【作者】 许兴芳；

【导师】 贺莲香；

【作者基本信息】 中南大学 ， 护理学， 2011， 硕士

【摘要】 目的：1.探讨直肠癌永久性结肠造口患者出院前的压力源；2.描述直肠癌永久性结肠造口患者出院前压力水平、应对方式及社会支持水平；3.描述直肠癌永久性结肠造口患者出院前的应对方式、社会支持与压力的关系；4.探讨直肠癌永久性结肠造口患者出院前压力的影响因素；方法：本课题采用流行病学横断面调查研究方法,对出院前的直肠癌永久性结肠造口患者进行研究。采用整群抽样的方法在湖南省长沙市四所三级甲等医院抽取符合条件的患者完成调查问卷。调查问卷包括一般资料问卷、结肠造口患者压力量表、压力应对量表和领悟社会支持量表(PSSS),分别用来调查患者的人口学资料、造口相关因素、患者的压力源及压力、应对方式和社会支持。选用SPSS13.0软件进行数据的统计分析。结果：1.结肠造口患者压力量表回译的结果与原量表无影响理念的分歧,专家评定结果满意,内容效度指数(CVI)为0.88。2.量表的内部一致性分析显示：结肠造口患者压力量表总的Cronbach’sα系数0.92,各分量表的Cronbach’sα为0.76-0.88,表明此量表具有较好的内部一致性。3.本研究前五项压力源依次是担心疾病复发、担心我的引流装置会意外脱落、不知道如何护理我的结肠造口并发症、由于需要护理造口,家庭成员的负担日益加重、担心运动和体力活动对结肠造口造成不良影响。主要是来自“身体状况改变导致的压力”及“结肠造口护理导致的压力”,“自我概念改变导致的压力”排在第三位,“与家人的相互作用发生改变导致的压力”排在第四位。4.出院前患者总的压力水平为中度(2.30±0.70),18.86%的患者属于高度压力水平,47.54%属于中度压力水平,26.28%属于轻度压力水平,仅有7.38%的患者没有压力。5.将一般资料与患者的压力水平作相关分析,结果显示性别、年龄、居住地、工作状态、与家人的关系、家庭收入、术前是否知道行造口、所在科室是否有造口师与压力水平均有相关性(p<0.05)。6.直肠癌永久性结肠造口患者均采用问题指向的及情感值向两种应对方式,问题指向得分为2.46±0.67,情感指向应对方式得分为2.01±0.61,但患者主要采用问题指向的应对方式,差异有统计学意义(p<0.05)；患者得到社会支持总分为63.91±7.86,得分由高到低依次是家庭支持、其他人支持和朋友支持,且差异有统计学意义(p<0.01)；患者压力与应对方式、社会支持的相关分析结果显示,患者的压力与问题指向的应对方式呈负相关(p<0.05),与情感指向社会支持呈正相关(p<0.01),与社会支持总分呈负相关(p<0.01)。7.作多元回归分析,结果表明,家庭收入、问题指向的应对方式、年龄、术前是否知道行造口、社会支持总得分及情感指向应对方式纳入以压力为依变量的回归方程(F=3.296,p=0.000)结论1.出院前直肠癌永久性结肠造口患者的压力源主要来自身体状况改变和结肠造口护理。2.64.09%的直肠癌永久性结肠造口患者出院前的压力水平为中度以上3.直肠癌永久性结肠造口患者主要采用问题指向的应对方式,问题指向的应对方式与压力水平呈负相关,情感指向的应对方式与压力水平呈正相关；直肠癌结肠永久性造口患者的社会支持与其压力水平呈负相关,来自家庭的支持最多,来自朋友的支持最少。4.直肠癌永久性结肠造口患者的压力水平受年龄、家庭收入、术前是否知道行造口、应对方式及社会支持等因素的影响。更多还原

【Abstract】 Objectives 1. To explore the major stressors among pre-discharged Rectal Cancer Patients with Permanent Colostomy;2. To identify the level of stress and Social Support and major coping strategies among pre-discharged Rectal Cancer Patients with Permanent Colostomy;3. To examine the relationship between stress and major coping strategies and the relationship between stress and Social Support;4. To explore the predicted factors of stress;Methods English version’the Stress of Colostomy Patients Scale’was translated, and back-translated, andrevised.Five experts were evaluated for the content validity.A pilot study was taken for making sure the feasibility of the questionnaire,estimating the sample size,and testing validity and reliability。It was a cross-sectional survey。The target population was Rectal Cancer Patients with Permanent Colostomy。Five state-own tertiary hospitals in Changsha, Hunan, were chosen by cluster sampling。They were three affiliated hospital of central south university, hunan Cancer hospital and hunan people’s hospital。The Stress of Colostomy Patients Scale, Jalowiec coping scale, and Social Support Scale were used to measure the stressors, Stress, Coping and Social Support among pre-discharged Rectal Cancer Patients with Permanent Colostomy.The data were analyzed with software SPSS13.0.Results 1. The Chinese version of The Stress of Colostomy Patients Scale was consistent with the original version and the result from the invited experts’assessment was satisfactory.The content validity index (CVI) was 0.88.2. Internal consistency analysis showed that the overall Conbach’s a of The Stress of Colostomy Patients Scale was 0.92,and the Conbach’s a of the subscales were from 0.76-0.88,and this scale has a better internal coherency.3. The five major stressors were’I worry about the recurrence of the disease’;’I worry that my drainage appliance will drop out unexpectedly’;’I don’t know how to care for my colostomy complications’;’My family members have increasing burdens from my colostomy care’; and’I worry that exercise and physical activities are harmful to the colostomy’.The stressors comes’Stressors from change in physical status’and’Stressors from colostomy care’4. Colostomy patients before discharge had a moderate level of stress (2.30±0.70), while 18.86% patients had a high level of stress; 47.54% patients had a moderate level of stress; 26.28% patients had a low level of stress; and only 7.38% had no stress.5. Demographic data of patients patients such as sex different, age, residence, working position,family relationship,family income, uninformed to stoma surgery and whether there were stoma therapy nurse had significant influence on the stress of colostomy patients(p<0.05).6. The colostomy patients used both of problem-focused coping and emotion-focused coping,but they mainly used problem-focused coping; The score of problem-focused coping was 2.46±0.67, the score of emotion-focused coping was 2.01±0.61.But the colostomy patients mainly used problem-focused coping(P<0.01).The score of social support was 63.91±7.86,patients receiving the most support from their family, followed by other people(1eaders, relatives and colleagues) and friends(P<0.01). Problem-focused coping was negatively correlated with theirstress(P<0.05),and emotion-focused coping was positively correlated with their stress(P<0.01).The social support of colostomy patients was negatively correlated with stress(P<0.01).7. Stepwise regression analysis revealed that stress related family income, problem-focused coping, age,whether they konw stoma surgery, social support,and emotion-focused coping were included to the regression equations in which the stress was as dependent variables.Conclusion 1. The main stressor was’Stressors from change in physical status’,followed’Stressors from colostomy care’.2.64.09% of the colostomy patients before discharge had a moderate level of stress.3. The colostomy patients mainly used problem-focused coping, Problem-focused coping was negatively correlated with theirstress,and emotion-focused coping was positively correlated with their stress. Patients receiving the most support from their family, followed by other people(1eaders, relatives and colleagues) and friends. The social support of colostomy patients was negatively correlated with stress.4. Demographic data of patients patients such as age,family income,whether they know stoma surgery,coping and social support and so on.更多还原