本文選題：治療性溝通　切入點(diǎn)：慢性鼻竇炎　出處：《山西醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:獲得慢性鼻竇炎患者術(shù)前焦慮抑郁情緒、各種心境狀態(tài)、主觀癥狀評(píng)分和慢性病自我效能的流行病學(xué)資料,并分析其相關(guān)性及影響因素;以治療性溝通系統(tǒng)(therapeutic communication system,TCS)作為干預(yù)手段,評(píng)價(jià)其對(duì)慢性鼻竇炎行鼻內(nèi)鏡術(shù)患者的效果;采用質(zhì)性研究方法對(duì)通過治療性溝通方法干預(yù)的患者進(jìn)行半結(jié)構(gòu)式訪談以獲取患者對(duì)干預(yù)方案的感受、態(tài)度和建議,評(píng)價(jià)和修正溝通方案。方法:本研究分為三部分。第一部分:橫斷面研究。采用便利抽樣的方法,抽取某三甲醫(yī)院耳鼻喉頭頸外科符合納入標(biāo)準(zhǔn)的慢性鼻竇炎(chronic rhinosinusitis,CRS)患者。在入院第一天采用一般情況調(diào)查表、簡(jiǎn)明心境量表(BPOMS)、醫(yī)院焦慮抑郁量表(HADS)、癥狀視覺評(píng)分量表(VAS)、慢性病管理自我效能量表(CDSES)收集資料。使用SPSS19.0統(tǒng)計(jì)軟件對(duì)調(diào)查數(shù)據(jù)進(jìn)行分析描述。第二部分:實(shí)驗(yàn)性研究。選取調(diào)查研究中愿意參與治療性溝通系統(tǒng)的患者為研究對(duì)象,隨機(jī)分為TCS干預(yù)組和對(duì)照組。干預(yù)組患者在一般護(hù)理的基礎(chǔ)上采用治療性溝通系統(tǒng),對(duì)照組采用一般護(hù)理方法。用BPOMS、HADS、CDSES、護(hù)理滿意度量表(NSNS)在出院前一天收集患者資料。SPSS19.0軟件分析干預(yù)后兩組患者在術(shù)后出院前整體心理水平、焦慮抑郁、慢性病管理自我效能和護(hù)理滿意度之間的差異。第三部分:質(zhì)性研究。采用現(xiàn)象學(xué)研究方法,立意取樣選取12例在研究二中接受TCS干預(yù)的CRS手術(shù)患者。應(yīng)用半結(jié)構(gòu)式訪談法收集患者對(duì)TCS干預(yù)的真實(shí)感受和體驗(yàn)。Colaizzi的資料分析方法對(duì)資料進(jìn)行分析和提煉主題。結(jié)果:1橫斷面研究:(1)CRS術(shù)前患者的焦慮、抑郁水平:用醫(yī)院焦慮抑郁量表(HADS)對(duì)158例CRS術(shù)前患者進(jìn)行調(diào)查。結(jié)果0-7分無焦慮癥狀的患者81例占51.3%,0-7分無抑郁的患者93例占58.9%;8-10分有可疑焦慮的患者42例占26.5%,8-10分有可疑抑郁的患者38例,占24%;11-21分確定存在焦慮的患者35例占22.2%,11-21分確定存在抑郁癥狀的患者27例占20.3%;以評(píng)分≥8分為癥狀陽性,焦慮77例占48.7%,抑郁65例占41.1%,焦慮合并抑郁54例占34.2%,單純焦慮23例占14.6%,單純抑郁11例占7.0%;對(duì)患者焦慮、抑郁的影響因素進(jìn)行分析結(jié)果不同文化程度、居住地、家庭月收入和醫(yī)療支付方式對(duì)CRS患者術(shù)前的焦慮水平有統(tǒng)計(jì)學(xué)差異(P0.05);不同文化程度、居住地、家庭月收入和支付方式在CRS術(shù)前患者抑郁水平也有統(tǒng)計(jì)學(xué)差異(P0.05)。(2)CRS患者癥狀VAS評(píng)分:用慢性鼻竇炎癥狀VAS評(píng)分量表調(diào)查評(píng)分均分大于5分的有93例占比59%;對(duì)VAS評(píng)分進(jìn)行單因素分析,癥狀視覺評(píng)分5的患者在焦慮、抑郁、心境評(píng)分大于癥狀視覺評(píng)分≤5的患者,癥狀視覺評(píng)分大于5的患者在癥狀管理自我效能評(píng)分小于癥狀視覺評(píng)分≤5的患者,差異均具有有統(tǒng)計(jì)學(xué)意義(P0.05)。(3)CRS患者術(shù)前心境評(píng)分:用簡(jiǎn)明心境量表調(diào)查的各維度得分由高到低分別是精力-活力、疲乏-遲鈍、緊張-焦慮、迷亂-混沌、抑郁-沮喪、憤怒-敵意;對(duì)量表各維度得分與癥狀視覺評(píng)分量表、慢性病自我管理效能量表的關(guān)系分析,結(jié)果簡(jiǎn)明心境量表各維度得分與癥狀視覺評(píng)分量表得分之間呈正相關(guān),除憤怒-敵意維度外各維度得分與慢性病自我管理效能量表得分呈負(fù)相關(guān),均具有統(tǒng)計(jì)學(xué)意義(P0.05)。(4)CRS患者慢性病管理自我效能:自我效能總分、癥狀管理自我效能評(píng)分和疾病共性管理自我效能評(píng)分≥7的人數(shù)百分比分別是61.4%、65.2%、54.4%。癥狀管理自我效能得分與患者焦慮、抑郁、VAS得分是負(fù)相關(guān)且具有統(tǒng)計(jì)學(xué)意義(P0.05)。2實(shí)驗(yàn)性研究:(1)治療性溝通對(duì)焦慮、抑郁的影響:干預(yù)前兩組患者得分均衡具有可比性,干預(yù)后干預(yù)組焦慮、抑郁得分低于對(duì)照組差異具有統(tǒng)計(jì)學(xué)意義(P0.05);兩組患者干預(yù)后焦慮、抑郁得分比干預(yù)前都有下降,干預(yù)組下降幅度大于對(duì)照組且差異具有統(tǒng)計(jì)學(xué)意義(P0.05)。(2)治療性溝通對(duì)簡(jiǎn)明心境量表得分影響:干預(yù)前兩組數(shù)據(jù)的得分均衡具有可比性,干預(yù)后兩組患者簡(jiǎn)明心境量表各維度得分差異組間比較具有統(tǒng)計(jì)學(xué)意義(P0.05);兩組患者各維度得分干預(yù)前后的差值差異均具有統(tǒng)計(jì)學(xué)意義(P0.05)。(3)治療性溝通對(duì)自我效能影響:干預(yù)前兩組數(shù)據(jù)的得分均衡具有可比性,干預(yù)后干預(yù)組和對(duì)照組兩組患者慢性病自我管理效能量表各維度得分組間比較差異均具有統(tǒng)計(jì)學(xué)意義,(P0.05),干預(yù)組和對(duì)照組慢性病自我管理效能量表各維度得分干預(yù)前后的差值都有上升,但干預(yù)組上升幅度較大且具有統(tǒng)計(jì)學(xué)意義,(P0.05)。(3)干預(yù)后干預(yù)組患者護(hù)理滿意度高于對(duì)照組且差異具有統(tǒng)計(jì)學(xué)意義(P0.05)3質(zhì)性研究:共提煉出三個(gè)主題分別是:患者對(duì)治療性溝通干預(yù)方法的感受;患者對(duì)治療性溝通方法的評(píng)價(jià);患者對(duì)治療性溝通方法的建議。結(jié)論:CRS鼻內(nèi)鏡術(shù)前患者的心理問題不容忽視。術(shù)前焦慮、抑郁的發(fā)生率較高,不同文化程度、居住地、家庭月收入和醫(yī)療支付方式是CRS患者焦慮、抑郁的影響因素;CRS患者鼻竇癥狀的嚴(yán)重程度會(huì)對(duì)患者焦慮、抑郁、各維度心境造成影響;CRS患者在心境各維度精力-活力、疲乏-遲鈍、緊張-焦慮、迷亂-混沌、抑郁-沮喪、憤怒-敵意方面都有負(fù)性表現(xiàn);CRS患者癥狀嚴(yán)重程度和不良心境狀態(tài)會(huì)降低患者對(duì)疾病的自我效能;CRS患者的疾病自我效能較低,患者的焦慮、抑郁、疾病癥狀嚴(yán)重程度影響患者對(duì)疾病的自我效能。醫(yī)護(hù)人員在治療護(hù)理過程中應(yīng)關(guān)注CRS患者的焦慮、抑郁、心境狀態(tài)、癥狀嚴(yán)重程度和對(duì)疾病的自我效能。治療性溝通模式的干預(yù)方法能夠改善CRS患者的焦慮、抑郁以及其他各種不良心境,增強(qiáng)患者對(duì)疾病的自我效能,提高患者對(duì)護(hù)理服務(wù)的滿意度,具有可操作性和臨床實(shí)用性,值得進(jìn)一步擴(kuò)大研究并在臨床上推廣應(yīng)用。后續(xù)的治療性溝通方案有待改進(jìn)如護(hù)士態(tài)度應(yīng)該更親切,讓多領(lǐng)域的醫(yī)務(wù)工作者參與其中,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.

【學(xué)位授予單位】：山西醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R473.76

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 孫琴;胡翠菊;;治療性溝通對(duì)塵肺患者自我護(hù)理能力及自我效能感的影響[J];臨床護(hù)理雜志;2016年05期

2 梁分鳳;彭正加;廖俊;;慢性鼻-鼻竇炎患者的精神心理特點(diǎn)及相關(guān)因素分析[J];中國耳鼻咽喉顱底外科雜志;2016年04期

3 王瑞芳;王宏艷;;綜合護(hù)理干預(yù)措施對(duì)慢性鼻竇炎鼻內(nèi)窺鏡手術(shù)患者生活質(zhì)量的影響[J];檢驗(yàn)醫(yī)學(xué)與臨床;2016年12期

4 劉學(xué)軍;倪麗艷;高金建;李勇;黃賽瑜;凡啟軍;張初琴;陳波蓓;;微創(chuàng)外科治療慢性鼻竇炎患者的負(fù)性情緒調(diào)查[J];中國內(nèi)鏡雜志;2015年11期

5 湯小麗;文麗;王禮芹;;綜合護(hù)理干預(yù)減輕慢性鼻竇炎術(shù)后不適的效果評(píng)價(jià)[J];實(shí)用臨床醫(yī)藥雜志;2015年10期

6 徐蓉;;護(hù)患溝通與患者滿意度探討[J];醫(yī)院管理論壇;2015年03期

7 楊浩;楊秀海;;心理干預(yù)對(duì)慢性鼻-鼻竇炎患者鼻內(nèi)鏡術(shù)后精神癥狀及生活質(zhì)量的影響研究[J];中國醫(yī)藥指南;2014年35期

8 李月玲;文國英;蔣維連;;治療性溝通系統(tǒng)對(duì)乳腺癌患者圍手術(shù)期焦慮抑郁情緒的影響[J];當(dāng)代護(hù)士(中旬刊);2014年12期

9 何慶文;袁小蘭;林大梁;劉愛國;肖才文;徐翔;;醫(yī)患溝通在擇期鼻部手術(shù)圍手術(shù)期中的應(yīng)用價(jià)值與評(píng)估[J];現(xiàn)代中西醫(yī)結(jié)合雜志;2014年27期

10 李健忠;;慢性鼻竇炎患者心理狀況調(diào)查與分析[J];齊齊哈爾醫(yī)學(xué)院學(xué)報(bào);2014年11期

相關(guān)會(huì)議論文 前1條

1 楊浩;楊秀海;梁秋林;馮超;;貴州部分地區(qū)慢性鼻、鼻竇炎患者術(shù)前心理健康狀況的調(diào)查分析[A];貴州省醫(yī)學(xué)會(huì)第七屆耳鼻咽喉頭頸外科學(xué)術(shù)會(huì)議資料匯編[C];2014年

相關(guān)碩士學(xué)位論文 前3條

1 陳圓圓;治療性溝通系統(tǒng)對(duì)乳腺癌術(shù)后化療患者生活質(zhì)量及社會(huì)支持度的影響[D];湖南師范大學(xué);2015年

2 衛(wèi)來;慢性鼻—鼻竇炎患者精神心理紊亂及手術(shù)療效分析[D];大連醫(yī)科大學(xué);2014年

3 焦靜;北京市三甲綜合醫(yī)院住院病人對(duì)護(hù)理服務(wù)滿意度現(xiàn)狀及影響因素的研究[D];中國協(xié)和醫(yī)科大學(xué);2009年

，

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