| Objective1. To study the status quo of comfortable condition and the quality of life of patients withPercutaneous Transhepatic Cholangial Drainage.2. To explore the application effect of the comfortable nursing in patients withpercutaneous liver puncture catheter drainage.Methods1. General Comfort Questionnaire and the MOS-36-item Short Form Health Survey wereconducted among103parents with Percutaneous Transhepatic Cholangial Drainage fromMarch2013to December2013in a upper first-class general hospitals.2. Eighty-one patients meeting the inclusion criteria, selected by convenience sampling,were divided into intervention group and control group,41patients in the control group,40patients in the intervention group, according to the chronological order of admission. Thecontrol group with reference to the guidelines for clinical nursing practice of2011editionimplemented routine nursing care. Intervention group, on the basis of conventional nursing,employed comfortable theory to assess the patient’s need for comfort, determined the relateduncomfortable factors, formulated and implemented corresponding nursing plan. Then GCQwas adopted to evaluate the patients’ condition. These procedures would continue until therewas improvement in patients’ uncomfortable state.During the initial admission and beforedischarge of patients, patient, GCQ and SF-36were distributed to patients, followed by on-siteinquiry investigation.3. Statistical analysis: Using SPSS17.0for data entry analysis. Measurement data wasrepresented by with x±s, compared using Independent sample t test (or rank sum test), one-way ANOVA analysis etc. Pairwise comparison between average number of diverse usedBonferroni method (homogeneity of variance) or Dunnett’s T3(heterogeneity of variance) test. Correlation analysis using Pearson correlation analysis or Spearman rank correlation analysis.The relationship between linear number used multiple regression analysis. Count data werecompared using chi-square test, nonparametric test or Fisher’s exact test.Results1. Patients with PTCD comfort conditions overall scored61.57±8.068points. For theaverage score of each entry, the physiological dimension scored lowest (1.77±0.419points),followed by the psychological dimension (2.09±0.386points) and environmental dimensions(2.17±0.231points) lower. The social dimension scored relatively high (2.73±0.269points).2. Analysis of factors affecting PTCD patient’s comfort conditions: family location(Beta=0.321) and religion (Beta=0.200) were the main factors affecting the status of patientcomfort. There was better comfort in the religious patients who resided in the city.3. Quality of life in patients with PTCD overall score77.99±11.296points. The averagescore for each dimension of entries: physical health aspects of physiological function (PF)dimension of the lowest score (4.35±1.954points), followed by the physiological function (RP)dimensions (5.52±3.744points); mental health, mental health (MH) dimension of the lowestscore (8.40±2.078points), followed by the vitality (VT) dimensions (9.12±2.782points).4. Analysis of factors affecting the quality of life in patients with PTCD The patient’sage (Beta=-0.472), smoking history (Beta=-0.169), comfort score (Beta=0.560) were the mainfactors affecting the quality of life in patients score. The greater the patient’s age was, withsmoking history, the lower their comfort total points scored, the lower the quality of their liveswould score. In addition, correlation analysis showed that the total score of each dimensionGCQ scores and overall quality of life scores and PF, VT, SF, MH dimension scores weresignificantly positive correlation; GCQ total score and the physical, psychological, social andBP scores of the scores were positively correlated; GCQ total score and scores of physiologicaland RE scores of positive correlation; GCQ physiological dimension scores and the scores werepositively correlated GH.5. In the early admission, comfortable condition score of two groups of patients were60.02±6.909points and62.30±8.624points respectively; before patients were discharged,control group scored72.17±10.833points, intervention group82.03±4.560points. There was improvement of patient’s comfort condition score (F=9.692,0.003) in both two groups.However, increase (F=17.769, P＜0.001) in intervention group was higher than that in controlgroup.6. In the initial admission, the patient’s quality of life scores of the two groups showed nosignificant difference in the control group77.510±11.134points and the intervention group77.99±10.806points; before patients were discharged, control group scored82.95±10.156points, the intervention group94.61±9.650points. Two groups of patients’ quality of life scoreswere improved (in the group F=14.843, P＜0.001), but increase in the intervention group wasgreater than that in the control group (F=9.690, P=0.003).7. Hospitalization days of patients in the control group were more than those in theintervention group. The difference was statistically significant (P <0.05).8. During hospitalization, the incidence rate of complications associated pipeline controlgroup of patients with multi-drug resistant infections and the incidence rate were both higherthan those of patients in the intervention group. The difference was statistically significant(χ2=7.903,6.896; P=0.032,0.033).Conclusion1. The condition survey of comfort in patients with PTCD shows that physiologicaldimension of comfort was the worst conditions, followed by psychological and environmentaldimensions, and the social dimension of comfort in relatively good condition. Therefore, in thecare process, medical care should focus on improving patients’ discomfort in the physicalaspects, patient’s psychological care and hospital environment.2. The condition survey of quality of life in patients with PTCD, showed that physicalhealth physiological function (PF) and physiological functions of the dimension (RP)dimension score lowest in physical health; mental health (MH) dimension scores lowest inmental health. Therefore, it is of significance to alleviate patients’ physiological andpsychological discomfort for improving patient’s quality of life. Furthermore, in nursingpractice, attention should focus on satisfaction of patients’ physiological and psychologicalneeds and improvement in all their physiological aspects.3. Comfort care should focus on improving the patient’s physical discomfort, but also pay attention to anxiety due to concerns about disease prognosis, treatment and economicconditions and other causes, depression and other negative psychological feelings. Especiallyfor low-income younger patients with malignancy, they should be given more psychologicalcounseling to enhance their confidence in overcoming the disease. Elderly patients, mostly inthe end stage of the disease, are not optimistic about disease prognosis. Thus, efforts should bemade to strengthen primary care, improve their daily living conditions, encourage family andgood companionship and to visit friends and family, to give its support, spiritual, psychologicaland social aspects, so that the elderly get the greatest degree of satisfaction on a psychologicallevel.4. Comfort care can not only reduce the number of hospitalization days, but also canreduce pipeline-related complications and the incidence of multi-drug resistant infections. Withcomfort care theory applied to nursing practice, all-around holistic nursing is provided forpatients. Furthermore, it fully takes into account individual patient factors and providespersonalized care interventions and more targeted solutions related to patient care issues,making patients more actively cooperate with treatment and care, so that it has played apositive role in treatment and prognosis of patients.5. Improving the comfort of patient can enhance patients’ quality of life. Studies haveshown that comfort condition of patients and their quality of life are positively correlated.Therefore, it can enhance the quality of life of patients through improvement of patients’comfort condition in physical, psychological, social and environmental aspects. |
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