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闭角型青光眼是眼科常见疾病,以老年病人为主,临床治疗不当或不及时可导致失明,相关数据显示我国青光眼病人中失明比例高达7.78%[1]。由于闭角型青光眼病情发展快、短时间视力急剧降低,且治疗往往需要联合手术,切口较大,手术操作复杂,受眼内干扰大,手术效果存在较大不确定性[2],病人围术期往往出现焦虑、抑郁等负面心理,影响治疗效果和生存质量。因此,围术期对闭角型青光眼病人采取有效护理干预措施十分必要。罗伊适应护理模式通过病人行为反应,分析刺激来源进而制定护理计划实施护理,强调病人整体性适应系统的存在,追求良好护理效果[3]。本研究将罗伊适应护理模式应用于闭角型青光眼病人围术期护理,探讨其对病人心理韧性、应对方式和生活质量的影响。
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2组病人干预前SAS、SDS评分差异均无统计学意义(P>0.05),干预后SAS、SDS评分均下降(P<0.01),且观察组干预后SAS、SDS评分均低于对照组(P<0.01)(见表 1)。
分组 n SAS SDS 干预前 观察组 30 59.37±7.76 59.93±8.70 对照组 30 59.87±7.49 58.67±7.92 t — 0.25 0.59 P — >0.05 >0.05 干预后 观察组 30 39.00±6.86** 42.73±8.46** 对照组 30 53.13±6.95** 49.80±8.21** t — 7.93 3.28 P — < 0.01 < 0.01 组内配对t检验:**P < 0.01 表 1 2组病人干预前后SAS、SDS评分的比较(x±s;分)
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2组病人干预前坚韧、自强、乐观、心理韧性总评分差异均无统计学意义(P>0.05),干预后2组坚韧、自强、乐观、心理韧性总评分均升高(P<0.01),且观察组干预后坚韧、自强、乐观、心理韧性总评分均高于对照组(P<0.01)(见表 2)。
分组 n 坚韧 自强 乐观 总分 干预前 观察组 30 22.97±3.33 10.90±3.03 4.50±1.74 38.37±7.54 对照组 30 23.13±3.25 10.67±3.09 4.67±1.88 38.43±7.34 t — 0.19 0.29 0.36 0.03 P — >0.05 >0.05 >0.05 >0.05 干预后 观察组 30 36.07±3.25** 22.60±2.97** 11.47±1.94** 70.13±7.54** 对照组 30 29.00±4.16** 15.87±3.01** 8.80±1.83** 53.57±8.20** t — 7.34 8.72 5.48 8.14 P — < 0.01 < 0.01 < 0.01 < 0.01 组内配对t检验:**P < 0.01 表 2 2组病人心理韧性评分的比较(x±s;分)
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2组病人干预前面对、回避、屈服评分差异均无统计学意义(P>0.05),观察组干预后面对评分增加(P<0.01),回避、屈服评分降低(P<0.01),对照组干预后面对、回避、屈服评分与干预前差异无统计学意义(P>0.05)。观察组干预后面对评分高于对照组(P<0.01),回避、屈服评分低于对照组(P<0.01)(见表 3)。
分组 n 面对 回避 屈服 干预前 观察组 30 18.03±4.20 13.87±4.20 9.33±3.43 对照组 30 18.40±4.43 14.70±4.27 9.80±4.14 t — 0.33 0.76 0.48 P — >0.05 >0.05 >0.05 干预后 观察组 30 23.10±4.24** 9.87±3.96** 6.13±2.92** 对照组 30 19.13±4.43 13.40±4.11 9.27±3.80 t — 3.55 3.39 3.59 P — < 0.01 < 0.01 < 0.01 组内配对t检验:**P < 0.01 表 3 2组病人干预前后应对方式评分的比较(x±s;分)
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2组病人干预前SF-36量表各评分差异均无统计学意义(P>0.05),干预后2组SF-36量表各评分均升高(P<0.01),且观察组干预后SF-36量表各评分均高于对照组(P<0.01)(见表 4)。
分组 n PF PR BP GH VT SF RE MH 干预前 观察组 30 79.30±8.33 58.47±5.33 61.63±5.44 58.40±7.14 69.00±5.18 59.20±7.25 54.00±5.77 67.67±7.65 对照组 30 80.03±7.62 58.70±5.43 60.33±5.80 58.50±6.90 69.80±5.15 59.30±7.53 53.30±5.60 66.90±7.42 t — 0.35 0.17 0.90 0.06 0.60 0.05 0.48 0.40 P — >0.05 >0.05 >0.05 >0.05 >0.05 >0.05 >0.05 >0.05 干预后 观察组 30 91.43±6.32** 77.57±5.35** 72.80±8.80** 83.37±7.09** 78.90±5.14** 81.20±7.15** 86.47±6.84** 80.53±7.68** 对照组 30 86.00±7.62** 68.70±5.42** 67.47±5.58** 71.53±6.87** 74.70±5.15** 71.27±7.56** 71.47±5.69** 70.90±7.44** t — 3.00 6.38 2.80 6.57 3.16 5.23 9.23 4.93 P — < 0.01 < 0.01 < 0.01 < 0.01 < 0.01 < 0.01 < 0.01 < 0.01 组内配对t检验:**P < 0.01 表 4 2组病人SF-36评分的比较(x±s;分)
罗伊适应护理模式对闭角型青光眼病人围术期心理韧性、应对方式及生活质量的影响
Effect of Roy's adaptive nursing model on the perioperative psychological resilience, coping style and quality of life in patients with angle-closure glaucoma
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摘要:
目的观察罗伊适应护理模式对闭角型青光眼病人围术期心理韧性、应对方式及生活质量的影响。 方法将60例闭角型青光眼病人随机分为2组,观察组(30例)给予罗伊适应护理模式干预至出院,对照组(30例)给予常规眼科护理。应用焦虑自评量表(SAS)、抑郁自评量表(SDS)、Connor-Davidson韧性量表、医学应对方式问卷(MCMQ)、健康调查简表(SF-36)评价病人焦虑抑郁程度、心理韧性、应对方式、生活质量,并对比2组病人干预前后SAS评分、SDS评分、心理韧性、应对方式、SF-36评分的情况。 结果观察组病人干预后SAS、SDS评分均低于对照组(P < 0.01),坚韧、自强、乐观、心理韧性总评分高于对照组(P < 0.01),面对评分高于对照组(P < 0.01),回避、屈服评分低于对照组(P < 0.01),SF-36量表各评分均高于对照组(P < 0.01)。 结论罗伊适应护理模式可降低闭角型青光眼病人围术期刺激源强度,促进适应性反应,提高病人心理韧性,改善应对方式和生活质量。 Abstract:ObjectiveTo observe the effects of Roy's adaptive nursing model on perioperative psychological resilience, coping style and quality of life of patients with angle closure glaucoma. MethodsSixty patients with angle closure glaucoma were randomly divided into the control group and observation group(30 cases each group).The observation group were treated with Roy's adaptive nursing intervention until discharge, and the control group were treated with routine ophthalmic nursing.The Self-rating Anxiety Scale(SAS), Self-rating Depression Scale(SDS), Connor-Davidson Resilience Scale, Medical Coping Style Questionnaire(MCMQ) and MOS item short from health survey(SF-36) were used to evaluate the degree of anxiety and depression, psychological resilience, coping style and quality of life of all patients.The differences of the SAS score, SDS score, psychological resilience, coping style and SF-36 were compared between two groups before and after intervention. ResultsThe scores of SAS and SDS in observation group after intervention were lower than those in control group(P < 0.05), the scores of resilience, self-improvement, optimism and total score of psychological toughness in observation group were higher than those in control group(P < 0.01), the face score in observation group was higher than that in control group(P < 0.05), the avoidance and yield scores in observation group were lower than those in control group(P < 0.05), and the score of each item of SF-36 in observation group were higher than those in control group(P < 0.01). ConclusionsRoy's adaptive nursing model can reduce the intensity of perioperative stimulus source, promote adaptive response, and improve patients'psychological resilience, coping style and quality of life in patients with angle closure glaucoma. -
表 1 2组病人干预前后SAS、SDS评分的比较(x±s;分)
分组 n SAS SDS 干预前 观察组 30 59.37±7.76 59.93±8.70 对照组 30 59.87±7.49 58.67±7.92 t — 0.25 0.59 P — >0.05 >0.05 干预后 观察组 30 39.00±6.86** 42.73±8.46** 对照组 30 53.13±6.95** 49.80±8.21** t — 7.93 3.28 P — < 0.01 < 0.01 组内配对t检验:**P < 0.01 表 2 2组病人心理韧性评分的比较(x±s;分)
分组 n 坚韧 自强 乐观 总分 干预前 观察组 30 22.97±3.33 10.90±3.03 4.50±1.74 38.37±7.54 对照组 30 23.13±3.25 10.67±3.09 4.67±1.88 38.43±7.34 t — 0.19 0.29 0.36 0.03 P — >0.05 >0.05 >0.05 >0.05 干预后 观察组 30 36.07±3.25** 22.60±2.97** 11.47±1.94** 70.13±7.54** 对照组 30 29.00±4.16** 15.87±3.01** 8.80±1.83** 53.57±8.20** t — 7.34 8.72 5.48 8.14 P — < 0.01 < 0.01 < 0.01 < 0.01 组内配对t检验:**P < 0.01 表 3 2组病人干预前后应对方式评分的比较(x±s;分)
分组 n 面对 回避 屈服 干预前 观察组 30 18.03±4.20 13.87±4.20 9.33±3.43 对照组 30 18.40±4.43 14.70±4.27 9.80±4.14 t — 0.33 0.76 0.48 P — >0.05 >0.05 >0.05 干预后 观察组 30 23.10±4.24** 9.87±3.96** 6.13±2.92** 对照组 30 19.13±4.43 13.40±4.11 9.27±3.80 t — 3.55 3.39 3.59 P — < 0.01 < 0.01 < 0.01 组内配对t检验:**P < 0.01 表 4 2组病人SF-36评分的比较(x±s;分)
分组 n PF PR BP GH VT SF RE MH 干预前 观察组 30 79.30±8.33 58.47±5.33 61.63±5.44 58.40±7.14 69.00±5.18 59.20±7.25 54.00±5.77 67.67±7.65 对照组 30 80.03±7.62 58.70±5.43 60.33±5.80 58.50±6.90 69.80±5.15 59.30±7.53 53.30±5.60 66.90±7.42 t — 0.35 0.17 0.90 0.06 0.60 0.05 0.48 0.40 P — >0.05 >0.05 >0.05 >0.05 >0.05 >0.05 >0.05 >0.05 干预后 观察组 30 91.43±6.32** 77.57±5.35** 72.80±8.80** 83.37±7.09** 78.90±5.14** 81.20±7.15** 86.47±6.84** 80.53±7.68** 对照组 30 86.00±7.62** 68.70±5.42** 67.47±5.58** 71.53±6.87** 74.70±5.15** 71.27±7.56** 71.47±5.69** 70.90±7.44** t — 3.00 6.38 2.80 6.57 3.16 5.23 9.23 4.93 P — < 0.01 < 0.01 < 0.01 < 0.01 < 0.01 < 0.01 < 0.01 < 0.01 组内配对t检验:**P < 0.01 -
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