| Objectives:To investigate the Self-care of Colorectal Cancer Patients with Permanent Stoma in early stage of hospitalized patients; to formalize the self-care management of stoma manual and meatures; to determine the effects of Transtheoretical Model Intervention(TTMI) and Motivational Interviewing(MI) in the view of positive phychology on stoma patients; to evaluate the effects of intervention on self-care management (the Stage of Chang,the Process of Chang,Decisional Balance,Self-efficacy),the Stoma Self-Efficacy,the self-care skill of stoma,the self-esteem,the quality of life.Methods:It was an Randomized controlled trial study. After the formaliztion of the manual and meatures,94hospitalized patients with stoma in the second Xiang-Ya hospital, the tumour hospital of Central South University were selected to be samples. They were randomly divided into two groups,47in the control group and47in the intervention group. Subjects in the intervention group were given the manual and received intervention which including TTMI four times and MI two times which is in view of positive phychology separately in addition to routine care in hospital, the one month and three month were given to the intervention group; while those in the control group were given routine care only. The outcome of self-care management (the Stage of Chang,the Process of Chang、Decisional Balance、Self-efficacy),the Stoma Self-Efficacy,the self-care skill of stoma,the self-esteem,the quality of life were evaluated at basic lineT,the time before leave hospitalT0,1monthT1,3monthT3,6month T6to analyze the effects of intervention.Results1. The baseline results showed that the average score of the Stoma Self-Efficacy,the esteem and the self-care skill was very low of Colorectal Cancer Patients with Permanent Stoma in early stage of hospitalized patients.(1) The Stoma Self-Efficacy and the self-care skill of stoma Repeated measures analysis of variance showed that main intervention effect and main time effect on the Stoma Self-Efficacy and the self-care skill was significant (P<0.05); there was significant interaction between time and intervention, and interaction diagram indicated that the increase degree of the Stoma Self-Efficacy and the self-care skill was higher in intervention group than that of control group over time after intervention.Compared the level of the Stoma Self-Efficacy and the self-care skill at different times in both group, the significantly different at T1,T3,T6(P<0.05). Compared the level of Stoma Self-Efficacy and the self-care skill for the patients in intervention group at T, T0, T1,T3and T6, the levels of Stoma Self-Efficacy and the self-care skill were significantly different between those at every times(P<0.05).(2) Self-care management of stoma processχ2test results showed that the stages of change at different times in both group were significantly different at T1,T3,T6(P<0.05).The Friedman M test in the intervention group showed were significantly different between those at every times(P<0.05).Repeated measures analysis of variance showed that main intervention effect and main time effect on the Decisional Balance, Process of Change and Self-efficacy were significant (P<0.05); there was significant interaction between time and intervention, and interaction diagram indicated that the increase or decrease degree of the on the Decisional Balance, Process of Change and Self-efficacy was higher in intervention group than that of control group at every times.Compared the level of the Decisional Balance, Process of Change and Self-efficacy at different times in both group, the levels of Decisional Balance, Process of Change and Self-efficacy were significantly different at T0,T1,T3and T6(P<0.05). Compared the level of Decisional Balance, Process of Change and Self-efficacy for the patients in intervention group at T,T0,T1,T3and T6.the levels of the scores of Cons, Cognitive Processes, Behavioral Processes and Self-efficacy were significantly different (P<0.05), the scores of Pros were not significantly different (P>0.05) at T0and T1,T0and T3,T1and T3. (2) self-esteem,the duration of the stama chassis fixing, quality of lifeRepeated measures analysis of variance showed that main intervention effect and main time effect on the self-esteem was significant (P<0.05); there was significant interaction between time and intervention, and interaction diagram indicated that the increase degree of the self-esteem was higher in intervention group than that of control group over time after intervention. Compared the level of the self-esteem at different times in both group,the levels of self-esteem were significantly different at T1, T3, T6(P<0.05). Compared the level of self-esteem for the patients in intervention group at T, T0, T1,T3and T6, the levels of self-esteem was significantly different between those at every times(P<0.05),except the appearance esteem and the social esteem was was not significantly different at at T and T0(P>0.05).Repeated measures analysis of variance showed that main intervention effect and main time effecon the duration of stoma chassis fixing was significant (P<0.05); there was not significant interaction between time and intervention(P>0.05), and interaction diagram indicated that the increase degree of the the duration of stoma chassis fixing was higher in intervention group than that of control group over time after intervention. Compared the level of the duration of stoma chassis fixing at different times in both intervention and control group, the levels of the duration of stoma chassis fixing were significantly different at T1,T3, T6(P<0.05). Compared the level of self-esteem for the patients in intervention group at T1,T3and T6, the levels of the duration of stoma chassis fixing was significantly different between T1and T3,T1and T6(P<0.05).Repeated measures analysis of variance showed that main intervention effect on the all aspects quality of life except gastrointestinal symptom,the confidence of satisfaction to Sex,Concerns about to future health、the side effects of chemotherapy was significant (P<0.05); the main time effect on the aspects all quality of life was significant(P<0.05); there were significant interaction between time and intervention on all aspects quality of life except social function,Nausea and vomiting, loss of appetite, diarrhea,gastrointestinal symptom、Concerns about to future health^Urinary symptoms,the confidence of satisfaction to Sex,the side effects of chemotherapy(P<0.05);and interaction diagram indicated that the increase or decrease degree of the on all aspects were higher in intervention group than that of control group.Compared the level of the all aspects quality of life at different times in both intervention and control group, the levels of all aspects quality of life at T,the Shortness of breath symptom,the side effects of chemotherapy and the confidence of satisfaction to Sex at T1,T3and T6、concerns about to future health and Nausea and vomiting at T3and T6and gastrointestinal symptom at T6was not significantly (P>0.05),the other aspects of quality of life was significant(P<0.05).Conclusion1. the average score of the Stoma Self-Efficacy、the self-care skill and the esteem were very low of Colorectal Cancer Patients with Permanent Stoma in early stage of hospitalized patients.2. Transtheoretical Model Intervention (TTMI) and Motivational Interviewing (MI) in the view of positive phychology can improve the level of the Stoma Self-Efficacy,the self-care skill and the esteem,what’more,it can longer the duration of the stoma chassis fixing.3. Transtheoretical Model Intervention (TTMI) and Motivational Interviewing (MI) in the view of positive phychology can improve most aspects of quality of life of Colorectal Cancer Patients with Permanent Stoma.4. TTMI and MI in the view of positive phychology can lead the self-care of stoma management stages of change to move forward; can improve the Pros and reduce the Cons; increase the Cognitive Processes and Behavioral Processes; also can improve the Self-efficacy of Colorectal Cancer Patients with Permanent Stoma. |
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