【作者】 耿莉；

【导师】 范秀珍；

【作者基本信息】 山东大学 ， 护理学， 2011， 硕士

【摘要】 目的：探讨“321”健康教育模式(一本疾病健康教育交流手册、两次多媒体视频信息支持、三次面对面情感沟通)对行内镜下黏膜剥离术治疗的早期胃癌患者疾病不确定感、焦虑抑郁的影响,为临床护士制定该类患者的针对性健康教育方案提供科学依据方法：抽取2008年1月～2010年5月在山东省立医院消化科行内镜下黏膜剥离术治疗的早期胃癌患者96例为研究对象,前48例作为对照组,后48例作为实验组,对照组接受病房护士提供的常规健康教育,实验组进入“321”健康教育模式管理程序中。采用一般状况调查问卷、疾病不确定感量表、状态焦虑量表、流调用抑郁量表对两组患者一般资料、三个时点(入院当天、术前一日晚、出院时)疾病不确定感、焦虑抑郁状态进行调查。结果：1.入院时所有研究对象的疾病不确定感平均得分为101.33±6.978,处于中等水平,经检验实验组与对照组疾病不确定感得分差异无统计学意义(p>0.05)；实施健康教育后,两组患者疾病不确定感得分均随时间的变化而降低,差异有统计学意义(p<0.05),其中实验组降低趋势快于对照组,差异有统计学意义(p<0.05)。经比较实验组患者在术前一天和出院时疾病不确定感得分均低于对照组,差异有统计学意义(p<0.05)。2.入院时两组患者疾病不确定感中不明确性、复杂性、信息缺乏各纬度得分差异无统计学意义(p>0.05),实施健康教育后,两组患者上述三个维度得分均随时间的变化而降低,差异有统计学意义(p<0.05),其中实验组降低趋势快于对照组,差异有统计学意义(p<0.05),经比较实验组患者在术前一天(t=1.917,p<0.05)和出院时(t=2.769,p<0.05)不明确性维度得分低于对照组,差异有统计学意义(p<0.05),实验组患者在术前一天和出院时复杂性维度得分低于对照组,差异有统计学意义(p<0.05)；实验组患者在术前一天和出院时信息缺乏纬度得分低于对照组,差异有统计学意义(p<0.05)。而实验组与对照组疾病不确定感中不可预测性维度三个时间点得分差异、随时间的变化及变化趋势的差异均无统计学意义(p>0.05)。3.入院时所有患者的焦虑(60.47±7.324)和抑郁(18.22±4.344)平均分显著高于国内常模(39.91,11.52),差异有统计学意义(p<0.00),经检验实验组与对照组患者入院时焦虑和抑郁水平得分的差异无统计学意义(p>0.05)；实施健康教育后,两组患者焦虑和抑郁得分均随时间的变化而降低,差异有统计学意义(p<0.05),其中实验组降低趋势快于对照组,差异有统计学意义(p<0.05)。经比较实验组患者在术前一天和出院时焦虑和抑郁水平得分均低于对照组,差异有统计学意义(p<0.05)。结论：“321”健康教育模式内容丰富、形式多样,可以在很大程度上满足患者的信息需求和情感寄托,能显著降低早期胃癌患者的疾病不确定感及焦虑抑郁水平。更多还原

【Abstract】 Objective:To evaluate the effect of "321" health education model (a disease-health educational exchange manual, two-time multimedia videoinformation supporting, three-time face to face emotional communication) on uncertainty in illness, anxiety and depression in early gastric cancer patients following endoscopic submucosal dissection, thus providing scientific basis for clinical nurses to develop targeted health education scheme.Methods:A sample of 96 early gastric cancer patients were recruited from the Department of Gastroenterology, Shandong Provincial Hospital during January 2008 to May 2010. They are evenly assigned into the control group (48 cases) and the experimental group (48 cases) according to the patients’ admission time. The conventional health education was provided to the control group, while the experimental group were brought into the "321" health education program. Measurements of uncertainty in illness, anxiety and depression were respectively taken by Mishel Uncertainty in Illness Scale, State Anxiety Inventory, Center for Epidemiological Studies depression Scale at each time point (the admission day, the evening before operation, the day of their discharge). Besides, the general information was taken by the general condition questionnaire.Results 1. The mean score on uncertainty in illness of all the patients is 101.33±6.978 on the admission day, belonging to the middle level. No statistical significance was obtained between the control group and the experimental group (p>0.05). After intervention, there was a trend of significantly declined scores on uncertainty in illness in the experimental group than in the control group (p<0.05). Uncertainty score in the experimental group was significantly lower than that of the control group on the evening before operation and the day of their discharge (p<0.05).2. There was no statistical significance in ambiguity dimension, complexity dimension and lack of information dimension between the control group and the experimental group on the admission day (p>0.05). After intervention, there was a trend of significantly declined scores on each dimension in the experimental group than in the control group (p<0.05). Each dimension score in the experimental group was significantly lower than that of the control group on the evening before operation and the day of their discharge (p<0.05). No statistical significance of scores on unpredictability dimension, the trend with time and at each time point was obtained between the two groups (P>0.05).3. The mean anxiety score of all the patients (60.47±7.324) was significantly higher than that of national norm (39.91) on admission day (p<0.00). Meanwhile, the mean depression score of all the patients(18.22±4.344) was significantly higher than that of national norm (11.52) on admission day (p<0.00). There was no statistical significance in anxiety score and depression score between the experimental group and the control group (p>0.05). After intervention, there was a trend of significantly declined scores on anxiety dimension and depression dimension in the experimental group than in the control group (p<0.05). Anxiety score and depression score in the experimental group were both significantly lower than that of the control group on the evening before operation and the day of their discharge (p<0.05).Conclusions"321" health education model can provide abundant content and diverse forms, thus it can to a large extent meet patients’ needs of information and emotional sustenance. Meanwhile it is an effective approach in reducing uncertainty in illness, anxiety and depression.更多还原