肿瘤患者PICC留置期间自我护理能力探究

　　中文摘要

　　目的了解肿瘤患者PICC留置期间自我护理能力情况,探讨人口学、健康促进行为、心理一致感、抑郁及社会支持对肿瘤患者PICC留置期间自我护理能力的影响,为有针对性的提高肿瘤患者PICC留置期间自我护理能力制定相应的干预措施提供一定理论依据。

　　方法采用方便取样法。2013年5月--11月对山东省某三级甲等医院PICC门诊及住院部符合纳入标准的130例患者进行调查。研究采用问卷调查法,以自填形式完成,研究内容包括六部分:一般资料调查表、自我护理能力量表、健康促进生活方式量表、心理一致感量表、抑郁自评量表及社会支持量表。采用SPSS18.0统计软件包进行统计分析。统计方法包括统计描述、方差分析、Pearson相关分析及多元线性回归分析。

　　结果共发放调查表130份,全部回收,有效回收率100%,具体结果如下:

　　1.肿瘤患者PICC留置期间自我护理能力得分为113.08±11.63分,54.6%的患者自我护理能力水平处于高等水平,除自我护理技能和健康知识水平维度得分有低等水平者外,其他维度得分均在中等水平及以上。各维度平均得分由高到低依次为健康责任感4.00±3.95分、自我概念3.23±0.45分、健康知识2.03±0.39分、自我护理技能1.61±0.41分。

　　2.肿瘤患者PICC留置期间健康促进行为总分135.72±15.69分,平均分2.61±0.30分;各维度平均得分由高到低依次为自我实现2.85±0.36分、应对压力2.78±0.45分、人际支持2.73±0.39分、营养2.65士0.39分、健康责任2.40±0.36分、运动锻炼 2.02±0.38 分。

　　3.肿瘤患者PICC留置期间心理一致感总分50.00±6.69分,平均分3,84士0.51分,三个维度平均分由高到低依次为意义感4.09±0.62分、处理或管理能力3.78±0.82 分、理解能力 3.70±0.66 分。

　　4.肿瘤患者PICC留置期间抑郁标准分为47.48±6.11分,高于国内常模33.46±8.55分(PC0.01)。抑郁发生率为29.2%,其中轻度抑郁为27.7% (36例),中度抑郁为1.5% (2例)。

　　5.肿瘤患者PICC留置期间社会支持总分37.93±7.40分,83.9%的患者社会支持水平在中等水平,仅有16.2%的患者社会支持达到高等水平。

　　6.单因素方差分析结果显示,不同性别、居住地、文化程度、职业、月收入、医疗付费方式、宗教信仰、子女个数、导管留置时间、是否出现并发症及KPS评分分组之间肿瘤患者PICC留置期间自我护理能力差异有统计学意义,不同年龄、婚姻状况、居住方式、置管次数、穿刺时机、穿刺部位及穿刺位置间自我护理能力差异无统计学意义。

　　7.Pearson相关分析显示,健康促进行为总分及各个维度与自我护理能力呈正相关(P<0.05),心理一致感总分、理解能力及处理或管理能力与自我护理能力呈正相关(尸<0.01),抑郁与自我护理能力不相关,但与自我护理技能呈负相关(P<0.05),社会支持总分、主观支持及支持利用度与自我护理呈正相关(P< 0_05)。

　　8.多元逐步分析结果显示:营养、心理一致感、居住地、支持利用度及宗教信仰,共能解释患者自我护理能力变异量的58.3%。

　　结论

　　1.肿瘤患者PICC留置期间自我护理能力与性别、居住地、文化程度、职业、月收入、医疗付费方式、宗教信仰、子女个数、导管留置时间、是否出现并发症及KPS评分显着相关。

　　2.肿瘤患者PICC留置期间自我护理能力处于高等水平,其中自我护理技能和健康知识得分水平相对较低,影响其自我护理能力的因素包括营养、心理一致感、居住地、支持利用度及宗教信仰。

　　关键词:自我护理能力;肿瘤;PICC;患者

　　ABSTRACT

　　Objective To understand the current situation of the self-care agency, healthpromotion behavior(HPB), sense of coherence(SOC),depression and social support incancer patients with PICC-line, to explore the influence of basic personal informationon self-care agency in cancer patients with PICC-line ; further analysis the influenceof health promotion behavior, psychological alignment, depression and social supporton self-care agency; thus to provide theoretical reference for improvement self-careagency in cancer patients with PICC-line.

　　Methods Convenience sampling was used.A total of 130 patients with PICC-linewere recruited randomly in class 3-A general hospitals in Shandong Province fromMay to November 2013.We used questionnaire packages included six parts: generalinformation questionnaire, Exercise of Self-Care Agency Scale, Health-Promoting LifestyleProfile II,Sense of Coherence Scale, Self-rating Depression Scale, Social SupportRating Scale.Using SPSS 18.0 statistical package for statistical analysis. Descriptiveanalysis, analysis of variance, Pearson correlation analysis and multiple linearregression analysis were performed to analyze the basic information5self-care agency,health promotion behavior, sense of coherence, depression and social support.

　　Results A total of 130 questionnaires were distributed,full recovery, effective ratewas 100o/o,detailed information was as follows:

　　1.Thetotal self-care agency score of tumor patients with PICC-line was 113.08士 11.63,54.6% of the patients self care agency at higher levels,in addition to the self careskills and health knowledge level dimension scores of those who have a low levels ,the other dimension scores are in medium level and above. The entries average ofeach dimension were health responsibility 4.00士3.95, self concept 3.23±0.45,thehealth knowledge level 2.03士0.39,self-care skills 1.61±0.41.

　　2.Thetotal HPB score of tumor patients with PICC-line was 135.72士 15.69,and theentries average score was 2.61 土0.30.The entries average of each dimension werespiritual growth 2.85±0.36,stress management 2.78士0.45,interpersonal relations2.73士0.39, nutrition 2.65士0.39,health responsibility 2.40土0.36,physical activity2.02 土 0.38.

　　3.Thetotal SOC score of tumor patients with PICC-line was 50.00士6.69, and theentries average score was 3.84土0.51. The entries average of each dimension weremeaningfulness 4.09±0.62, manageability 3.78土0.82,comprehensibility 3.70士0.66.

　　4.Thetotal SDS score of tumor patients with PICC-line was 47,48士6.11, higher thandomestic norm 33.46士8.55 (P < 0.01). The incidence of depression was 29.2%, milddepression in 36 cases (27.7%), moderate depression 2 cases (1.5%).

　　5.Thetotal SSRS score of tumor patients with PICC-line was 37.93士7.40,83.9% ofpatients social support level in the medium level, only 16.2% of patients socialsupport to achieve higher level.

　　6.Theone-way analysis of variance results show,there were statistical differences ofself-care agency in different characteristics of social demography and disease ofcancer patients with PICC-line,those were different sex,place of residence,educationbackground,occupation,income,medical payment,religion?the number ofchildren,catheter indwelling time,complications7and KPS score;there were notstatistical differences of self-care agency in different age,marital status,livingpattem?the number of tube,puncture time,insertion locationand site of insertion.

　　7.ThePearson correlation analysis results show,the total score and the average scoreof each dimension of HPB was positively correlated (P < 0.05 ) ;self-care agency wasmoderate positive correlated with the total score of SOC, comprehensibility andmanageability (P < 0.01) ;depression was not correlated with the total score ofself-care agency, but low negatively related to nursing skill and health knowledge {P< 0.05);social support, subjective support and support utilization degree and self-careangency was low to moderate positive correlation (P < 0.05).

　　8.Multiple stepwise analysis results showed that nutrition,SOC,place of residence,support utilization degree and religious beliefs, can explain 58.3% of the patientsself-care agency variance.

　　Conclusion1.Cancerpatients during the PICC-line self-care ability has a significantly correlationwith gender,place of residence,education, occupation, income,religion,medicalpayment method, the number of children, catheter indwelling time,complications andKPS score.

　　2.Cancerpatients during the PICC-line self-care ability at higher levels, the variousdimensions of self nursing skill and health knowledge is relatively low. Nutrition,SOC, place of residence, supported the use of degrees and religious beliefs are themain factors that influence the tumor patients self-care ability.

　　Keywords: self-care agency; tumor; PICC; patients

 

　　目录

　　中文摘要

　　Abstract

　　第一章 前言

　　第二章文献回顾

　　1.肿瘤发生状况

　　2.PICC杂概述

　　3.自我护理能力

　　第三章研究对象与方法

　　2研究工具

　　3.数据收集

　　4.数据处理

　　5.质量控制

　　6.伦理问题

　　第四章研究结果

　　1.研究对象的一般资料

　　2.肿瘤患者PICC留置期间健康促进行为分析

　　3.肿瘤患者PICC留置期间心理一致感分析

　　4.肿瘤患者PICC留置期间抑郁分析

　　5.肿瘤患者PICC留置期间社会支持分析

　　6.肿瘤患者PICC留置期间自我护理能力分析

　　第五章讨论

　　1.肿瘤患者PICC留置期间健康促进行为

　　2.肿瘤患者PICC留置期间心理一致感

　　3.肿瘤患者PICC留置期间抑郁

　　4.肿瘤患者PICC留置期间社会支持

　　5.肿瘤患者PICC留置期间自我护理能力及影响因素

　　第六章

　　1.研究结论

　　2.研究建议

　　3.研究局限性

　　参考文献

　　致谢