按需护理层级模式对临终关怀层级护理干预患者生命质量和态度的影响  

Influence of need-based nursing hierarchy mode and palliative care hierarchy nursing intervention on patients＇ quality of life and attitude

作　　者：田宝文[1] 张国艳[2] 王静[3] 张强华[4] 戚晓华[5] 刘桂芳[6] 赵海丰[7] 朱劲松[1] 

机构地区：[1]佳木斯大学附属第一医院科研科,154003 [2]佳木斯大学附属第一医院肾内科,154003 [3]佳木斯大学附属第一医院护理部,154003 [4]佳木斯大学附属第一医院麻醉科,154003 [5]佳木斯大学附属第一医院护理教研室,154003 [6]佳木斯大学附属第一医院耳鼻喉科,154003 [7]佳木斯大学附属第一医院肿瘤放化疗科,154003

出　　处：《中华现代护理杂志》2016年第3期309-313,共5页Chinese Journal of Modern Nursing

基　　金：黑龙江省教育厅科学技术研究项目（12531709）

摘　　要：目的 构建一种理想的临终关怀护理模式并应用于临床,以期改善肿瘤患者临终期生命态度与生命质量.方法 对同期住院的肿瘤中晚期患者分为观察组（96例）和对照组（101例）,观察组应用改良的层级护理模式,对照组应用常规疾病护理模式.干预前后应用生命质量评定量表（QLQ-C30）、死亡态度描绘量表（DAP-R）、住院患者焦虑抑郁量表（HAD）和护理需求调查表对两组患者进行评估并比较.结果 两组患者干预前QLQ-C30、HAD评分比较差异无统计学意义,不同护理模式护理干预后除疼痛症状外,层级护理观察组均优于常规护理对照组（P〈0.05）,干预组对死亡恐惧维度高度认同者显著减少,自然接受维度高度认同者增加（P〈0.01）,死亡逃避和逃离接受维度,观察组较对照组认同度降低（P〈0.05）.结论 按需层级护理模式既能在一定程度上改善临终患者的生命质量,又能减轻患者面对死亡逼近时的恐惧和逃避心理.Objective To build an ideal palliative nursing care mode and apply into the clinical practice, in order to improve the tumor patients＇ quality of life and attitudes during their terminal stages. Methods The study investigated 197 advanced tumor patients and divided them into observation group （ n=96） and control group （n=101）. The patients of observation group received developed hierarchy nursing mode and the patients of control group received normal nursing care. The results before and after the intervention were compared according to the assessment scale of quality of life （ QLQ-C30 ） , the assessment scale of attitude towards death （DAP-R）, and the assessment scale of patients＇ anxiety and depression （HAD）, and nursing needs investigation. Results Before the intervention, the scores of QLQ-C30 and HAD were no statistical difference;however, after the intervention, the scores in the observation group were obviously better than that in the control group, except for painful symptoms （P〈0. 05）. In the observation group, fewer patients were afraid of death and more of them showed their acceptance compared with the control group （P〈0. 01）. Moreover, the patients of observation group performed less escape from death than that of the control group （P 〈0. 05）. Conclusions Need-based nursing hierarchy mode is a great palliative care mode in order to improve the terminal patients＇quality of life, and reduce the fear and psychological escape of death.

关 键 词：肿瘤 临终医护 生命质量 需要 层级 生命态度 

分 类 号：R48[医药卫生—临床医学]