乳腺癌根治术患者康复需求与一般自我效能感的调查研究
摘要
满足病人的需求是护理工作的根本目标,更是护理可持续发展的基础,伴随着人们生活水平的不断提高,患者的需求从内容和形式上都出现了多样化的局面。特别是乳腺癌患者,不仅要经受一般癌症患者的各种不适应情绪和行为反应,如愤怒、焦虑、抑郁、悲伤、恐惧等,还要受到因手术导致乳房缺失所带来的严重影响,如自我形象的严重改变、对家庭婚姻的担心、对自身价值的否定等。因此,患者不仅需要高超的医术、优良的服务、舒适的环境,更需要得到心理、生活、教育等多方面的综合服务。研究乳腺癌根治术患者康复需求的具体内容,可以为临床工作更好的满足患者需求,提高护理服务质量,提供依据和借鉴。
自我效能感,作为自我意识的一部分,也称自我能力的有效感,是指人们成功地实施和完成某个行为目标或应付某种困难情境所具有的信念,只有个体相信自己具备完成某项任务的能力时,才会积极的付出努力并克服困难完成既定的计划和目标。乳腺癌根治术患者在住院期间自我效能感的高低直接影响着患者在治疗、护理、康复过程中与医护人员的配合程度以及术后对自身疾病的康复信念。因此,了解乳腺癌根治术患者的自我效能感水平,为临床工作在康复护理的过程中,渗透自我效能感理论,提高患者的康复信念和执行能力,具有重要的意义。
Objective:
Investigation the rehabilitation needs and general level of self-efficacy of patients with radical mastectomy during the hospital, in order to provide theoretical basis for clinical work to promote better patient health, meet the needs of patients,to achieve a comprehensive rehabilitation and healthy return to society.
Methods:
A total of 200 breast cancer with radical mastectomy are selected from 4 hospitals of Jilin province. Survey must meet the following criteria:①long-established residents of Jilin Province ;②30-65 years old;③pathologically confirmed breast cancer, the patients with radical surgery in parallel;④be able to fill the questionnaire;⑤intellectual or cognitive function in normal people.
The rehabilitation needs are assessed by using a self-designed investigation questionnaire. It contains physiology needs,N1、society needs,N3、self-respect needs,N4、self-realization needs,N5、Information needs,N6、Aesthetic needs,N7,totalled 46 items.This questionnaire has good reliability and validity. GSES is one-dimensional scale, 10 divided by the sum of 10 items is the total scale score , range of 1-4. the middle of the standard is 2.5 points, 2.5 points lower than the scores show that the subjects of self-efficacy at a low level, the higher the test scores indicate higher self-efficacy.
The statistics methods used includes chi-square test、ANOVA、step linear regression、correlation analysis,and so on.
Results:
1、Analyzation of rehabilitation needs for breast cancer with radical mastectomy.(1)the needs of information,receiving care and social identity ,physical function, sexual education,are demanded by patients much higher. In addition to, as the same as other patients, the breast cancers have these needs: staff skill levels, attitude of nurse, environment of hospital. (2) In seven different aspects of needs, the highest demand is the information needs, an average score is 38.18 points. Demand for the lowest degree is self-actualization needs ,with the average score of 12.04 points.(3)the major factors of rehabilitation needs are Occupation, education level, sources of hospital cost, state of mind, self-care ability, hospitalization frequency, recurrence and metastasis after radical mastectomy for breast cancer.
2、General level of self-efficacy. (1)Through the investigation , the radical mastectomy for breast cancer patients with the level of general self-efficacy is generally low, an average score 2.19 points.(2) Education level, mental state, the number of hospitalization, postoperative recurrence are the main factors of general self-efficacy in breast cancer patients .Among these influences, higher education, better mental state, patients with higher levels of self-efficacy; patients with the number of hospitalized more than three times have the higher level of self-efficacy than the initial patients.Local recurrence in patients with lowest levels of self-efficacy.(3)Self-efficacy have a positive correlation with self-esteem needs, self-fulfillment needs and aesthetic needs.
Conclusions:
1、Radical mastectomy for breast cancer patients have a wide range of needs during hospitalization. Different personal characteristics, there is great difference demands.
2、Occupation, education level, mental state, the relationship with her husband, hospitalization frequency, self-care ability, the source of hospital fees, whether the recurrence and metastasis after radical mastectomy are most import influences for breast cancer patients.
3、The second, lower self-efficacy bate the confidence of patients.nurses should pay attention to the level of self-efficacy in patients and take a scientific and effective methods to improve the level of self-efficacy in patients.
4、Self-efficacy have a positive correlation with self-esteem needs, self-fulfillment needs and aesthetic needs.
自我效能感,作为自我意识的一部分,也称自我能力的有效感,是指人们成功地实施和完成某个行为目标或应付某种困难情境所具有的信念,只有个体相信自己具备完成某项任务的能力时,才会积极的付出努力并克服困难完成既定的计划和目标。乳腺癌根治术患者在住院期间自我效能感的高低直接影响着患者在治疗、护理、康复过程中与医护人员的配合程度以及术后对自身疾病的康复信念。因此,了解乳腺癌根治术患者的自我效能感水平,为临床工作在康复护理的过程中,渗透自我效能感理论,提高患者的康复信念和执行能力,具有重要的意义。
Objective:
Investigation the rehabilitation needs and general level of self-efficacy of patients with radical mastectomy during the hospital, in order to provide theoretical basis for clinical work to promote better patient health, meet the needs of patients,to achieve a comprehensive rehabilitation and healthy return to society.
Methods:
A total of 200 breast cancer with radical mastectomy are selected from 4 hospitals of Jilin province. Survey must meet the following criteria:①long-established residents of Jilin Province ;②30-65 years old;③pathologically confirmed breast cancer, the patients with radical surgery in parallel;④be able to fill the questionnaire;⑤intellectual or cognitive function in normal people.
The rehabilitation needs are assessed by using a self-designed investigation questionnaire. It contains physiology needs,N1、society needs,N3、self-respect needs,N4、self-realization needs,N5、Information needs,N6、Aesthetic needs,N7,totalled 46 items.This questionnaire has good reliability and validity. GSES is one-dimensional scale, 10 divided by the sum of 10 items is the total scale score , range of 1-4. the middle of the standard is 2.5 points, 2.5 points lower than the scores show that the subjects of self-efficacy at a low level, the higher the test scores indicate higher self-efficacy.
The statistics methods used includes chi-square test、ANOVA、step linear regression、correlation analysis,and so on.
Results:
1、Analyzation of rehabilitation needs for breast cancer with radical mastectomy.(1)the needs of information,receiving care and social identity ,physical function, sexual education,are demanded by patients much higher. In addition to, as the same as other patients, the breast cancers have these needs: staff skill levels, attitude of nurse, environment of hospital. (2) In seven different aspects of needs, the highest demand is the information needs, an average score is 38.18 points. Demand for the lowest degree is self-actualization needs ,with the average score of 12.04 points.(3)the major factors of rehabilitation needs are Occupation, education level, sources of hospital cost, state of mind, self-care ability, hospitalization frequency, recurrence and metastasis after radical mastectomy for breast cancer.
2、General level of self-efficacy. (1)Through the investigation , the radical mastectomy for breast cancer patients with the level of general self-efficacy is generally low, an average score 2.19 points.(2) Education level, mental state, the number of hospitalization, postoperative recurrence are the main factors of general self-efficacy in breast cancer patients .Among these influences, higher education, better mental state, patients with higher levels of self-efficacy; patients with the number of hospitalized more than three times have the higher level of self-efficacy than the initial patients.Local recurrence in patients with lowest levels of self-efficacy.(3)Self-efficacy have a positive correlation with self-esteem needs, self-fulfillment needs and aesthetic needs.
Conclusions:
1、Radical mastectomy for breast cancer patients have a wide range of needs during hospitalization. Different personal characteristics, there is great difference demands.
2、Occupation, education level, mental state, the relationship with her husband, hospitalization frequency, self-care ability, the source of hospital fees, whether the recurrence and metastasis after radical mastectomy are most import influences for breast cancer patients.
3、The second, lower self-efficacy bate the confidence of patients.nurses should pay attention to the level of self-efficacy in patients and take a scientific and effective methods to improve the level of self-efficacy in patients.
4、Self-efficacy have a positive correlation with self-esteem needs, self-fulfillment needs and aesthetic needs.
引文
[1]郭仁宣.乳腺外科学[M].辽宁科学技术出版社,2003.
[2]季永领.乳腺癌根治术加放射治疗后上肢并发症的临床分析[D].苏州大学,2004.
[3]周英杰.乳腺癌防治与康复[M].天津科技翻译出版公司,2004.
[4]杨洪菊.三级综合医院住院病人护理需求的评估研究[D].山东大学社会医学与卫生事业管理,2007.
[5]TAYLOR SE. Adjustment to threatening events: atheory of cognitive adaptation[J]. Gen intern med,2000,38(5):1161-1173.
[6]AMBLER N, RUMSEY M,HARCOURT D. Specialist nurse counsellor interventions at the time of diagnosis of breast cancer: Comparing advocacy with a conventional approach[J]. Adv Nurs,1999,29:445-453.
[7]BETH MARLOW,TANIA CARTMILL,HOLLY CIEPLUCHA,SARAH LOWRIE.AN interactive process model of psychosocial support needs for women living with breast cancer[J]. Psycho-Oncology 2003,12: 319-330.
[8]AFAF GIRGIS,BINA NAUSHEEN,ANILA KAMAL. Familial social support and depression in breast cancer: An exploratory study on a Pakistani sample[J]. Psycho-Oncology,2007, 16: 859-862.
[9]KAREN I. CHALMERS,KAREN A. LUKER,SAMUEL J. LEINSTER.. Information and support needs of women with primary relatives with breast cancer: development of the Information and Support Needs Questionnaire[J].Blackwell Science Ltd, Journal of Advanced Nursing, 2000,35(4):497-507.
[10]谢淑丽,朱明光,曹月辉.乳腺癌放疗患者的需求及其影响因素研究[J].解放军护理杂志,2003,20(6):28-29.
[11]王世平,李晓玲.乳房切除术后不同时间病人需求的调查与分析[J].护士进修杂志,2004,19(10):935-937.
[12]虞玲丽,延国姣.乳腺癌化疗患者健康教育需求探讨[J].中国现代医学杂志,2005,15(12):1875-1879.
[13]刘丽华,李国荣,陈华等.乳腺切除术后病人全面康复认知与需求调查分析[J].家庭护士,2008,6(8):2171-2173.
[14]陈述政,陆劲松,施勇.乳腺癌术后乳房缺损患者对乳房再造手术的心理需求调查[J].实用肿瘤杂志,2006,21(5):457-458.
[15]刘青,张传平.性生活康复指导在女性乳腺癌术后的应用[J].齐鲁护理杂志,2008,14(20):91-92.
[16]毛小玲.大学生成就目标定向及其与应对自我效能感、应对方式的关系研究[D].广西师范大学,2007..
[17]胡艳红.大学生择业效能感的因素分析及其与职业兴趣、职业价值观的关系研究[D].陕西师范大学,基础心理学,2003.
[18]黄营英.护理本科生自我效能感和应对方式的相关性研究[D].中国医科大学, 2007.
[19]王云鹏.大学生学业自我效能感、成就动机与职业兴趣之间的关系研究[D].吉林大学,2006.
[20]罗碧华.本科护生自我效能与临床沟通能力的相关研究[D].中南大学, 2007.
[21] R Zachariae,CG Pedersen,AB Jensen,E Ehrnrooth,PB Rossen. Association of perceived physician communication style with patient satisfaction, distress, cancer-related self- efficacy,and perceived control over the disease[J]. British Journal of Cancer 2003, 88:658 - 665.
[22]文华,苏小茵,高玲玲.化疗期乳腺癌病人抑郁与自我效能的相关性研究[J].中华护理杂志,2007,42(4):322-323.
[23]KEI HIRAI,YOKO SUZUKI,SATORU TSUNETO,MASAYUKI IKENAGA. A structural model of the relationships among self-efficacy,psychological adjustment, and physi- cal condition in japanese advanced cancer patients[J]. Psycho-Oncology2002, 11: 221-229.
[24]孙萍.护理干预对社区原发性高血压患者自我功效和依从行为影响的研究[D].中国协和医科大学,2006.
[25]HEIDI E.TIEGELIS,MARIET HAGEDOORN,ROBBERT SANDERMAN. The impact of an informational self-management intervention on the association between control and illness uncertainty before and psychological distress after radiotherapy[J]. Psycho- Oncology 2004,13: 248-259 .
[26]邹闰华.马斯洛人学与企业人本管理研究[D].湖南师范大学,外国哲学,2006.
[27]于洋.整形美容手术者一般自我效能感与术后满意度的相关性研究[D].中国协和医科大学,2007.
[28]EDWARD LINDOP ,SUE CANNON. Evaluating the self-assessed support needs of women with breast cancer[J]. Blackwell Science Ltd, Journal of Advanced Nursing, 2003,34(6), 760-771.
[29]刘志平,李美红.外科病人住院期间人性化护理需求调查分析[J].护理研究,2007,21(8):2099-2101.
[30]KAREN LUKER, KINTA BEAVER, LYNN AUSTIN. An evaluation of information cards as a means of improving communication between hospital and primary care for women with breast cancer[J]. Journal of Advanced Nursing, 2000, 31(5):1174-1182.
[31]石荣光,李冬梅.创伤骨折患者自我效能的相关因素调查分析及对策[J].护士进修杂志,2006,21(7):594-596.
[32]SANSNEE JIROJWONG, ROBERT MACLENNAN. Health beliefs,perceived self- efficacy,and breast self-examination among Thai migrants in Brisbane[J]. Journal of Advanced Nursing,2003,41(3):241-249.
[33]MICHAELO’DONNELL.Health promotion behaviors that promote healing[J]. The journal of alternative and complementary medicine,2004,1(10):49-60.
[34]ROB SANSON,AFAF GIRGIS,ALLISON BOYAS.The unmet supportive care needs of patients with cancer[J].American cancer society,2000,88(1):226-237.
[35]R.I.OVERBERG,L.L.ALPAY,J. VERHOEF. Illness stories on the Internet: what do breast cancer patients want at the end of treatment? [J]. Psycho-Oncology 2007,16: 937–944.
[36]罗晓梅,黄天雯,郑瑞玉.健康教育对提高乳腺癌术后患者生活质量的探讨[J].现代临床护理,2004,3(6):3-5.
[37]闫春梅,冯新玮,邢爱红.康复期乳腺癌病人的健康教育研究进展[J].护理研究,2008,22(2):478-479.
[38]付菊芳,张茹英,李武平.晚期癌症病人需求评估体系构建方法[J].护理研究,2004,18(7):128-1210.
[39]吕玉玲,张秀卿.乳腺癌根治术后患者健康教育需求与护士认知的调查[J].齐鲁护理杂志,2002,8(4):252-253.
[40]SHULAMITH KREITLER,DINA PELEG,MALLY EHRENFELD.Stress,self-efficacy and quality of life in cancer patients[J]. Psycho-Oncology 2007,16:329-341.
[41]THOMAS V.MERLUZZI, RAYMOND C. NAIRN,KRUPA HEGDE. Self-efficacy for coping with cancer:revision of the cancer behavior inventory [J]. Psycho-Oncology,2001, 10:206- 217.
[42]杨廷忠,施卫星,许亮文.临床护理的一种思路和方法[J].中华护理杂志,2004,39(5):393-396.
[43]王爱平,梅卫婷,鲍文卿.自我效能理论在全髋关节置换术患者康复训练中的应用[J].解放军护理杂志,2008,25(48):7-9.
[2]季永领.乳腺癌根治术加放射治疗后上肢并发症的临床分析[D].苏州大学,2004.
[3]周英杰.乳腺癌防治与康复[M].天津科技翻译出版公司,2004.
[4]杨洪菊.三级综合医院住院病人护理需求的评估研究[D].山东大学社会医学与卫生事业管理,2007.
[5]TAYLOR SE. Adjustment to threatening events: atheory of cognitive adaptation[J]. Gen intern med,2000,38(5):1161-1173.
[6]AMBLER N, RUMSEY M,HARCOURT D. Specialist nurse counsellor interventions at the time of diagnosis of breast cancer: Comparing advocacy with a conventional approach[J]. Adv Nurs,1999,29:445-453.
[7]BETH MARLOW,TANIA CARTMILL,HOLLY CIEPLUCHA,SARAH LOWRIE.AN interactive process model of psychosocial support needs for women living with breast cancer[J]. Psycho-Oncology 2003,12: 319-330.
[8]AFAF GIRGIS,BINA NAUSHEEN,ANILA KAMAL. Familial social support and depression in breast cancer: An exploratory study on a Pakistani sample[J]. Psycho-Oncology,2007, 16: 859-862.
[9]KAREN I. CHALMERS,KAREN A. LUKER,SAMUEL J. LEINSTER.. Information and support needs of women with primary relatives with breast cancer: development of the Information and Support Needs Questionnaire[J].Blackwell Science Ltd, Journal of Advanced Nursing, 2000,35(4):497-507.
[10]谢淑丽,朱明光,曹月辉.乳腺癌放疗患者的需求及其影响因素研究[J].解放军护理杂志,2003,20(6):28-29.
[11]王世平,李晓玲.乳房切除术后不同时间病人需求的调查与分析[J].护士进修杂志,2004,19(10):935-937.
[12]虞玲丽,延国姣.乳腺癌化疗患者健康教育需求探讨[J].中国现代医学杂志,2005,15(12):1875-1879.
[13]刘丽华,李国荣,陈华等.乳腺切除术后病人全面康复认知与需求调查分析[J].家庭护士,2008,6(8):2171-2173.
[14]陈述政,陆劲松,施勇.乳腺癌术后乳房缺损患者对乳房再造手术的心理需求调查[J].实用肿瘤杂志,2006,21(5):457-458.
[15]刘青,张传平.性生活康复指导在女性乳腺癌术后的应用[J].齐鲁护理杂志,2008,14(20):91-92.
[16]毛小玲.大学生成就目标定向及其与应对自我效能感、应对方式的关系研究[D].广西师范大学,2007..
[17]胡艳红.大学生择业效能感的因素分析及其与职业兴趣、职业价值观的关系研究[D].陕西师范大学,基础心理学,2003.
[18]黄营英.护理本科生自我效能感和应对方式的相关性研究[D].中国医科大学, 2007.
[19]王云鹏.大学生学业自我效能感、成就动机与职业兴趣之间的关系研究[D].吉林大学,2006.
[20]罗碧华.本科护生自我效能与临床沟通能力的相关研究[D].中南大学, 2007.
[21] R Zachariae,CG Pedersen,AB Jensen,E Ehrnrooth,PB Rossen. Association of perceived physician communication style with patient satisfaction, distress, cancer-related self- efficacy,and perceived control over the disease[J]. British Journal of Cancer 2003, 88:658 - 665.
[22]文华,苏小茵,高玲玲.化疗期乳腺癌病人抑郁与自我效能的相关性研究[J].中华护理杂志,2007,42(4):322-323.
[23]KEI HIRAI,YOKO SUZUKI,SATORU TSUNETO,MASAYUKI IKENAGA. A structural model of the relationships among self-efficacy,psychological adjustment, and physi- cal condition in japanese advanced cancer patients[J]. Psycho-Oncology2002, 11: 221-229.
[24]孙萍.护理干预对社区原发性高血压患者自我功效和依从行为影响的研究[D].中国协和医科大学,2006.
[25]HEIDI E.TIEGELIS,MARIET HAGEDOORN,ROBBERT SANDERMAN. The impact of an informational self-management intervention on the association between control and illness uncertainty before and psychological distress after radiotherapy[J]. Psycho- Oncology 2004,13: 248-259 .
[26]邹闰华.马斯洛人学与企业人本管理研究[D].湖南师范大学,外国哲学,2006.
[27]于洋.整形美容手术者一般自我效能感与术后满意度的相关性研究[D].中国协和医科大学,2007.
[28]EDWARD LINDOP ,SUE CANNON. Evaluating the self-assessed support needs of women with breast cancer[J]. Blackwell Science Ltd, Journal of Advanced Nursing, 2003,34(6), 760-771.
[29]刘志平,李美红.外科病人住院期间人性化护理需求调查分析[J].护理研究,2007,21(8):2099-2101.
[30]KAREN LUKER, KINTA BEAVER, LYNN AUSTIN. An evaluation of information cards as a means of improving communication between hospital and primary care for women with breast cancer[J]. Journal of Advanced Nursing, 2000, 31(5):1174-1182.
[31]石荣光,李冬梅.创伤骨折患者自我效能的相关因素调查分析及对策[J].护士进修杂志,2006,21(7):594-596.
[32]SANSNEE JIROJWONG, ROBERT MACLENNAN. Health beliefs,perceived self- efficacy,and breast self-examination among Thai migrants in Brisbane[J]. Journal of Advanced Nursing,2003,41(3):241-249.
[33]MICHAELO’DONNELL.Health promotion behaviors that promote healing[J]. The journal of alternative and complementary medicine,2004,1(10):49-60.
[34]ROB SANSON,AFAF GIRGIS,ALLISON BOYAS.The unmet supportive care needs of patients with cancer[J].American cancer society,2000,88(1):226-237.
[35]R.I.OVERBERG,L.L.ALPAY,J. VERHOEF. Illness stories on the Internet: what do breast cancer patients want at the end of treatment? [J]. Psycho-Oncology 2007,16: 937–944.
[36]罗晓梅,黄天雯,郑瑞玉.健康教育对提高乳腺癌术后患者生活质量的探讨[J].现代临床护理,2004,3(6):3-5.
[37]闫春梅,冯新玮,邢爱红.康复期乳腺癌病人的健康教育研究进展[J].护理研究,2008,22(2):478-479.
[38]付菊芳,张茹英,李武平.晚期癌症病人需求评估体系构建方法[J].护理研究,2004,18(7):128-1210.
[39]吕玉玲,张秀卿.乳腺癌根治术后患者健康教育需求与护士认知的调查[J].齐鲁护理杂志,2002,8(4):252-253.
[40]SHULAMITH KREITLER,DINA PELEG,MALLY EHRENFELD.Stress,self-efficacy and quality of life in cancer patients[J]. Psycho-Oncology 2007,16:329-341.
[41]THOMAS V.MERLUZZI, RAYMOND C. NAIRN,KRUPA HEGDE. Self-efficacy for coping with cancer:revision of the cancer behavior inventory [J]. Psycho-Oncology,2001, 10:206- 217.
[42]杨廷忠,施卫星,许亮文.临床护理的一种思路和方法[J].中华护理杂志,2004,39(5):393-396.
[43]王爱平,梅卫婷,鲍文卿.自我效能理论在全髋关节置换术患者康复训练中的应用[J].解放军护理杂志,2008,25(48):7-9.