| Obejective: In order to obtain the epidemiological data of patients with chronic sinusitis,including anxiety,depression,mood states,subjective symptom scores,chronic disease self-efficacy,and analysis of their correlation and influencing factors.Therapeutic communication system is as a means of intervention to evaluate the effect of interventional therapy on patients with chronic sinusitis after endoscopic sinus surgery.Using qualitative research methods,through semi-structured interviews with patients who were treated with therapeutic communication methods,obtain the patient’s feelings,attitudes and suggestions about the intervention program,then evaluate and revise the communication program.Methods: This study is divided into three parts.Part I: the data were collected using the general questionnaire,the brief mood scale(BPOMS),the hospital anxiety and Depression Scale(HADS),the symptom visual rating scale(VAS),and the chronic disease management self-efficacy scale.Use SPSS19.0 statistical software to analyze the survey data.The second part: The patients in the study who were interested in participating in the therapeutic communication system were divided into TCS intervention group and control group.The intervention group was treated with the therapeutic communication system,and the control group with general nursing method.Patients’ data were collected by BPOMS,HADS,CDSES,and nursing satisfaction scale(NSNS)on day before discharge.SPSS19.0 software was used to analyze the difference of psychological level,anxiety and depression,chronic disease management self-efficacy and nursing satisfaction between the two groups after the intervention.The third part: qualitative research: 12 patients were treated with the TCS intervention.Half structured interview was used to collect the real feelings and experiences of TCS intervention.Colaizzi data analysis method was used to analyze the data and refine the theme.Results: 1 Cross-sectional study:(1)The level of anxiety and depression in patients with CRS before the surgery:Using hospital anxiety and Depression Scale(HADS),158 cases of CRS patients were investigated before the operation.results : Patients without anxiety symptoms accounting for 51.3%,Patients without depression accounting for 58.9%;Patients with suspected anxiety accounting for 26.5%,Patients with suspicious depression accounting for 24%;Patients with identified anxiety accounting for 22.2%;Patients with identified depressive symptoms accounting for 20.3%.When score is more than 8 points,we can think patients have positive symptoms.Patients with anxiety accounting for 48.7%;Patients with depression accounting for 41.1%;Patients with anxiety and depression accounting for 34.2%;Patients with only anxiety patients accounting for 14.6%;Patients with only depressiong accounting for 7%.The influencing factors of anxiety and depression were analyzed: The different cultural degree,place of residence,family income and medical payment methods have significant difference on CRS patients’ preoperative anxiety level(P < 0.05);Different cultural level,residence,family income and payment also have significant difference on CRS patients’ preoperative anxiety level(P < 0.05);.(2)VAS symptom score of CRS patients: There were 93 cases of patients with average score of more than 5 points,accounting for 59%.When the patients’ symptoms of visual score are > 5,their anxiety score,depression score,mood score were higher than the patients who symptoms of visual score are ≦5.When the patients’ symptoms of visual score are > 5,their score of symptom management self-efficacy are less than the patients who symptoms of visual score are ≦5,the difference was statistically significant(P <0.05).(3)Preoperative mood score in patients with CRS: The each dimension scores of mood scale from high to low are energy-energy,fatigue-slow,tension-anxiety,confusion-depression,chaos-depression,anger-hostility.Analysis of the relationship between the scores of each dimension and VAS score,chronic disease self-management self-efficacy score.We can find there was a positive correlation between the scores of VAS and the each dimension scores.In addition to the angerhostility dimension,each dimension scores were negatively correlated with the scores of chronic disease self-management.The difference was statistically significant(P < 0.05).(4)Disease management self-efficacy: The patients whose self-efficacy score,symptom management self-efficacy score and common disease management self-efficacy are more than 7 account for 61.4%,65.2%,54.4%.Self-efficacy scores are negatively correlated with anxiety score,depression score,and VAS score,and difference was statistically significant(P < 0.05).2 Experimental study(1)The effect of therapeutic communication on anxiety and depression: Before intervention,the scores of the two groups are balanced and comparable.After intervention,the anxiety and depression scores of the intervention group were lower than those of the control group(P < 0.05).Two groups of patients’ anxiety and depression scores were decreased after intervention.The intervention group decreased more than the control group.The differences is statistically significant(P < 0.05).(2)The effect of therapeutic communication on the score of the brief mood scale: Before the intervention,the scores of the two groups were balanced.After the intervention,two groups of patients ‘each dimension scores ‘difference are statistically significant(P < 0.05).(3)Before the intervention,the scores of the two groups patients’ chronic disease self management efficacy scale are balanced;After intervention,the two groups of patients’ chronic disease self management efficacy scale scores were statistically significant differences(P < 0.05).The two groups of patients’ scores of each dimension of chronic disease self-management self-efficacy scale are all increased,however,the increase of the intervention group is significant and statistically significant(P < 0.05).(3)The nursing satisfaction of the intervention group was higher than that of the control group,and the difference was statistically significant(P < 0.05),after intervention.3 Qualitative research A total of three themes were extracted: the patient’s perception of the therapeutic communication intervention,the patient’s evaluation of the therapeutic communication approach,and the patient’s recommendations for therapeutic communication.Conclusion: Psychological problems of patients before CRS nasal endoscopic surgery can’t be ignored.The incidence of anxiety and depression was high before operation.Different educational level,residence,family monthly income and medical payment are the influencing factors of anxiety and depression in patients with CRS.The severity of nasal sinus symptoms in patients with CRS may be related to anxiety,depression and mood.CRS patients in the various dimensions of energy-energy,fatigue-slow,tension-anxiety,confusion-depression,chaos-depression,anger-hostility have negative performance.CRS patients with symptom severity and bad mood state can reduce the patient’s self-efficacy.CRS patients had lower self-efficacy.Patients’ anxiety,depression and severity of disease symptoms affect their self-efficacy.Medical staff should pay attention to the anxiety,depression,mood state,symptom severity and self-efficacy of the CRS patients in the course of treatment and nursing.The intervention method of therapeutic communication mode can improve the CRS patient’s anxiety,depression and other negative mood,enhance patients’ self-efficacy,improve patients’ satisfaction with nursing service,has the maneuverability and clinical utility,is worth further research.The following therapeutic communication programs need to be improved: Nurses’ attitude should be more cordial;Multi field medical workers should be involved;The effectiveness of information transmission should be improved. |
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