| Objective:To explore the application and effect assessment of Orem self-care intervention based on the theory of the Orem self-care in oral care of radiotherapy patients with NPC,on the basis of Orem self-care theory we adopted the corresponding nursing intervention measures to improve their self-care ability and the oral condition of radiation and chemotherapy patients with NPC,for clinical medical staff improve the condition of patients oral cavity and the quality of their life to provide the feasible theoretical basis and effective intervention measures.Methods:This research adopted the semi-random design.From October2015 to September 2016,collected 101 cases of radiation and chemotherapy patients with NPC in the first affiliated hospital of guangxi medical university.Divided the patients into two groups according to the ward,that is the control group had 51 cases in the first ward,the experimental group for the second wardof 50 cases.Two groups of patients in gender,age,occupation,cultural level,family economic status,clinical stage,pathological type,and treatment methodswere not statistically significant(P > 0.05),with comparability.The control group shall be carried out the care in accordance with the routine care of Radiotherapy department;the experimental group was taken the theory of Orem self-care intervention based on the theory of the Orem self-care in the whole nursing process,according to patients' self care ability and adopted the corresponding nursing system.Identified patients with existing problems and madecorresponding self care plan,by enabling three nursing system were the compensatory system,partly compensatory nursing system and support-education system to meet their self care needs.In the two groups were collected patients general demographic information,self-care ability,comfort level,quality of life,oral saliva pH value and weight etc before the intervention.The pH value of oral saliva and the pain scores of oral cavity were recorded in the process of radiotherapy every day.We evaluated and recorded the degree ofpatients oral mucositis in different stages of radiotherapy(1-10 times,11-20 times,21 times-end),respectively.After radiotherapy we evaluatedpatients with Self-care ability measure-ment scale(ESCA),quality of life questionnaire-core(QLQ-C30),radiation therapy in patients with head and neck tumors of comfort scale and recorded the result,meanwhilerecorded the patient's weight.We analyzed the Data with the SPSS17.0 statistical software after establishing a database,with P<0.05 wasconsidered statisticallysignificant.Result:1.Comparison of the self care ability in thetwo groups of patients with NPC:(1)Before radiotherapy,the ESCA score average was(82.50±10.31)of the two groups,patients with self-care ability was generally at the intermediate level;(2)The scores of ESCA and four dimensionswere no statistically significant difference(P>0.05)before treatment;(3)After the intervention,the scores of ESCA and four dimensions of the experimental group were higher than that of the control group,the difference was statistically significant(P < 0.05).2.Comparison of the incidence,reaction degree and pain scoresbetween two groups of patients with oral mucositis:(1)Theincidence of oral mucositis of experimental group patients was higher than that of the control group,the difference was statistically significant;(2)Before radiotherapy,two groups of patients with oral cavity in good condition,without oral mucositis and pain,with comparability;(3)In the process of radiotherapy(Radiotherapy 1-10 times,11-20 times,20 times-end),the experimental group patients with oral mucositis reaction degree was lighter than the control group remained statistically significant(P<0.05);(4)With the extension of radiation time,patients with oral pain intensified,the pain scoresof experimental group was lighter than that of the control group.Two groups of patients with pain scores difference was statistically significant(P < 0.05),starting from the 4th radiotherapy.3.Comparison of oral saliva pH value between two groups of patients:(1)Before radiotherapy,the oral saliva pH value of control group and experimental group were(6.70±0.25)and(6.70±0.32)respectively,there was no statistically significant difference comparing the two groups(P > 0.05);(2)The oral p H value decreased gradually with the time of radiotherapy,the experimental group oral saliva pH value was higher than the control group,starting from the tenth radiotherapy,the experimental group of patients with oral pH value was higher than the control group,the differences were statistically significant(P<0.05).4.Comparison of weight between the two groups:Before treatment,the weight of two groups were(59.08±5.08)and(60.52±5.55)respectively,with no statistical difference(P>0.05);after treatment the weight of experimental group was higher than the control group,the difference was statistically significant(P< 0.05).5.Comparison of life quality and comfort levels between the two groups:(1)The quality of life and comfort levels were not statistically significant(P>0.05)at admission for two groups of patients with NPC;(2)After treatment,the experimental group of function areas and total health scores were higher than the control group,the difference had statistical significance(P < 0.05);The domain scoresin the field of symptoms of fatigue,nausea,vomiting,pain,insomnia,loss of appetite were lower than the control group,there were statistical differences(P < 0.05);(3)After the intervention,experimental group of the total score of comfort level and its four dimensions scores were higher than the control group,the difference was statistically significant(P < 0.05).Conclusion:1.The self-care ability ofpatients with nasopharyngeal carcinoma was in medium level,lack of the health knowledge and self-care skills apparently.The patient's self-care ability and the level of health knowledge were significantly improved after the nursing intervention,thus improved the overall self-care ability of patients.2.Patients with nasopharyngeal carcinoma can produce different degree oforal mucositis after radiotherapy,we can reduce the incidence of oral mucositis,the reaction degree and the pain of oral after nursing intervention.3.The oral saliva pH value of the nasopharyngeal carcinoma patients decreased gradually during radiotherapy,implemented the nursing intervention can improve the patient's mouth pH value,changed the environment within the oral cavity.4.The weight declined with different degrees in patients with nasopharyngeal carcinoma(NPC)during treatment.The self nursing intervention under the guidance of the theory of self nursing intervention can improve the patient's weight,reduce patients side effects,so as to improve the life quality of patients.5.Oral mucositis seriously affected the quality of life and comfort level of patients with nasopharyngeal carcinoma after radiotherapy.After self nursing intervention,the patient's quality of life and the comfort level are improved. |
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