Objective To observe the effects of the comprehensive nursing intervention based on trans-theoretical model (TTM) on uncertainty at peroperative period and incidence of postoperative delirium in patients with esophagus cancer. Methods The patients with esophageal cancer who underwent comprehensive nursing intervention based on TTM in our hospital were divided into control group and observation group. The patients in control group were given regular nursing care, however,the patients in observation group were treated by comprehensive nursing intervention based on TTM. The scores of perioperative uncertainty and anxiety,postoperative delirium, life quality score, knowledge and self-management levels were observed and compared between the two groups.Results There were no significant differences in the scores of uncertainty and anxiety on admission between two groups(P>0.05). However,the scores of uncertainty and anxiety on 1d before operation, operation day,1d after operation and on discharge from hospital in observation group were significantly lower than those in control group (P<0.05). The delirium scores on 1d after operation, on discharge from hospital and on 6m after discharge from hospital in control group were significantly higher than those in observation group(P<0.05). There were no significant differences in life quality scores on admission between two groups (P>0.05), however,which were obviously improved on discharge from hospital and on 6m after discharge from hospital in both groups (P<0.05),moreover,which in observation group were superior to those in control group (P<0.05). On admission there were no significant differences in knowledge scores and self-management behavior scores between two groups (P >0. 05),however,which in observation group were superior to those in control group on 6m after discharge from hospital (P<0.05).Conclusion The comprehensive nursing intervention model based on TTM can improve patient's cognition and self-management behavior,which is beneficial to eliminate the uncertainty of disease and avoid postoperative delirium of patients with esophageal cancer, so as to improve the postoperative life quality of patients.%目的 探讨跨理论模型综合干预对于食管癌患者围手术期不确定感与术后谵妄的影响.方法 分别选择开展跨理论模型综合干预(trans-theoretical model of change,TTM)研究时间前后的食管癌患者为对照组与观察组,对照组予以常规护理,观察组进行TTM模型的综合护理干预.对比2组的围手术期不确定感评分与焦虑感评分,术后谵妄情况、生存质量评分、知识与自我管理水平等相关指标.结果 2组患者入院时的不确定感评分与焦虑感评分均无显著统计学意义(P>0.05).但术前1 d、手术日、术后1 d及出院时,观察组的不确定感评分与焦虑感评分均显著低于对照组(P<0.05).术后1 d及出院时与出院6个月后,对照组的谵妄评分均维持在较高水平,而观察组的同期评分及谵妄发生率均显著低于对照组同期水平(P<0.05).入院时,2组的生活质量量表评分、未见显著差异(P>0.05).出院时及出院后6个月,2组均相对于入院时有显著改善(P<0.05),但观察组显著优于对照组(P<0.05).入院时,2组的疾病知识评分及自我管理行为未见显著差异(P>0.05).出院后6个月,观察组显著优于对照组(P<0.05).结论 基于跨理论模型的综合护理干预模式可提高患者的疾病认知和自我管理行为,有利于消除食管癌患者的疾病不确定感,避免术后谵妄,从而改善术后生活质量.
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