【作者】 李月；

【导师】 韩丽沙；

【作者基本信息】 北京中医药大学 ， 中医护理， 2012， 硕士

【摘要】 目的：评估肺癌患者的家庭功能状况,并探讨其影响因素；了解肺癌患者和家属的应对方式,并探讨患者和家属的应对方式与家庭功能的关系；了解肺癌患者的抑郁状态,并探讨患者抑郁状态与其家庭功能的关系,以家庭为切入点寻找提高患者生命质量的合理途径。方法：采用问卷和访谈相结合的方法对肺癌患者的家庭进行研究。研究对象为2011年10月至2012年2月在北京市三家三甲医院胸部肿瘤科住院的肺癌患者及其家属,共107个家庭(每个家庭2人)纳入研究。采用一般情况调查表、家庭关怀度指数问卷(APGAR).家庭功能评定量表(FAD)、家庭负担会谈量表(FBS)、医学应对问卷(MCMQ).简明应对方式问卷(SCSQ).自评抑郁量表(SDS)对肺癌患者的家庭功能及其影响因素、患者和家属的应对方式、患者的抑郁状态进行测评,通过问卷收集的全部数据使用SPSS统计软件进行处理。采用质性研究的方法作为辅助和补充,对5个家庭的10位成员进行深度访谈,访谈资料遵循质性研究的原则进行整理和转录,并将定量研究与定性研究获得的数据进行整合。结果：1家庭功能评估：应用家庭关怀度指数问卷(APGAR)调查发现肺癌患者主观评价的家庭功能良好,93.5%的肺癌患者主观认为其家庭功能处于良好状态；应用家庭功能评定量表(FAD)对肺癌患者的家庭功能进行多维度评定,发现与功能不良的界值分相比,总体功能得分<界值分,差异有统计学意义(t=-2.745,P<0.05),问题解决、沟通、角色维度得分<界值分,差异有统计学意义(t=一5.715,P<0.01；t=一5.297,P<0.01t=一3.299,P<0.01),情感介入和行为控制维度得分>界值分,差异有统计学意义(t=3.083,P<0.01；t=14.548,P<0.01),情感反应维度得分与界值分差异无统计学意义(t=0.996,P>0.05),提示肺癌患者家庭的总体功能、问题解决、沟通和角色功能未见不良,情感介入和行为控制功能不良,情感反应功能弱化。2家庭功能的影响因素：家庭人均月收入、家庭负担、患者的年龄、婚龄、文化程度、性别、患者是否为家庭的主要经济来源、患者与家人的亲密程度以及家属的年龄和文化程度均对家庭功能产生影响。3肺癌患者和家属的应对方式及与家庭功能的关系：肺癌患者回避和屈服应对方式的得分与一般患者人群得分比较,差异有统计学意义(t=12.112,P<0.01；t=9.537,P<0.01),患者家属积极和消极应对方式得分与常模比较,差异有统计学意义(t=3.771,P<0.01: t=-6.200,P<0.01)；相关分析显示应对方式与家庭功能之间存在一定的相关(P<0.05)。4肺癌患者抑郁状态及与家庭功能的关系：肺癌患者的SDS评分显著高于国内常模(t=8.469,P<0.01),相关分析显示患者的抑郁状态与其家庭功能呈负相关(P<0.05)。5质性访谈的结果在某些方面对定量研究的结果予以支持。结论：肺癌患者家庭功能在某些维度存在不良,应在护理工作中有针对性的进行干预；应重视具有不利影响因素的家庭,并给予关注和支持；通过了解家庭功能和应对方式、抑郁状态的互动关系和规律,可尝试对患者及家属的应对方式进行干预,作为改善家庭功能的可行途径；可将家庭功能作为改善患者心理状态的切入点。在对肺癌患者的护理工作中,应将患者的家庭视为护理对象,以家庭功能为切入点,以改善患者的身心健康状态,提高其生命质量。更多还原

【Abstract】 Objective:To explore the condition and influence factors of family function of the patients with lung cancer;To explore the coping styles of the patients with lung cancer and their family members;To explore the correlativity among family function and coping styles;To explore the state of depression of the patients with lung cancer;To explore the correlativity among family function and depression.Methods:The present study used the mixed methods-combine questionary and interview.The data covered107patients with lung cancer who are in hospital in thoracic tumor department of three A-level hospitals in Beijing from October2011to February2012and their family members. The thesis examines the family function and its influence factors by questionary, APGAR, FAD and FBS; examines the coping styles by MCMQ and SCSQ;examines the depression by SDS.Entire data are statistical analyzed by the software SPSS.Besides,the qualitative study is used as supplementary by interviewing10members from5families.The data are collected and recoded according the rules of qualitative study,then integrate the data from the two parts.Results:1Assessment of family function:APGAR shows that the subjective evaluation of family function by patients themselves is good,93.5%patients agree that their family function are in good condition. Multidimensional assessment by FAD shows that the score of GF<boundary, the statistical meaning is significant (t=-2.745,P<0.05), the score of PS,CM,RL <boundary, the statistical meaning is significant (t=-5.715, P<0.01; t=-5.297,P<0.01t=-3.299,P<0.01>7the score of AI,BC>boundary,the statistical meaning is significant, there is no statistical meaning between the score of AR and boundary (t=0.996, P>0.05), it means that there is no declination and defect with the function of GF, PS,CM and RL;but the function of Al and BC are declination and defect;the function of AR is weaken.2The influence factors:it shows that the family income,family burden,age, marriage age,cultural,sex,whether the patient provide main financial support for family, and intimacy between family members,these all are the factors.3Coping styles and correlativity with family function:comparing score of avoiding and giving up of patients with normal score, the statistical meaning is significant (t=12.112, P<0.01; t=9.537, P<0.01); comparing score of positive and negative of family members with normal score, the statistical meaning is significant (t=3.771, P<0.01; t=-6.200, P<0.01); analysis of correlation shows that there is interaction between coping styles and family function (P<0.05).4Depression and correlativity with family function:the score of SDS with patients is higher than normal score, the statistical meaning is significant (t=8.469,P<0.01), analysis of correlation shows that there is negative-correlation between depression and family function (P<0.05).5The data from qualitative study shows agreement with the results of quantitative study in some aspects.Conclusion:Some dimensions of family function of patients with lung cancer are declination and defect,nurses should intervent by nursing measures with a purpose;also should pay attention to the families with adverse factors; besides,nurses coule try to help the family to improve the family function by changing their coping styles;and could help the patients to improve their mental health by improving their family function.In our nursing practice,we should take the family as our object,help the patients to improve their quality of life by improve their family function.更多还原