| BackgroundThe world health organization (WHO) issued the basic practice guidelines for the prevention and control of cervical cancer (second edition):cervical cancer is one of the world’s most deadly but the easiest to prevent. According to retrospective investigation from 29 provinces, municipalities, autonomous regions in our country, it’s analysis results show that cervical cancer is the fourth mortality of total cancer mortality and second most common cause of female cancer mortality, morbidity among the top of the female malignant tumors. Worldwide, there are over 27 million people die of cervical cancer, of which up to 83% of morbidity and 85% of mortality. With recent decades, the universal application of cervical cytology screening techniques, most cervical cancer was diagnosed at an early stage, so that to early treatment and care, at present, the incidence and mortality of cervical cancer rate has decreased significantly. National Comprehensive Cancer Network (NCCN) states: early stage and smaller lesions in patients, surgery is the preferred treatment. As long as early detection, early treatment, cervical cancer is completely curable. After surgery for early diagnosis and treatment, early cervical cancer patients would survival period of more than 20 years. Unlike other malignant tumor, cervical cancer, as occurred in the female reproductive system, is a special kind of parts of the malignant lesions, effects to the structure of the female patients and their families and the psychological fear and obstacles are not less than surgery itself caused by trauma, by the way, effects on reproductive and sexual function also not allow to ignore, these complications will seriously affect the long-term quality of life of patients and family functioning condition. As patients with early cervical cancer, psychological factors and sex and reproduction should be more prominent and obvious, therefore, how to improve early postoperative mortality in patients with cervical cancer by nursing method of long-term quality of life and family functioning condition is a big problem, but also the general nursing researchers’voice. Family nursing intervention is generated by the economic development of a new type of nursing intervention method, it makes the nursing work from the hospital to the family, society, it is an emphasis on participation of medical staff, patients and their families in every way, a kind of long-term health promotion behavior of nursing intervention. In recent years, the family nursing intervention in coronary heart disease, chronic obstructive pulmonary disease, chronic renal failure, and diabetes, schizophrenia is fully affirmation, the value of its long-term physiology, psychological problems, family function and quality of life have positive coverage.In summary, the patient’s quality of life and family function after surgery for cervical cancer early need mutual concern and attention from health care workers. However, by now, there is no comprehensive report related literature at home and abroad in early postoperative patients with cervical cancer using the family nursing intervention to improve the postoperative quality of life for a long time, improve the function of family studies, therefore, the purpose of this paper is to explore the family nursing intervention in patients with early cervical cancer postoperative quality of life and the influence of family functioning, and analyze the function of family type distribution, and to provide certain guiding basis for the future clinical use of family nursing intervention measures.Obstruct1. This research based on early postoperative patients with cervical cancer, to carry out targeted family nursing intervention, by patient quality of life scores before and after the intervention, the family function score and the change of family structure and distribution types, in order to improve the long-term quality of life of patients, family function and optimize the structure of family type.2. Based on the postoperative patients with early cervical cancer, through the analysis of health need and possible problems and judgment, and from the nursing team, psychological intervention and rehabilitation exercise, family education and follow-up and so on various aspects to strengthen and develop a set of health promoting nursing intervention mode through the intervention period of 6 months, evaluating the effectiveness of its prognostic result, hope to find and establish a reasonable and effective individualized family nursing intervention methods, based on the thinking and optimize the optimal disadvantages of this method, for the future clinical use of family nursing intervention measures to provide a certain amount of research basis and guidance.MethodsThis cross-sectional survey was performed from December 2012 to April 2014 in two gynecologic oncology wards in hospitals in Guangdong province, all 244 patients were diagnosed as early(Ⅰ～Ⅱa stage). Using simple random sampling method, all the cases were divided into two groups, the family nursing intervention group and normal control group, control group accepted routine nursing care, no special nursing measures and guidance after discharge; Family nursing intervention group (hereinafter referred to as the intervention group) on the basis of conventional nursing after discharge to implement family nursing intervention, intervention content mainly includes:1. Establish a family nursing intervention group; 2. The guide for a long time in physiological function rehabilitation training:namely kegel pelvic floor muscle exercise; 3. Guide the learning mood release management movement method: simple and easy method of yoga, tai chi, jogging, mountain climbing and so on; 4. Attach great importance to the role of informal social support system:synchronous education on patients and patients’ family members, friends, the establishment of patients into each other; 5. To strengthen the follow-up system. This study introduced the quality of life score, type of family function score and family function for evaluating indicators, using the general information questionnaire, family cohesion and adaptability Scale Chinese version (FACES II), function in patients with cervical cancer Assessment Scale (FACT-Cx) to investigate patients.The intervention period is 6 months. In the postoperative 1 week before leaving hospital ratings as the basis before the intervention,6 months after discharge ratings as after the intervention. All the information collected will be double entry, using SPSS 17.0 software package for data statistical analysis (inspection level alpha= 0.05), and for general information, including cervical cancer patient demographic data (degree of disease staging, culture, employment, income, health insurance, etc.) using a ratio, mean and standard deviation for general descriptive statistical analysis. Measurement data to meet the normal distribution are distributed by mean ± standard deviation. To compare differences in the early family cohesion and adaptability with the national norm of cancer patients, single sample t test is be used; paired sample t test were compared in patients with cervical cancer early postoperative intervention one week before the difference between the level of quality of life after six months, Multiple linear regression was employed to analyze the factors affecting uncertainty in illness.Results1. In this study, a total of 244 questionnaires were returned 226 valid questionnaires, the effective recovery rate of 92.62%. Survey respondents aged 27 to 69 years, mean (46.11 ± 8.91) years.2. The data of two groups of patients Χ2 test results show that the two groups in the household registration type (Χ2=2.236, P>0.05)、age (Χ2=1.192, P>0.05)、 education (Χ2=5.874, P>0.05)、family income (Χ2=4.979, P>0.05),and charge source (Χ2=2.722, P>0.05),there is no statistical difference of comparable between the two groups.3. The family nursing intervention on the influence of early cervical cancer postoperative quality of life.1 week after operative, the intervention group (119 cases), quality of life scores (89.43±10.92)、specificity scores (25.85±5.53); Control group (107 cases), quality of life scores (90.07±10.19)、specificity scores (25.56±5.33). T test showed that before the intervention, two groups in terms of dimension of quality of life score and total score had no statistical significance (P>0.05).After 6 months intervention, the paired t test results show that the total quality of life score after intervention group intervention (t=6.906, P=6.906) and cervical cancer specificity scores (t=9.089, P=9.089), the condition of social/family (t=3.559, P=0.000), the emotional state (t=3.298, P=3.298) significant increase, compared with before (P<0.05);And the control group, the quality of life score and each dimension scores had no statistical significance (P>0.05).Two independent sample t test showed that the two groups after intervention quality of life score (101.10±10.524VS91.63±10.039)、specificity scores (32.57±5.543VS26.38±4.688)、 social/family status scores (20.10±3.718VS18.27±4.011)、emotional status scores (17.12±3.756VS 15.37±4.1921) were statistically significant (P<0.05), while in the body condition (16.76±5.325VS16.84±5.831) and functional status (14.55±7.897VS 14.76±7.627) had no statistical difference (P>0.05).4. The family nursing intervention in patients with early cervical cancer postoperative effects of family intimacy and adaptability. Before the intervention, in intervention group, the intimacy score (67.00±7.929), adaptive score (45.86±6.632); In control group, the intimacy score (66.84±8.093), adaptive score (45.89±6.404). Two groups on terms of family intimacy and adaptability score had no statistical difference (t=0.149, P=0.882; t= 0.035, P=0.972), compared with domestic norm family, in the study of early cervical cancer patients with intimacy was higher (t=3.524, P<0.05), lower adaptability (t=3.704, P<0.05); Six months after intervention, in intervention group, the intimacy score (70.25±7.279), adaptive score (49.05±6.011); In control group, the intimacy score (66.70±7.867), adaptive score (46.04±6.210). Intervention group in intimacy and adaptability score were significant increase, compared with before (P<0.05), while the control group intimacy and adaptability score had no statistical difference, compared with before (P>0.05), two groups of intimacy and adaptability score after the intervention were statistically significant (t=3.524, P=0.001; t=3.704, P=0.000).5.1 week before the intervention, there is no statistical differences between the two groups of the family type (Χ2=1.649,P=0.648); Six months after intervention, intervention group in balanced family proportion increased before intervention, less and less extreme type (low) proportion, the difference statistically difference (Χ2 =17.770, P=0.000);While the control group family type distribution of no statistical difference (Χ2=0.393,P=0.942).Before and after the intervention, draw scatter plot, the author found that after intervention in cases of family types mainly embodied in the middle, and extreme type loose-rigid family ratio decreased significantly, in particular, part of the family by loose-rigid type and middle type into balance. In addition, in this study, the two extreme types are divided into two sub-types:extreme type (low) and extreme type (high). Intervention after six months, balanced family in the intervention group increased from 41.2% to 41.2%, the proportion of intermediate type family declined from 52.1% to 52.1%, the proportion of the extreme model (low) decreased from 4.2% to 4.2%, and the proportion of families, however, to my surprise, close through high proportion of extreme families increased from 2.5% to 10.1%.Conclusion1. The family nursing intervention can improve the level of early cervical cancer patients with postoperative quality of life. Family nursing intervention by improving the early cervical cancer patients with postoperative social/family situation, emotional and sexual and reproductive tract conditions so as to ultimately improve the quality of life.2. The family nursing intervention can improve postoperative family function in patients with early cervical cancer. Patients after operative are higher than the general population level of intimacy and lower adaptability. Targeted home nursing intervention mainly by improving the patients’ family care support between consciousness, thus improve the patients in the family intimate degree, on the other hand, the intervention to a certain extent can improve the family’s ability to fight against disease, mainly in the improvement of adaptability.3. The family nursing intervention can improve the structure of family type and postoperative in patients with early cervical cancer. Family nursing intervention can make part of the targeted close through the lower extreme type among family and part of the family into balanced family, significantly increase the balanced family scale, optimize the structure of family type of early postoperative patients with cervical cancer, promote the full play of family functioning.4. The family nursing intervention is an effective and feasible mode of nursing intervention, carried out in patients with early cervical cancer postoperative targeted family nursing intervention can improve the level of quality of life, improve the function of family. Therefore, the family nursing intervention mode should be more in-depth thinking and clinical use. |
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