血友病患者心理健康狀況及系統(tǒng)化綜合關(guān)懷干預(yù)效果研究
發(fā)布時間：2018-12-14 01:04
【摘要】：目的研究血友病患者心理健康狀況及其影響因素,并根據(jù)影響因素制定系統(tǒng)化綜合關(guān)懷方案,依據(jù)其效果分析為血友病臨床護理工作提供理論依據(jù)。方法選取泰安市某三甲醫(yī)院登記注冊的血友病患者67名,首次調(diào)查采用患者基本資料調(diào)查表收集患者的人口社會學(xué)特征和臨床特征,采用焦慮自評量表(SAS)、抑郁自評量表(SDS)和心理癥狀自評量表(SCL-90)測量患者干預(yù)前的心理健康狀況,應(yīng)用SPSS 17.0軟件分析患者心理健康狀況與人口社會學(xué)特征及臨床特征之間的相關(guān)性,找出影響血友病患者心理健康狀況的因素。依據(jù)影響因素制定和落實系統(tǒng)化綜合關(guān)懷方案,包括建立患者健康管理檔案、開展凝血因子家庭實時注射指導(dǎo)和預(yù)防治療、RICE(R-Rest患肢休息制動,I-Ice冰敷,C-Compression局部壓迫,E-Elevation抬高患肢)出血急救知識健康教育、康復(fù)鍛煉、心理疏導(dǎo)、提供非血源性凝血因子、社會救助等,干預(yù)12個月后再次調(diào)查67名患者的心理健康狀況,分析干預(yù)前、后心理健康狀況的變化,并與國內(nèi)正常人群心理健康狀況的常模進行比較。結(jié)果1.干預(yù)前血友病患者的心理健康狀況明顯低于國內(nèi)正常人群的常模水平(P0.01),其中75%的患者有不同程度的焦慮,65%的患者有不同程度的抑郁,半數(shù)以上的患者有不同程度的軀體化、強迫癥狀、人際關(guān)系敏感、抑郁、焦慮、敵對、恐怖、偏執(zhí)、精神病性等心理癥狀。2.單因素分析發(fā)現(xiàn)文化程度越低、婚姻和工作狀況越差、醫(yī)療費用不足、生活自理能力越差、病程時間越長、凝血因子缺乏越嚴重、出血次數(shù)越多、出血時伴感染、治療不及時、無預(yù)防治療、已發(fā)生關(guān)節(jié)畸形及感染輸血相關(guān)感染性疾病的患者心理健康狀況越差(P0.05)。3.多因素分析發(fā)現(xiàn)文化程度、工作狀況、醫(yī)療費用、生活自理程度、病程、凝血因子缺乏程度、每年出血次數(shù)、治療是否及時、輸血相關(guān)感染性疾病、預(yù)防治療及出血時伴感染等因素影響血友病患者的心理健康水平(P0.01)。4.實施系統(tǒng)化綜合關(guān)懷方案后,患者存在輕度焦慮、重度焦慮、中度抑郁、軀體化癥狀、抑郁癥狀、焦慮癥狀、敵對癥狀、恐怖癥狀、偏執(zhí)癥狀、精神病性癥狀及其他癥狀的病例數(shù)較干預(yù)前顯著下降(P0.01),血友病患者心理健康狀況得到顯著改善(P0.01),但干預(yù)后的心理健康狀況仍低于國內(nèi)正常人群的常模水平(P0.01)。結(jié)論血友病患者心理健康水平較低,多數(shù)患者存在心理健康問題,實施好系統(tǒng)化綜合關(guān)懷方案能夠顯著提高血友病患者心理健康水平。鑒于該方案初步實施效果顯示血友病患者心理健康狀況仍低于正常人群水平,所以系統(tǒng)化綜合關(guān)懷措施應(yīng)持續(xù)推進。
[Abstract]:Objective to study the mental health status of hemophilia patients and its influencing factors, and to establish a systematic and comprehensive care scheme according to the influencing factors, and to provide theoretical basis for clinical nursing care of hemophilia patients. Methods Sixty-seven hemophilia patients registered in a third Class A Hospital in Taian City were selected. The sociological and clinical characteristics of the patients were collected by the basic information questionnaire for the first time. The self-rating anxiety scale (SAS),) was used to collect the demographic and clinical characteristics of the patients. (SDS) and SCL-90 were used to measure the mental health status of patients before intervention. SPSS 17.0 software was used to analyze the correlation between mental health status, demographic and sociological characteristics and clinical characteristics. Find out the factors that affect the mental health of hemophilia patients. According to the influencing factors, a systematic comprehensive care program was formulated and implemented, including the establishment of patient health management files, the development of real-time family injection of coagulation factors and the prevention and treatment of rest and immobilization of the affected limbs of, RICE (R-Rest, and the application of I-Ice ice compress. First aid knowledge education, rehabilitation exercise, psychological guidance, non-blood coagulation factor, social assistance, etc. After 12 months of intervention, 67 patients' mental health status were investigated again. The changes of mental health status before and after intervention were analyzed and compared with the norm of mental health status of normal population in China. Result 1. Before intervention, the mental health status of hemophilia patients was significantly lower than the norm level of normal population in China (P0.01), 75% of the patients had different degree of anxiety, 65% of the patients had different degrees of depression. More than half of the patients had somatization, obsessive-compulsive symptoms, interpersonal sensitivity, depression, anxiety, hostility, phobia, paranoid ideation, psychosis and other psychological symptoms. 2. Univariate analysis showed that the lower the education level, the worse the marriage and work condition, the less the medical expenses, the worse the self-care ability, the longer the course of disease, the more serious the coagulation factor deficiency, the more bleeding, the more infection, the less timely treatment. Without preventive treatment, the lower the mental health status of the patients with joint malformation and transfusion related infectious diseases (P0.05). Multivariate analysis showed that education, work status, medical expenses, self-care of life, course of disease, lack of coagulation factors, bleeding times per year, timely treatment, transfusion related infectious diseases, Preventive treatment and infection during bleeding affected the mental health of hemophilia patients (P0.01). 4. There were mild anxiety, severe anxiety, moderate depression, somatization symptoms, depression symptoms, anxiety symptoms, hostility symptoms, phobic symptoms, paranoid symptoms, The number of psychotic symptoms and other symptoms decreased significantly (P0.01), and the mental health status of hemophilia patients improved significantly (P0.01). However, the mental health status after intervention was still lower than the norm level of normal population in China (P0.01). Conclusion the mental health level of hemophilia patients is low and most of them have mental health problems. The implementation of systematic and comprehensive care program can significantly improve the mental health level of hemophilia patients. In view of the preliminary effect of the program, the mental health status of hemophilia patients is still lower than that of normal population, so the systematic comprehensive care measures should be continuously promoted.
【學(xué)位授予單位】：青島大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R473.5
本文編號：2377602
[Abstract]:Objective to study the mental health status of hemophilia patients and its influencing factors, and to establish a systematic and comprehensive care scheme according to the influencing factors, and to provide theoretical basis for clinical nursing care of hemophilia patients. Methods Sixty-seven hemophilia patients registered in a third Class A Hospital in Taian City were selected. The sociological and clinical characteristics of the patients were collected by the basic information questionnaire for the first time. The self-rating anxiety scale (SAS),) was used to collect the demographic and clinical characteristics of the patients. (SDS) and SCL-90 were used to measure the mental health status of patients before intervention. SPSS 17.0 software was used to analyze the correlation between mental health status, demographic and sociological characteristics and clinical characteristics. Find out the factors that affect the mental health of hemophilia patients. According to the influencing factors, a systematic comprehensive care program was formulated and implemented, including the establishment of patient health management files, the development of real-time family injection of coagulation factors and the prevention and treatment of rest and immobilization of the affected limbs of, RICE (R-Rest, and the application of I-Ice ice compress. First aid knowledge education, rehabilitation exercise, psychological guidance, non-blood coagulation factor, social assistance, etc. After 12 months of intervention, 67 patients' mental health status were investigated again. The changes of mental health status before and after intervention were analyzed and compared with the norm of mental health status of normal population in China. Result 1. Before intervention, the mental health status of hemophilia patients was significantly lower than the norm level of normal population in China (P0.01), 75% of the patients had different degree of anxiety, 65% of the patients had different degrees of depression. More than half of the patients had somatization, obsessive-compulsive symptoms, interpersonal sensitivity, depression, anxiety, hostility, phobia, paranoid ideation, psychosis and other psychological symptoms. 2. Univariate analysis showed that the lower the education level, the worse the marriage and work condition, the less the medical expenses, the worse the self-care ability, the longer the course of disease, the more serious the coagulation factor deficiency, the more bleeding, the more infection, the less timely treatment. Without preventive treatment, the lower the mental health status of the patients with joint malformation and transfusion related infectious diseases (P0.05). Multivariate analysis showed that education, work status, medical expenses, self-care of life, course of disease, lack of coagulation factors, bleeding times per year, timely treatment, transfusion related infectious diseases, Preventive treatment and infection during bleeding affected the mental health of hemophilia patients (P0.01). 4. There were mild anxiety, severe anxiety, moderate depression, somatization symptoms, depression symptoms, anxiety symptoms, hostility symptoms, phobic symptoms, paranoid symptoms, The number of psychotic symptoms and other symptoms decreased significantly (P0.01), and the mental health status of hemophilia patients improved significantly (P0.01). However, the mental health status after intervention was still lower than the norm level of normal population in China (P0.01). Conclusion the mental health level of hemophilia patients is low and most of them have mental health problems. The implementation of systematic and comprehensive care program can significantly improve the mental health level of hemophilia patients. In view of the preliminary effect of the program, the mental health status of hemophilia patients is still lower than that of normal population, so the systematic comprehensive care measures should be continuously promoted.
【學(xué)位授予單位】：青島大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R473.5
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