發(fā)布時間：2018-01-09 04:21

  本文關鍵詞：慢性阻塞性肺疾病患者希望水平的現(xiàn)況調查及干預研究　出處：《廣西醫(yī)科大學》2017年碩士論文　論文類型：學位論文

  更多相關文章： 慢性阻塞性肺疾病 希望水平 生活質量 自我效能 照顧者 干預

【摘要】：目的了解慢性阻塞性肺疾病(Chronic obstructive pulmonary disease,COPD)患者的希望水平現(xiàn)狀,明確患者希望水平與生活質量、照顧者希望水平的關系以及影響患者希望水平的因素;通過與COPD患者進行半結構式深度訪談進一步剖析其內心的希望體驗;探索能有效提高我國COPD患者希望水平與自我效能的綜合護理干預模式。方法本研究包含調查、質性和干預研究三個部分。(1)調查研究:通過便利抽樣選取2015年6月到2016年4月在廣西醫(yī)科大學第一附屬醫(yī)院東院和西院呼吸內科住院的COPD患者及其家庭照顧者118對,共336例作為研究對象。采用一般資料調查表、Herth希望指數(shù)量表、COPD評估測試問卷分別評估患者的一般情況、希望水平、生活質量和照顧者的一般情況、希望水平。分析COPD患者的希望水平與自身生活質量、照顧者希望水平之間的關系;通過多元逐步回歸法分析影響COPD患者希望水平的因素。(2)質性研究:采用目的抽樣法,在參與第一部分問卷調查的患者中選取16例有代表性的作為研究對象,通過半結構式深度訪談探討患者內心的希望體驗。(3)干預研究:選擇2016年5月到2017年1月期間在廣西醫(yī)科大學第一附屬醫(yī)院東院呼吸內科一、二病區(qū)住院,同時符合納入和排除標準的COPD患者各30例作為研究對象。二病區(qū)的患者為對照組,給予常規(guī)護理;一病區(qū)的患者為干預組,在常規(guī)護理的基礎上增加綜合護理干預。干預前以及干預6周后應用Herth希望指數(shù)量表和COPD自我效能量表分別對兩組患者進行測評,比較評估結果,評價綜合護理干預模式對提高我國COPD患者希望水平與自我效能的效果。結果(1)118例COPD患者希望水平總分為(33.69±4.66)分,其中64.4%的患者處于中等希望水平,35.6%的患者處于高等希望水平;COPD患者的生活質量總分為(22.68±5.60)分,照顧者希望水平得分(35.03±4.41)分;進行Pearson相關分析,發(fā)現(xiàn)COPD患者的希望水平總分與其生活質量得分呈顯著負相關,與照顧者希望水平總分及各維度得分呈顯著正相關;多元逐步回歸分析結果顯示:患者的生活質量、文化程度、是否在職、婚姻狀況、醫(yī)療付費方式和照顧者的希望水平6個因素進入回歸方程,共同解釋了患者希望水平總變異的55.6%。(2)通過應用Colaizzi 7步分析法聯(lián)合Nvivo8.0軟件整理分析訪談資料,研究者最后歸納出4個主要的主題:(1)對希望的理解:希望是對未來生活的向往、希望是活好當下、希望是努力治療;(2)阻礙希望的因素:身體不適感強烈、對疾病認知不足、負性情緒、家庭不和睦、治療效果不佳,害怕疾病復發(fā);(3)促進希望的因素:病情好轉、外在支持、內在目標;(4)希望促使患者付出行動—改變現(xiàn)狀:改變不良習慣、主動學習。(3)實施干預前,干預組和對照組患者的希望水平與自我效能得分比較差異無顯著性(P0.05);進行綜合護理干預以后,兩組患者的希望水平與自我效能得分比較差異具有顯著性(P0.05);在干預前后干預組患者的希望水平與自我效能得分比較具有明顯差異(P0.05)。結論(1)COPD患者處于中等至高等希望水平,生活質量受到較嚴重影響,COPD患者家庭照顧者的希望水平亦處于中等至高等。(2)多種因素能夠影響COPD患者的希望水平,其中生活質量、文化程度、是否在職、婚姻狀況、醫(yī)療付費方式和照顧者希望水平6個因素是其主要影響因素。(3)通過深度訪談,揭示了COPD患者對希望的理解、促進希望的因素、阻礙希望的因素、希望能夠促使患者付出行動—改變現(xiàn)狀。研究結果較好地闡釋了COPD患者保持中高希望水平的原因。能幫助醫(yī)護人員更好地了解患者的需求,為下一步針對關鍵影響因素制定干預措施提供了科學依據(jù)。提高COPD患者的希望水平,對維持其身心健康具有重要意義。(4)綜合護理干預模式能有效提高我國COPD患者的希望水平與自我效能。
[Abstract]:Objective to investigate the chronic obstructive pulmonary disease (Chronic obstructive pulmonary disease, COPD) of hope level of patients, patients with clear level of hope and quality of life, caregivers hope level and their hope level factors; through semi-structured interviews with COPD patients and analyze the inner to explore the effective experience; I want to improve in patients with COPD and the level of comprehensive nursing intervention self-efficacy model. This study contains three parts of qualitative investigation and intervention research. (1) research: by convenience sampling from June 2015 to April 2016 in the First Affiliated Hospital of Guangxi Medical University COPD patients hospitalized and Eastern Hospital Respiratory Medicine West Hospital and family care on the 118, a total of 336 cases as the research object. The general information questionnaire, Herth hope index scale, COPD assessment test respectively. In general, patients hope level, in general, the quality of life and the caregiver's level of hope. The hope level analysis of COPD patients and their caregivers to quality of life, the relationship between levels; by multivariate analysis the factors influence the hope level of patients with COPD stepwise regression method. (2): Qualitative study using purposive sampling in the first part, a questionnaire survey of patients with 16 cases selected representative as the research object, through semi-structured depth interviews to explore the patients of hope inside experience. (3) intervention study: May 2016 to January 2017 in the First Affiliated Hospital of Guangxi Medical University, Eastern Hospital wards, two, at the same time, in accordance with the inclusion and the exclusion criteria of COPD of the 30 cases of patients as the research object. In two patients as control group, were given routine nursing care; ward of the patients in routine care intervention group. Comprehensive nursing intervention based on the intervention. Before and 6 weeks after intervention by Herth hope index scale and COPD self efficacy scale were used to test two groups of patients, compare the evaluation results, the evaluation of comprehensive nursing intervention mode in China to improve the hope level of patients with COPD and self efficacy. Results 118 cases of COPD (1) the hope level of patients with total score (33.69 + 4.66), 64.4% of them were at the middle level of hope, 35.6% of patients in a higher level of hope; the scores of quality of life for patients with COPD (22.68 + 5.60), caregiver level of hope score (35.03 + 4.41); Pearson correlation analysis, found that patients with COPD hope is negatively related to the total score and life quality score was positively related to the level of the score and caregiver hope; multiple stepwise regression analysis showed that the quality of life of the patients, the degree of culture, Whether the job, marital status, medical billing and caregiver to level 6 factors into the regression equation, the common interpretation of the hope level of patients with the total variation of 55.6%. (2) by using Colaizzi 7 step method combined with Nvivo8.0 software analysis of the interview data, researchers finally summed up 4 main themes: (1) I hope to understand: hope is longing for the future life, hope is to live in the moment, the hope is to treatment; (2) factors that hinder the hope: physical discomfort, lack of knowledge about the disease, negative emotions, family harmony, poor treatment, fear of recurrence of the disease; (3) promote hope the factors: the condition improved, external support, intrinsic goals; (4) to the patients with action - Change: change the bad habits, active learning. (3) before the intervention, the score intervention group and the control group patients the level of hope and self-efficacy are relatively poor Had no significant difference (P0.05); after the intervention, the score of the two groups of patients the level of hope and self-efficacy significantly (P0.05); in the intervention group score of hope level and self efficacy compared with the significant difference (P0.05). Conclusion (1) COPD in patients with moderate to high I hope the level of quality of life have been seriously affected, the family caregivers of patients with COPD is also in the middle to high level of hope. (2) a variety of factors which can affect the COPD patients in the hope level, including the quality of life, culture degree, whether the job, marital status, medical billing and caregiver hope level 6 factors are the factors the main effect (3). Through in-depth interviews, reveals COPD patients hope for understanding, hope promoting factors, factors that hinder the hope, hope can make the patients pay action to change the status quo. Good results Explanation of the COPD patients maintain a high level of hope. The reason can help medical staff to better understand the needs of patients, to provide a scientific basis for the next step for the key factors to improve the intervention measures. Patients with COPD level of hope, health is of great significance for the maintenance of the body and mind. (4) the comprehensive nursing intervention mode can effectively improve the patients with COPD in our country the level of hope and self-efficacy.

【學位授予單位】：廣西醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R473.5

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