; 11-21 points were determined in 35 anxiety patients accounted for 22.2%, 11-21 points to determine 27 cases of depressive symptoms accounted for 20.3% of patients; to score over 8 is divided into 77 cases of positive symptoms, anxiety and depression accounted for 48.7%, 65 cases accounted for 41.1%, 54 cases of anxiety with depression accounted for 34.2%, 23 cases with anxiety accounted for 14.6% single. Pure depression in 11 cases accounted for 7% of the patients; anxiety, the influencing factors of depression were analyzed by the different cultural level, residence, family income and medical payment methods have significant difference on CRS in patients with preoperative anxiety level (P0.05); different cultural level, residence, family income and payment in the preoperative CRS level of depression patients also had significant difference (P0.05). (2) CRS patients with VAS scores: chronic sinusitis symptoms scores of VAS questionnaire score was greater than 5 of the 93 cases accounted for 59%; VAS scores were analyzed by univariate analysis, visual symptoms score of 5 in patients with anxiety, depression, mood score greater than visual symptoms score of 5 or less of patients, visual symptoms score greater than 5 of the patients in the symptom management self-efficacy score less than visual symptoms score of 5 or less of patients, differences have statistical significance (P0.05). (3) CRS patients with mood score: Jane The scores of Ming mood questionnaire survey from high to low is energy - energy, fatigue slow tension, anxiety, confusion and chaos, depression, depression, anger hostility; the scores of symptoms and visual rating scale, chronic disease self management effectiveness scale analysis. The results of POMS scores and visual symptoms score was positively related to the score, in addition to the dimensions of anger hostility dimension scores and chronic disease self-efficacy scores were negatively correlated, were statistically significant (P0.05). (4) CRS patients with chronic disease management self-efficacy: self-efficacy scores. The symptom management self-efficacy score and common disease management self-efficacy score more than 7 percentages were 61.4%, 65.2%, 54.4%. symptom management self-efficacy and anxiety, depression, VAS score is negative and statistically significant (P0.05.2) Experimental study: (1) therapeutic communication on anxiety, depression of two groups before intervention score balanced comparable group anxiety intervention, depression scores were lower than the control group the difference was statistically significant (P0.05); the two groups of patients after the intervention of anxiety, depression score were decreased than before intervention and the intervention group decreased than that of control group and the difference was statistically significant (P0.05). (2) therapeutic communication on POMS scores: score before the equilibrium data of the two groups are comparable to those of the two groups after intervention POMS scores of differences between groups was statistically significant (P0.05); difference of the two groups before and after the intervention of the dimensions of patient scores were statistically significant (P0.05). (3) effects of therapeutic communication on self efficacy: balanced score before the data of the two groups are comparable, the intervention group and control group Two groups of patients with chronic disease self-efficacy scores between the groups were statistically significant, (P0.05), the intervention group and the control group of chronic disease self management efficacy scale difference before and after the intervention the scores have increased, but the intervention group increased greatly and has statistical significance (P0.05). (3) the intervention group patients nursing satisfaction was higher than the control group and the difference was statistically significant (P0.05): a total of 3 qualitative research extracted three themes are: patients feel of the intervention methods of communication; evaluation of patients therapeutic communication method; patients of therapeutic communication method. Conclusion: the psychological problems of nasal endoscopic surgery patients before CRS can not be ignored. The preoperative anxiety, the higher incidence of depression, different cultural level, residence, family income and medical payment is the anxiety of CRS patients and the influencing factors of depression; C The severity of nasal symptoms in RS patients of depression will affect all dimensions, anxiety, mood; patients with CRS in each dimension of mind - energy vitality, fatigue slow, tension anxiety, confusion and chaos, depression, depression, anger hostility have negative performance; patients with CRS symptoms and severity of adverse the state of mind will reduce the patients' self-efficacy; patients with CRS disease patients with low self-efficacy, anxiety, depression, disease severity of disease and effect of self-efficacy. Medical staff should pay more attention to CRS patients with anxiety, depression, mood state in the process of the treatment and nursing, the severity of symptoms and diseases self efficacy intervention method. Therapeutic communication mode can improve CRS patients' anxiety, depression and other negative mood, enhance patients' self-efficacy, improve the degree of satisfaction of patients with. It is feasible and practical. It is worthy of further research and clinical application. The follow-up therapeutic communication plan needs to be improved, such as nurses' attitude should be more cordial, so that many fields of medical workers should take part in it, and pay attention to patients' ability of receiving and understanding.

【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R473.76

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