發(fā)布時(shí)間：2018-01-07 12:37

  本文關(guān)鍵詞：乳腺癌患者生命意義感、經(jīng)驗(yàn)性回避與創(chuàng)傷后成長(zhǎng)水平的縱向調(diào)查　出處：《大連醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

  更多相關(guān)文章： 乳腺癌 生命意義感 經(jīng)驗(yàn)性回避 創(chuàng)傷后成長(zhǎng)

【摘要】：研究目的(1)初步探索乳腺癌患者的生命意義感、經(jīng)驗(yàn)性回避以及創(chuàng)傷后成長(zhǎng)的現(xiàn)狀及其隨時(shí)間的動(dòng)態(tài)變化;(2)初步探索乳腺癌患者不同疾病階段生命意義感、經(jīng)驗(yàn)性回避與創(chuàng)傷后成長(zhǎng)的相關(guān)關(guān)系;(3)為臨床上更有效地激發(fā)創(chuàng)傷后成長(zhǎng)從而恢復(fù)和提升乳腺癌患者的身心機(jī)能提供有益的指導(dǎo)。研究方法運(yùn)用方便抽樣的方法抽取2015年9月-2016年9月于大連醫(yī)科大學(xué)附屬第一醫(yī)院就診且初次確診為原發(fā)性乳腺癌,擬行乳腺癌簡(jiǎn)化根治術(shù)、術(shù)后常規(guī)化療的患者80例。研究工具包括一般資料調(diào)查表(General Information Questionnaire)、生命意義感量表漢化版(China Meaning in Life Questionnaire,C-MLQ)、接納與行動(dòng)問(wèn)卷第二版(Acceptance Action Questionnaire,AAQ-II)以及創(chuàng)傷后成長(zhǎng)評(píng)定量表(Chinese-post-traumatic growth inventory,C-PTGI)。于手術(shù)前一天(T_1)向患者介紹本次調(diào)查研究的目的、意義及配合要點(diǎn),待患者同意后,簽署知情同意書,隨后,發(fā)放本課題的研究者設(shè)計(jì)的一般資料調(diào)查表,C-MLQ,AAQ-II與C-PTGI量表進(jìn)行問(wèn)卷調(diào)查;分別于手術(shù)后第三天(T_2)、術(shù)后28天即患者第一次化療期間(T_3)以及患者完成末次(第四/六/八次)化療期間(T_4)發(fā)放C-MLQ,AAQ-II與C-PTGI量表進(jìn)行縱向調(diào)查。問(wèn)卷當(dāng)場(chǎng)發(fā)放,當(dāng)場(chǎng)收回,建立醫(yī)患交流微信群,以利于回答患者治療和康復(fù)期間的問(wèn)題,便于與研究對(duì)象形成良性的護(hù)患關(guān)系,體現(xiàn)人性化與個(gè)性化護(hù)理;大幅度改善患者的依從性。雙人錄入所得數(shù)據(jù),通過(guò)SPSS19.0統(tǒng)計(jì)軟件進(jìn)行數(shù)據(jù)的整合、處理和分析。應(yīng)用的統(tǒng)計(jì)方法包括(1)描述性統(tǒng)計(jì)分析、(2)X2檢驗(yàn)、(3)單因素方差分析和獨(dú)立樣本T檢驗(yàn)、(4)重復(fù)測(cè)量方差分析、(5)Pearson相關(guān)分析、(6)多元線性回歸方程等統(tǒng)計(jì)分析方法。結(jié)果1.乳腺癌患者生命意義感水平的動(dòng)態(tài)變化情況本研究選取的80例乳腺癌患者T_1生命意義感得分為47.08±9.44,其中存在生命意義感得分為27.44±5.73,尋找生命意義感得分為19.64±4.66;T_2時(shí)間段患者的生命意義感總分為49.21±7.66;T_3時(shí)間段的得分為44.99±9.88;T_4為49.81±9.31,經(jīng)重復(fù)測(cè)量方差分析得知四次生命意義感總分呈現(xiàn)出波動(dòng)性上升的變化且差異顯著(P0.05)。2.乳腺癌患者經(jīng)驗(yàn)性回避的動(dòng)態(tài)變化情況經(jīng)調(diào)查可得乳腺癌患者T_1時(shí)間段經(jīng)驗(yàn)性回避得分為18.51±7.19;T_2得分最高,為19.21±9.72;T_3時(shí)期得分為18.01±6.91;T_4時(shí)期得分最低,為15.65±5.58。經(jīng)重復(fù)方差測(cè)量可知乳腺癌患者四個(gè)時(shí)間段的經(jīng)驗(yàn)性回避水平差異具有顯著意義,除手術(shù)后經(jīng)驗(yàn)性回避得分略高于手術(shù)前外,大體呈現(xiàn)逐步下降趨勢(shì)。3.乳腺癌患者創(chuàng)傷后成長(zhǎng)的動(dòng)態(tài)變化情況80例研究對(duì)象T_1-T_4的創(chuàng)傷后成長(zhǎng)得分依次為:83.04±20.90;62.84±19.21;59.58±13.78;67.85±13.51。數(shù)據(jù)顯示患者的創(chuàng)傷后成長(zhǎng)呈現(xiàn)出先下降后上升的趨勢(shì),T_3(第一次化療)時(shí)期創(chuàng)傷后成長(zhǎng)水平最低,而隨著治療的進(jìn)行,患者的創(chuàng)傷后成長(zhǎng)逐步提升,且差異具有統(tǒng)計(jì)學(xué)意義(P0.05)。4.乳腺癌患者生命意義感、經(jīng)驗(yàn)性回避與創(chuàng)傷后成長(zhǎng)的相關(guān)性分析對(duì)乳腺癌患者的生命意義感、經(jīng)驗(yàn)性回避與創(chuàng)傷后成長(zhǎng)進(jìn)行Pearson相關(guān)分析得乳腺癌患者的生命意義感與創(chuàng)傷后成長(zhǎng)呈正相關(guān),r=0.470,0.513,0.416,0.640,T_2時(shí)間段乳腺癌患者的生命意義感總分與經(jīng)驗(yàn)性回避成負(fù)相關(guān),r=-0.36(P0.01);將生命意義感與創(chuàng)傷后成長(zhǎng)進(jìn)行多重線性回歸分析可得R2=0.203,0.244,0.156,0.399(P0.01),預(yù)示乳腺癌患者的生命意義感是創(chuàng)傷后成長(zhǎng)的影響因素。結(jié)論1.診斷、手術(shù)與化療階段乳腺癌患者的生命意義感呈波動(dòng)性上升,在第一次化療時(shí)生命意義感得分最低,而后逐漸升高,直至化療末期生命意義感最高,表明患癌這一事實(shí)可能使患者生命意義感下降,在手術(shù)與第一次化療階段表現(xiàn)的最為明顯,而隨著化療的進(jìn)行,患者的生命意義感逐步提升;故醫(yī)務(wù)人員應(yīng)加強(qiáng)對(duì)術(shù)后與第一次化療期患者生命意義感的干預(yù);2.乳腺癌患者除手術(shù)后經(jīng)驗(yàn)性回避得分略高于手術(shù)前外,乳腺癌患者的經(jīng)驗(yàn)性回避程度逐漸下降,表明隨著時(shí)間的流逝,患者能夠正視疾病,自我接納的程度逐步提高,醫(yī)務(wù)人員應(yīng)重點(diǎn)關(guān)注術(shù)后患者的經(jīng)驗(yàn)性回避,并進(jìn)行合理的指導(dǎo);3.乳腺癌患者的創(chuàng)傷后成長(zhǎng)呈現(xiàn)先下降后上升的趨勢(shì),表明手術(shù)及化療會(huì)對(duì)患者的創(chuàng)傷后成長(zhǎng)造成一定的影響,但隨著治療的順利進(jìn)行,患者的創(chuàng)傷后成長(zhǎng)呈上升趨勢(shì),表明手術(shù)及化療階段醫(yī)務(wù)人員對(duì)其進(jìn)行的健康宣教等護(hù)理干預(yù)能提升患者創(chuàng)傷后成長(zhǎng)水平;4.乳腺癌患者的生命意義感是創(chuàng)傷后成長(zhǎng)影響因素,提高患者的生命意義感有助于提高患者的創(chuàng)傷后成長(zhǎng)。
[Abstract]:The purpose of the study is to explore (1) breast cancer patients with the sense of the meaning of life, the dynamic change situation of experiential avoidance and post-traumatic growth and over time; (2) a preliminary exploration of breast cancer patients in different stages of life meaning, experiential avoidance relationship with posttraumatic growth; (3) provide a useful guide to to restore and improve the physical and mental function of breast cancer patients for clinical more effectively stimulate posttraumatic growth. Research methods used convenient sampling methods from September 2015 -2016 year in September in the First Affiliated Hospital of Dalian Medical University hospital and diagnosed as primary breast cancer, breast cancer underwent simplified radical operation, 80 cases received chemotherapy after operation. The research tools included general information questionnaire (General Information Questionnaire), the meaning of life scale Chinese Version (China Meaning in Life Questionnaire, C-MLQ), acceptance and action The questionnaire (Acceptance Action version second Questionnaire, AAQ-II) and post-traumatic growth Rating Scale (Chinese-post-traumatic growth inventory, C-PTGI). On the day before surgery (T_1) were introduced to the research purpose, significance and matching points, when the patients consent signed informed consent, then design and research grant the general information questionnaire, C-MLQ, AAQ-II and C-PTGI questionnaire; respectively in third days after surgery (T_2), the 28 day postoperatively in patients during the first chemotherapy (T_3) and the patients completed the last (fourth / six / eight) during chemotherapy (T_4) issued C-MLQ. AAQ-II and C-PTGI scale longitudinal survey questionnaires were distributed and collected on the spot, the establishment of doctor-patient communication WeChat groups, in order to answer patients during treatment and rehabilitation, to facilitate the formation of benign relationship between nurse and the object of study, reflect the humanity and Individualized nursing care; improve patient compliance greatly. The data of double entry, data integration through SPSS19.0 statistical software, processing and analysis. The application of statistical methods including descriptive statistical analysis (1), (2) X2 (3) test, single factor variance analysis and independent sample T test, (4) repeated measurement of variance analysis, Pearson correlation analysis (5), (6) multiple linear regression equations and statistical analysis method. The dynamic change of the meaning of life in 1. breast cancer patients. The level of this study selected 80 cases of breast cancer patients with T_1 sense of the meaning of life score was 47.08 + 9.44, the sense of the meaning of life score of 27.44 5.73, find the meaning of life score was 19.64 + 4.66; T_2 time with sense of the meaning of life score was 49.21 + 7.66; T_3 time score was 44.99 + 9.88; T_4 = 49.81 + 9.31, the repeated measures analysis of variance was four times the meaning of life The total score showed rising volatility changes and the difference was significant (P0.05) the dynamic changes of breast cancer patients with.2. experience can be avoided through the investigation of breast cancer patients with T_1 time period of experiential avoidance score was 18.51 + 7.19; the highest score is 19.21 + T_2, 9.72; T_3 score was 18.01 + 6.91 T_4 period; the lowest score, significant is 15.65 + 5.58. by repeated variance measured in patients with breast cancer in four periods of experiential avoidance level difference, except the operation after the experiential avoidance scores slightly higher than before surgery, generally presents the dynamic changes of a declining trend in.3. breast cancer patients with posttraumatic growth of 80 cases of T_1-T_4 studied posttraumatic growth score as follows: 83.04 + 20.90; 62.84 + 19.21; 59.58 + 13.78; 67.85 + 13.51. data showed that patients with posttraumatic growth showed a upward trend after the first drop, T_3 (for the first time a period of chemotherapy) After injury, the lowest level of growth, and with the treatment, patients with posttraumatic growth increased gradually, and the difference was statistically significant (P0.05) in patients with breast cancer.4. the sense of meaning of life, experiential avoidance and posttraumatic growth correlation analysis of breast cancer patients with the sense of the meaning of life, experiential avoidance and posttraumatic growth by Pearson analysis to breast cancer patients life meaning and posttraumatic growth was positively related to r=0.470,0.513,0.416,0.640, T_2 period in patients with breast cancer the meaning of life scores and experiential avoidance negatively related to r=-0.36 (P0.01); the meaning of life and posttraumatic growth were analyzed using multiple linear regression analysis was R2=0.203,0.244,0.156,0.399 (P0.01) in patients with breast cancer, indicating the meaning of life is the influencing factors of posttraumatic growth. Conclusion 1. diagnosis, surgery and chemotherapy for breast cancer patients life meaning sense of a wave Dynamic rise during the first chemotherapy when the meaning of life the lowest score, and then gradually increased until the end of chemotherapy, the meaning of life, shows the fact that cancer patients may make sense of the meaning of life decline, in the first stage of surgery and chemotherapy is the most obvious, but with the chemotherapy of patients with the meaning of life feeling gradually increased; therefore medical staff should strengthen the meaning of life and the first postoperative patients sense of intervention; 2. breast cancer patients after surgery in addition to experiential avoidance scores slightly higher than before surgery, breast cancer patients showed that the degree of experiential avoidance decreased gradually with the passage of time, patients can face disease, self acceptance gradually increase the level of medical personnel, should focus on the postoperative patients with experiential avoidance and reasonable guidance; and 3. breast cancer patients with posttraumatic growth decreased first and increased later, That surgery and chemotherapy will cause a certain impact on the patients with posttraumatic growth, but with the success of treatment, patients with posttraumatic growth showed an upward trend, that of the surgery and chemotherapy stage medical personnel health education and nursing intervention can improve patients with posttraumatic growth; 4. patients with breast cancer of the meaning of life is posttraumatic growth factors, improve the patient's sense of the meaning of life is helpful to improve the patients with posttraumatic growth.

【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R473.73

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