Effect of ADOPT nursing mode on the herth hope index level and quality of life of aged patients with colostomy
Abstract
Objective
To investigate the status of hope and quality of life in patients with colorectal cancer. To explore the effect of ADOPT nursing model on the hope level and quality of life of patients with colostomy.
Methods导购
儿童牙疼快速止疼方法
In this study, 124 patients with colostomy after rectal cancer surgery were randomly divided into control group and experimental group, each group of 62 cas. Patients in the control group were given routine nursing care. The patients in the experimental group were treated by 6 months ADOPT nursing mode on the basis of routine nursing care by the nursing backbone after ostomy and psychological counling training. The model includes personalized guidance, patient group intervention, colostomy lf-care manual, telephone follow-up, outpatient follow-up and home visits. The two groups of patients were statistically evaluated and evaluated using the Herth hopeindex, the Quality of Life Scale, the Ost
omy Adjustment Scale, and the Ostibility Asssment Table at the first day of operation, at discharge and 6 months after discharge.
Results
1．There was no significant difference in gender, age, education, marital status, occupation, family monthly income, medical payments, religious beliefs, family relationships, living categories, clinical stage, tumor metastasis or not, due to hospitalization of two groups of patients (P>0.05).科研计划书
2．There was no statistically significant difference between the control group and the experimental group in the stomatal skin complications, stoma retraction and stomatal
mucosal paration (P>0.05). At 6 months after discharge, the skin lesions, stenosis and stoma prolap scales were significantly higher in the control group than in the control group (P <0.05).
3．There were significant differences between the two groups in the body adaptation, psychological adaptation, social adaptation for different time periods and the intervention mode (P <0.05). And there was a significant difference between the two groups in terms of total score and three adaptation(P <0.05).
南方朔
4．There was no significant difference in the level of hope index between the two groups (P>0.05). At the time of discharge, the hope levels of the two groups were improved, but the experimental group was higher than the control group (P<0.05). After 6 months of ADOPT nursing intervention, the level of hope in the experimental group was significantly higher than the control group (P <0.05).
5．There was no significant difference between the two groups in the 15 items of the quality of life asssment (P>0.05). After 6 months of nursing intervention, we found that the 14 quality of life scores in the experimental group were significantly improved, and significantly better than the control group (P<0.05). There were no significant changes in the economic difficulties between the two groups before and after the intervention. Conclusion
1．Hospitalized rectal cancer colostomy patients with low levelsof adaptation and hopepostoperative.
2．ADOPT nursing mode is conducive to improve the level of colostomy patients and reduce stomatal complications.
3．ADOPT nursing mode is conducive to improve the level of hope and quality of life of patients with colostomy.
Postgraduate student: Qixin Zhang (Nursing)
Directed by Prof. Lili Wei
Key words：Rectal cancer; Colostomy; Elderly patients; Hope level; Quality of life
目录
引言 (1)
研究对象和方法 (4)
1 研究对象 (4)
步枪结构2 研究方法 (4)
结果 (11)
1 随访及样本流失情况 (11)
2 两组直肠癌患者的一般资料 (11)
3 两组患者造口并发症比较 (13)
4 两组患者造口适应 (14)
5 两组患者希望水平 (15)
6 两组患者生活质量比较 (16)
讨论 (17)
春节感想作文结论 (22)
参考文献 (23)
综述 (25)
春节庙会综述参考文献 (34)
我会等你攻读学位期间的研究成果 (38)
附录 (39)
致谢 (50)
学位论文独创性声明、学位论文知识产权权属声明 (51)
引言
引言
直肠癌是临床常见的消化道恶性肿瘤。据世界卫生组织国际癌症研究机构统计，2010年结直肠癌在全球新发肿瘤病例中约占9.4%，并且在恶性肿瘤发病排位中为第4位[1]。而每年因结直肠癌死亡的病例约为新发病例的50%左右。地域性的分布也是直肠癌发病的一个特点，非洲、亚洲、拉丁美洲及部分欧洲地区属于直肠癌低发地区，而新加坡、匈牙利、中国香港、日本等地区则属于高发地区，并且近10年有上升趋势[2]。我国直肠癌的发病也从以往的低发病区域逐渐转为高发区域。据我国的统计资料显示，2005年全国结直肠癌的发病人数达17.2万，而死亡人数则超过一半，约为9.9万人。据上海市的直肠癌统计报告显示，1973-2005年上海地区共计有24662例直肠癌患者发病，直肠癌的发病率从以往的6.09/10万人上升到14.7/10万人，发病率呈逐渐上升趋势[3]。因此，直肠癌的预防与治疗也是临床工作的重中之重。
目前，对于直肠癌的临床治疗，腹会阴联合直肠癌根治术（Miles术）仍然是当前治疗低位直肠癌的主
要手术方式。低位结肠癌，其肿瘤位置较低、距离肛门约5-7cm，如果广泛切除将直接影响到肛门括约肌。如果肿瘤较大且具有浸润性，或骨盆狭窄使得肿瘤切除后肠道端端吻合不可能的情况下，患者则需要进行造口术。低位直肠癌的患者约占直肠癌总患者的70%。据统计，行Miles术的直肠癌患者，术后5年及10年生存率分别为58.9%和49.9%。对于早期发现的直肠癌，其行根治术后的5年生存率高达90%[4]。这些数据给我们临床治疗直肠癌带来了信心与希望。然而大约15%的直肠癌患者需要做结肠造口术。而且造口后，患者需要终身携带肠造口。据NIH统计，美国每年结肠造口的患者约为10万人，而近10年累计造口的患者高达100万人[5]。我国每年有大量新增的结肠造口患者，累计的患者同样数量众多。相关研究显示，87.32%的老年肠造口患者不能接受造口所带来的巨大变化，并且需要家属在术后早期协助进行造口的护理，存在较强的依赖性。因此，其结肠造口后的护理更是新的院外医疗问题。良好的护理能够使患者重新树立信心、适应结肠造口、提高生活质量、提高生存期。
结肠造口病人因生理的改变，自我认知也受到不同程度的影响，伴随着无助与丧失自我控制的负面情绪相继出现，此时患者心理能否平衡关系到其是否能够应对及调整造口后的生活[6]，这也是造口患者护理的目标所在。即患者在生理限制的情况下，仍然能达到较高层次的自我适应及自我照顾。患者的自我照顾能力受到知识、技能及动机相互促成的，并且也会受到个体生理、心理等内在环境的影响[7]。直肠癌患者行外科手术后，因伤口及引流导尿管等侵入性留置材料，破坏人体正常抗菌防线，导致高危性的感染问题，如果术后院内护理没有做好适当的预防措施，将使
