家庭正向行为支持方案的构建及应用研究

doi:10.3761/j.issn.0254-1769.2021.11.003

摘要/Abstract

摘要：

目的构建家庭正向行为支持（positive behavior support,PBS）方案,并探讨其在学龄前恶性肿瘤患儿情绪行为影响中的应用效果。方法以家庭系统理论为框架构建家庭PBS方案,选取2019年3月—2020年2月于重庆市某三级甲等儿童医院就诊的100例学龄前恶性肿瘤患儿为研究对象,采用随机数字表法分为试验组（n=50）和对照组（n=50）。试验组在常规护理基础上接受为期3个月的家庭PBS方案,对照组实施常规护理。比较两组干预前后家庭亲密度与适应性量表得分、养育心理灵活性问卷得分及长处与困难问卷得分。结果两组干预后长处与困难问卷得分低于干预前（均P<0.001）,家庭亲密度与适应性量表得分高于干预前（均P<0.001）;试验组干预后养育心理灵活性问卷得分高于干预前（P<0.001）;干预后试验组长处与困难问卷得分低于对照组（P<0.001）,家庭亲密度与适应性量表得分和养育心理灵活性问卷得分高于对照组（均P<0.05）。结论应用家庭PBS方案可减少学龄前恶性肿瘤患儿情绪行为问题的发生,改善家庭亲密度与适应性,提高父母养育心理灵活性。

关键词: 家庭系统理论, 正向行为支持, 恶性肿瘤, 学龄前儿童, 情绪行为问题, 儿科护理学

Abstract:

Objective To construct a family-positive behavior support programme based on Family System Theory for preschool children with malignant tumors,and to explore effects of its application. Methods From March 2019 to February 2020,100 preschool children with malignant tumors were selected and randomly allocated into an experimental group（n=50） and a control group（n=50）. The experimental group was given interventions of the family- positive behavior support,while the control group was given the routine psychological care. The scores of Family Adaptation and Cohesion Evaluation Scales Ⅱ（FACES Ⅱ）,Parental Psychological Flexibility Questionnaire（PPFQ）and Strengths and Difficulties Questionnaire（SDQ） before and after the intervention between 2 groups were compared. Results After intervention,the total scores of SDQ in the experimental group and the control group were lower than those before intervention（P<0.001）,and the total scores of FACES Ⅱ were higher than those before intervention（P<0.001）;the total score of PPFQ in the experimental group after intervention was higher than it before intervention（P<0.001）. After intervention,the total score of SDQ in the experimental group was lower than those in the control group（P<0.001）;the total scores of FACES Ⅱ and PPFQ in the experimental group were higher than those in the control group（P<0.05）. Conclusion Regardless of whether the children with malignant tumors have emotional and behavioral problems,the family-positive behavior support programme can reduce the incidence of emotional behavior problems,improve family intimacy and adaptability and parental psychological flexibility.

Key words: Family System Theory, Positive Behavior Support, Malignant Tumors, Preschool Children, Emotional and Behavioral Problems, Pediatric Nursing

潘小容, 莫霖, 刘倩, 张世群, 郭小利, 姚娟, 黄晓燕. 家庭正向行为支持方案的构建及应用研究[J]. 中华护理杂志, 2021, 56(11): 1618-1626.

PAN Xiaorong, MO Lin, LIU Qian, ZHANG Shiqun, GUO Xiaoli, YAO Juan, HUANG Xiaoyan. Construction and application of family-positive behavior support programme for preschool children with malignant tumors[J]. Chinese Journal of Nursing, 2021, 56(11): 1618-1626.

图/表 4

表1 家庭正向行为支持方案具体内容

Table 1 Specific content of family positive behavior support program

表2 两组一般资料比较[例（百分比,%）]

Table 2 Sociodemographic characteristics of the participants[example （percentage,%）]

表3 干预前后两组有情绪行为问题患儿的长处与困难问卷、养育心理灵活性问卷和家庭亲密度与适应性量表得分比较（分,$\bar{x}$±s）

Table 1 Comparison of the total scores of SDQ、PPFQ and FACES Ⅱ in children with emotional behavior problems by treatment groups and protocol phases（socres,$\bar{x}$±s）

表4 干预前后两组无情绪行为问题患儿的长处与困难问卷、养育心理灵活性问卷和家庭亲密度与适应性量表得分比较（分,$\bar{x}$±s）

Table 4 Comparison of the total scores of SDQ、PPFQ and FACES Ⅱ in children without emotional behavior problems by treatment groups and protocol phases（socres,$\bar{x}$±s）

参考文献 32

[1]	GBD Childhood Cancer Collaborators. The global burden of childhood and adolescent cancer in 2017:an analysis of the global burden of disease study 2017[J]. Lancet Oncol, 2019, 20(9):1211-1225. DOI URL
[2]	周艳玲, 安嘉璐, 田玲. 我国儿童恶性肿瘤的流行病学分析[J]. 中国当代儿科杂志, 2015, 17(7):649-654.
	Zhou YL, An JL, Tian L. Epidemiological analysis of childhood cancer in China[J]. Chin J Contemp Pediatr, 2015, 17(7):649-654.
[3]	Howlader N, Noone AM, Krapcho M, et al. Previous version:SEER cancer statistics review, 1975-2010[EB/OL]. (2013-06-14)[2019-07-31]. https://seer.cancer.gov/archive/csr/1975_2010/ .
[4]	孙玉倩, 孙秉赋, 温颖娜, 等. 恶性肿瘤患儿心理行为问题及家庭功能特征研究[J]. 中华行为医学与脑科学杂志[J]. 2013, 22(6):526-528.
	Sun YQ, Sun BF, Wen YN, et al. Study on the features of psychosocial behavioural problems and family function of child with cancer[J]. Chin J Behav Med Brain Sci, 2013, 22(6):526-528.
[5]	廖婧, 周雪贞, 卜秀青, 等. 恶性肿瘤患儿诱导化疗期的症状群研究[J]. 中国护理管理, 2018, 18(5):622-626.
	Liao J, Zhou XZ, Bu XQ, et al. Symptom clusters during induction chemotherapy in children with malignant tumor[J]. Chin Nurs Manag, 2018, 18(5):622-626.
[6]	Wiener L, Devine KA, Thompson AL. Advances in pediatric psychooncology[J]. Curr Opin Pediatr, 2020, 32(1):41-47. DOI PMID
[7]	牛霞, 吴徳, 杨娅娟, 等. 家庭环境对脑瘫患儿家长心理稳态影响的病例对照研究[J]. 中国康复医学杂志, 2018, 33(4):429-435.
	Niu X, Wu D, Yang YJ, et al. Effects of family environment on psychological status of caregivers of children with cerebral palsy:a case-control study[J]. Chin J Rehabil Med, 2018, 33(4):429-435.
[8]	Moraes LJ, Miranda MB, Loures LF, et al. A systematic review of psychoneuroimmunology-based interventions[J]. Psychol Health Med, 2018, 23(6):635-652. DOI PMID
[9]	王媛, 王鹏, 张姗红, 等. 注意缺陷多动障碍儿童的父母养育方式与情绪问题的关系[J]. 中国心理卫生杂志, 2019, 33(8):607-611.
	Wang Y, Wang P, Zhang SH, et al. Relationship between emotional problems and parenting styles in children with attention-deficit/hyperactivity disorder[J]. Chin Ment Heal J, 2019, 33(8):607-611.
[10]	Combrinck-Graham L. Developments in family systems theory and research[J]. J Am Acad Child Adolesc Psychiatry, 1990, 29(4):501-512.
[11]	Sangly FE. Contemporary family sociology[M]. Fang Xuan trans. Tianjin: Tianjin People’s Publishing House, 2012:13-19.
[12]	任晓丽, 钟士恩, 黄佩红, 等. 基于家庭系统理论的亲子旅游动机测量研究:以南京市红山森林动物园为例[J]. 人文地理, 2019, 34(2):152-160.
	Ren XL, Zhong SE, Huang PH, et al. Measurement research of parent-child tourist motivations based on the theory of family system:an example of Nanjing Hongshan forest zoo[J]. Hum Geogr, 2019, 34(2):152-160.
[13]	MacDonald A. Handbook of evidence-based practices in intellectual and developmental disabilities[EB/OL]. (2016)[2021-04-04]. https://link.springer.com/book/10.1007%2F978-3-319-26583-4 .
[14]	卢祖琴, 黄晓靖. 积极行为支持干预智障儿童课堂干扰行为的成效[J]. 教育教学论坛, 2020(48):144-146.
	Lu ZQ, Huang XJ. Effectiveness of the intervention study on disruptive classroom behavior of intellectual disability child with positive behavior support[J]. Educ Teach Forum, 2020(48):144-146.
[15]	Nylén K, Karlberg M, Klang N, et al. Knowledge and will:an explorative study on the implementation of school-wide positive behavior support in Sweden[J]. Front Psychol, 2021, 12:618099. DOI PMID
[16]	潘小容, 莫霖, 刘倩, 等. 学龄前恶性肿瘤患儿意志控制在家庭环境与情绪行为间的中介效应[J]. 中华行为医学与脑科学杂志, 2020, 29(7):629-634.
	Pan XR, Mo L, Liu Q, et al. Mediating effect of children’s effortful control on correlation between home environment and mental and behavioral problems among preschool children with malignant tumors[J]. Chin J Behav Med Brain Sci, 2020, 29(7):629-634.
[17]	Montgomery DC. 试验设计与分析(第6版)[M]. 傅钰生,张健,王振宇译. 北京: 人民邮电出版社, 2009.
	Montgomery DC. Design and analysis of experiments[M]. 6th ed.Fu YS, Zhang J,Wang ZY trans. Beijing: People’s Posts and Telecommunications Press, 2009.
[18]	寇建华, 杜亚松, 夏黎明. 儿童长处和困难问卷(父母版)上海常模的信度和效度[J]. 上海精神医学, 2005, 17(1):25-28.
	Kou JH, Du YS, Xia LM. Reliability and validity of “children strengths and difficulties questionnaire” in Shanghai norm[J]. Shanghai Arch Psychiatry, 2005, 17(1):25-28.
[19]	汤静燕, 李志光. 儿童肿瘤诊断治疗学[M]. 北京: 人民军医出版社, 2011.
	Tang JY, Li ZG. Children’s tumor diagnosis and therapy[M]. Beijing: Peoples’ Military Medical Press, 2011.
[20]	Singh NN, Lancioni GE, Karazsia BT, et al. Effects of mindfulness-based positive behavior support(MBPBS) training are equally beneficial for mothers and their children with autism spectrum disorder or with intellectual disabilities[J]. Front Psychol, 2019, 10:385. DOI URL
[21]	费立鹏, 沈其杰, 郑延平, 等. “家庭亲密度和适应性量表”和“家庭环境量表”的初步评价:正常家庭与精神分裂症家庭成员对照研究[J]. 中国心理卫生杂志, 1991, 5(5):198-202,238.
	Fei LP, Shen QJ, Zheng YP, et al. Preliminary evaluation of Chinese version of FACES Ⅱ and FES:comparison of normal families and families of schizophrenic patients[J]. Chin Ment Heal J, 1991, 5(5):198-202,238.
[22]	李志红, 杨林华, 朱丽莎, 等. 父母养育心理灵活性问卷中文版的信效度初步研究[J]. 中国心理卫生杂志, 2018, 32(2):166-173.
	Li ZH, Yang LH, Zhu LS, et al. A preliminary study of validity and reliability of the Chinese version of the Parental Psychological Flexibility Questionnaire[J]. Chin Ment Heal J, 2018, 32(2):166-173.
[23]	徐耿, 宫相君, 朱子清, 等. 学龄前儿童睡眠障碍在儿童行为情绪问题与父母教养方式间中介效应[J]. 中国公共卫生, 2020, 36(8):1143-1146.
	Xu G, Gong XJ, Zhu ZQ, et al. Mediating effect of sleep disorders on correlation between behavioral/emotional problem and parenting style among preschool children[J]. Chin J Public Heal, 2020, 36(8):1143-1146.
[24]	韩赛, 任永霞, 刘旭垚, 等. 童趣化情境认知干预在眼科学龄期全麻手术患儿中的应用[J]. 中华护理杂志, 2021, 56(4):539-544.
	Han S, Ren YX, Liu XY, et al. Application research of playful situational cognitive intervention in school-aged children un-dergoing ophthalmic surgeries with general anesthesia[J]. Chin J Nurs, 2021, 56(4):539-544.
[25]	冯哲, 崔梓天, 黄敏施, 等. 家长行为管理技能小组训练治疗学龄前儿童外化性行为问题研究[J]. 中国实用儿科杂志, 2018, 33(7):538-541.
	Feng Z, Cui ZT, Huang MS, et al. Parent behavioral management skills group training to treat preschoolers’ externalizing problem behaviors[J]. Chin J Pract Pediatr, 2018, 33(7):538-541.
[26]	Rogers SJ, Estes A, Vismara L, et al. Enhancing low-intensity coaching in parent implemented early start Denver model intervention for early autism:a randomized comparison treatment trial[J]. J Autism Dev Disord, 2019, 49(2):632-646. DOI PMID
[27]	林楠, 罗业涛, 蒋小平, 等. 重庆地区白血病患儿家庭管理影响因素的结构方程模型分析[J]. 解放军护理杂志, 2018, 35(24):1-5.
	Lin N, Luo YT, Jiang XP, et al. Influence factors of family management in children with leukemia in Chongqing:a structural equation modeling analysis[J]. Nurs J Chin PLA, 2018, 35(24):1-5.
[28]	姚娟, 莫霖, 郭小利, 等. 互联网+多元联动模式在恶性肿瘤患儿PICC居家延续性护理中的应用[J]. 中华护理杂志, 2020, 55(5):756-761.
	Yao J, Mo L, Guo XL, et al. Application of internet plus multiple linkage on home-based continuous nursing care for PICC in children with malignant tumor[J]. Chin J Nurs, 2020, 55(5):756-761.
[29]	吴岩, 林桐, 李文, 等. 上海市新入幼儿园儿童亲子互动水平与儿童早期发展横断面调查[J]. 中国循证儿科杂志, 2020, 15(6):406-410.
	Wu Y, Lin T, Li W, et al. Parent-child interaction and early childhood development of newly enrolled preschoolers in Shanghai kindergartens:a cross-sectional survey[J]. Chin J Evid-Based Pediatr, 2020, 15(6):406-410.
[30]	缪华灵, 郭成, 王亭月, 等. 新冠肺炎疫情下留守儿童社会适应水平及其与家庭亲密度的关系:心理素质的中介作用[J]. 西南大学学报(自然科学版), 2021, 43(1):31-38.
	Miao HL, Guo C, Wang TY, et al. Social adaptation of left-behind children and its relationship with family cohesion during the COVID-19 epidemic:the mediating role of psychological suzhi[J]. J Southwest Univ Nat Sci Ed, 2021, 43(1):31-38.
[31]	Brassell AA, Rosenberg E, Parent J, et al. Parent’s psychological flexibility:associations with parenting and child psychosocial well-being[J]. J Context Behav Sci, 2016, 5(2):111-120. DOI URL
[32]	Coyne LW, Gould ER, Grimaldi M, et al. First things first:parent psychological flexibility and self-compassion during COVID-19[J]. Behav Anal Pract, 2020:1-7.