叙事疗法对永久性肠造口患者病耻感影响的研究

doi:10.3761/j.issn.0254-1769.2019.08.001

摘要/Abstract

摘要：

目的评价叙事疗法对永久性肠造口患者病耻感的影响。方法选取2018年4月—11月在某三级甲等医院胃肠外科、结直肠肛门外科行腹会阴联合直肠癌根治术的47例患者,通过一对一、面对面或视频通话的形式,对患者进行每周1次、每次30~45 min、共8次的叙事疗法;采用社会影响量表和造口适应量表评价干预前后的效果。结果出院前1 d、干预结束、干预结束后1个月,患者社会影响量表得分分别为（59.64±6.62）分、（53.87±8.78）分、（47.98±8.47）分,不同时间点病耻感差异有统计学意义（F=179.078,P<0.001）;造口适应量表得分分别为（40.49±7.13）分、（45.68±6.87）分、（46.70±7.11）分,不同时间点社会心理适应水平差异有统计学意义（校正后F=75.295,P<0.001）。结论叙事疗法有助于降低永久性肠造口患者的病耻感并提高其社会心理适应水平。

关键词: 直肠肿瘤, 肠造口术, 病耻感, 叙事疗法, 社会适应, 心理护理

Abstract:

Objective To explore the effects of narrative therapy on stigma in permanent stoma patients. Methods A total of 47 patients with permanent stoma were recruited from April 2018 to November 2018 in the department of gastroenterology and colorectal surgery,and were given narrative therapy：totally 8 times,30 to 45 mins for each time,once per week,through one-on-one,face-to-face or video call. Social Impact Scale（SIS） and Ostomy Adjustment Inventory-20 were used to evaluate the effects of intervention. Results At the times of one day before discharge,after intervention and one month after intervention,the scores of SIS were 59.64±6.62,53.87±8.78,and 47.98±8.47,the time effect of stigma level in permanent stoma patients were statistically significant,F=179.078,P<0.001. The scores of OAI-20 were 40.49±7.13,45.68±6.87,and 46.70±7.11,and the differences were statistically significant,F=75.295,P<0.001. Conclusion Narrative therapy can reduce the stigma level in permanent stoma patients and improve the level of psycho-social adaptation.

Key words: Rectal Neoplasms, Enterostomy, Stigma, Narrative Therapy, Social Adjustment, PSYCHOLO-GICAL NURSING

张宽新, 屈清荣, 石佩玉, 王碧轩. 叙事疗法对永久性肠造口患者病耻感影响的研究[J]. 中华护理杂志, 2019, 54(8): 1125-1129.

ZHANG Kuanxin, QU Qing-rong, SHI Peiyu, WANG Bixuan. The effects of narrative therapy on stigma of patients with permanent stoma[J]. Chinese Journal of Nursing, 2019, 54(8): 1125-1129.

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项目		例数	百分比(％)
性别	男	27	57.4
	女	20	42.6
居住地	城镇	15	31.9
	农村	32	68.1
婚姻状况	已婚	45	95.7
	丧偶	2	4.3
文化程度	小学及以下	23	48.9
	初中	12	25.5
	高中或中专	7	14.9
	大专及以上	5	10.6
基础疾病	高血压	13	27.7
	冠心病	5	10.6
	糖尿病	5	10.6
病理分期	A期	18	38.3
	B期	6	12.8
	C期	23	48.9
化疗方案	未化疗	9	19.1
	卡培他滨+奥沙利铂	13	27.7
	奥沙利铂+氟尿嘧啶+ 左亚叶酸钙	17	36.2
	其他	8	20.0

项目		例数	百分比(％)
性别	男	27	57.4
	女	20	42.6
居住地	城镇	15	31.9
	农村	32	68.1
婚姻状况	已婚	45	95.7
	丧偶	2	4.3
文化程度	小学及以下	23	48.9
	初中	12	25.5
	高中或中专	7	14.9
	大专及以上	5	10.6
基础疾病	高血压	13	27.7
	冠心病	5	10.6
	糖尿病	5	10.6
病理分期	A期	18	38.3
	B期	6	12.8
	C期	23	48.9
化疗方案	未化疗	9	19.1
	卡培他滨+奥沙利铂	13	27.7
	奥沙利铂+氟尿嘧啶+ 左亚叶酸钙	17	36.2
	其他	8	20.0

项目	出院前1 d	干预结束时	干预结束后1个月	t₁值	P₁值	t₂值	P₂值	t₃值	P₃值
社会排斥	21.64±2.86	19.36±3.50	17.01±3.29	8.902	<0.001	8.655	<0.001	3.995	<0.001
经济不安全感	8.83±1.45	8.49±1.57	7.17±1.99	1.533	0.132	5.68	<0.001	5.574	<0.001
内在羞耻感	12.98±2.76	11.19±3.22	9.47±3.07	7.182	<0.001	9.76	<0.001	7.099	<0.001
社会隔离	16.19±2.52	14.83±3.03	13.36±3.36	4.931	<0.001	8.119	<0.001	6.346	<0.001
病耻感	59.64±6.62	53.87±8.78	47.98±8.47	10.046	<0.001	16.327	<0.001	10.596	<0.001

项目	出院前1 d	干预结束时	干预结束后1个月	t₁值	P₁值	t₂值	P₂值	t₃值	P₃值
社会排斥	21.64±2.86	19.36±3.50	17.01±3.29	8.902	<0.001	8.655	<0.001	3.995	<0.001
经济不安全感	8.83±1.45	8.49±1.57	7.17±1.99	1.533	0.132	5.68	<0.001	5.574	<0.001
内在羞耻感	12.98±2.76	11.19±3.22	9.47±3.07	7.182	<0.001	9.76	<0.001	7.099	<0.001
社会隔离	16.19±2.52	14.83±3.03	13.36±3.36	4.931	<0.001	8.119	<0.001	6.346	<0.001
病耻感	59.64±6.62	53.87±8.78	47.98±8.47	10.046	<0.001	16.327	<0.001	10.596	<0.001