The Study Of Application Of Orem Support-education System To Breast Cancer Patients’ Self-managementduring Chemotherapy

Objective:Explore diary therapy and Orem support-education system’s influence on the breastcancers’ physical and mental health and self-management ability. Through the diarytherapy, we can know the breast cancers’ psychology and physical problems duringchemotherapy and build a feasible and effective self-management model.Methods:Chosen from patients hospitalized in cancer center, the first hospital of jilinuniversity from May2012to February2013,80cases of patients with postoperativebreast cancer chemotherapy period were divided into experimental group and controlgroup with40cases in each, according to random letters. When the second and sixthchemotherapy, we use SCL-90(anxiety, depression and body) to assess patients’ state ofmind and use Chinese self-management sense measurement scale, C-SUPPH, to assessthe patients’ level of self-management sense to disease.Regularly monitor serum cortisol(Cor) and changes of immune index, IL-2. Study the relativity between mood disordersand immune function, and the relativity between the physical-and-psychology health andself-management ability of breast cancers during chemotherapy. The control group aregiven routine care, and according to self-management and self-requirement, theexperimental group are supported with Orem support-education system model, whichcould offer humanistic psychology support and education. we adopt one-to-oneintervention every time the chemotherapy, each20-30minutes. Patients will bedistributed mission diaries and be told the aim and details of keeping a diaries. Checkpatients’ diaries regularly, and assess patients’ state of mind and physical symptoms.Finally, the data collected will be input into database for statistical analysis respectively. Results:(1) The patients during chemotherapy have more scores of omatization, depression,anxiety factor in SCL–90than domestic norm groups. and the difference is significant,(2) The self-management sense level assessment of breast cancer patients duringchemotherapy shows that12%of patients were in high levels and82.7%in the mediumlevel; Depression and self-management ability to disease showed a negative correlation(r=-0.449~-0.663, P<0.01); After the intervention, the patients’ total and each latitudescores of self-management ability to disease, in the intervention group, were comparedwith the scores in the control group. And the differences were statistically significant (P <0.001);(3) Breast cancer patients’ on chemotherapy serum Cor levels, in the interventiongroup,were significantly lower than the control group (P<0.01),and the differences werestatistically significant.IL-2testing results were significantly higher than control group (P<0.01), withsignificant statistical significance.Show that comprehensive nursing intervention caneffectively improve patients’ psychological status and improve their body’s immunefunction.(4)The relativity analysis of the patients’ SCL-90scores in the breast cancerchemotherapy and immune function: the scores of Cor and SCL-90were positivelycorrelated; and the scores of Cor were negatively correlated with that of IL-2.Draw aconclusion that the higher scores of SCL-90are, the worse the psychological condition,the more psychological problems,the lower the immune function.(5)Through the multiple factor correlation analysis: Cor and IL-2are significantlynegatively correlated （P＜0.05）,and anxiety and depression are significantly positivelyrelated（P＜0.05）.Conclusion:(1)The Education Supporting system of Orem self-care mode is feasible andeffective to promote the patients’ self-management in the breast cancer chemotherapy; (2)The self-management intervention can arouse the activity of the breast cancerpatients and their family members, help them cooperate with the medical staff activitily,reduce patients’ adverse reactions, make the whole chemotherapy scheme smoothly, andimprove the patients’ quality of life;(3) Diary therapy, is the bridge of medical staff and patients to communicateeffectively.It can not only provide the medical staff with a large number of breast cancerpatients’ psychological problems during chemotherapy, but release the patients’ innerdepressive emotion, which will help ease the pressure more effectively;(4)The diary records the progress of the illness and the situation of alleviation andseveral new problems in daily life. Doctors can timely grasp the health condition ofpatients, know the problems in the treatment, and psychological problems patients face,correct cognitive errors, help the patient solve practical problems better and enhanceconfidence and courage to conquer the disease.(5) The correlation analysis showed：There is a negative relationship between SCL-90patients with somatization, depression, anxiety and self-management self-efficacydimensions（P＜0.01），. Among them, the strongest correlation of anxiety and depressionwith the score of self-efficacy scores.