| Objective: 1.To explore the methods of preventing oral infection,improving oral hygiene and promoting comfortable oral nursing for patients with gastric cancer after operation.2.Implement the concept of "enhance recovery after surgery(ERAS)",and explore the methods of promoting early activity,improving daily living ability and rehabilitation of patients with gastric cancer after operation.3.To evaluate the self-care ability of patients with gastric cancer.4.To explore the effect of self-oral nursing on self-care ability and comfort of patients with gastric cancer after operation and the methods to improve self-care ability and comfort of patients.Methods: During March 2018 to November 2018,106 gastric cancer patients were recruited prospectively in a major hospital in Chengde City,Hebei Province.They were divided into control group and experimental group by simple randomization,each group included 53 patients.According to inclusion and exclusion criteria,99 patients were included in the study,49 in the control group and 50 in the experimental group.Patients in the control group were given conventional oral care after operation,while patients in the experimental group were given self-oral care based on Orem self-care theory.According to Barthel index of patients' activities of daily life,patients were given self-oral nursing intervention by selecting complete compensation system,partial compensation system and supportive education system in stages.Record the occurrence of oral complications such as halitosis,pharyngalgia,oral infection,whether the nursing process is comfortable and so on.One case was recorded at one time.Oral cleanliness was evaluated on the 2nd and 4th day after operation,and the first time of getting out of bed and anal exhaust were recorded.The patients' self-care ability and comfort were assessed with the exercise of self-care agency scale(ESCA)and the General Comfort Questionnaire(GCQ)before operation and the day before discharge.The data were analyzed by software SPSS22.0.Results: 1.The oral cleanliness of the experimental group on the 2nd day(16.20±1.14)and the 4th day(13.68±0.65)was significantly(P < 0.05)better than that of the control group on the 2nd day(20.00±2.08)and the 4th day(21.85±1.83).The incidence of xerostomia,halitosis,parched lips and pharyngalgia in the experimental group was 24%,6%,2% and 20%,which was significantly(P < 0.05)lower than that of the control group(73%,43%,14%,57%).There was no oral infection in the experimental group and 6 cases in the control group.During oral nursing,90% of the patients in the experimental group felt comfortable,while only 16% of the patients in the control group felt comfortable.The percentages of nausea(43%),tension(31%)and fatigue(49%)in the control group were significantly(P<0.05)higher than those in the experimental group(8%,12%,6%).2.The first time of getting out of bed and anal exhaust in the experimental group were(26.10±5.13)h and(3.0±0.8)d,which were earlier than those in the control group(29.78±5.41)h and(3.9±1.3)d,there was significant difference(P < 0.05).3.The ESCA of gastric cancer patients before operation was(81.37 ±16.79),the experimental group was(82.22±16.69),the control group was(80.51±17.02),with no statistically significant(P > 0.05),most of which were at the middle level.From the four dimensions of ESCA,in terms of level,58.6% of patients with gastric cancer had high self-concept,40.4% had high self-responsibility,3% had high self-nursing skills,8.1% had high health knowledge,and the two dimensions of self-nursing skills and health knowledge accounted for a small proportion of high level,most of them were at medium and low level.4.After self-oral care,the total score of self-care ability in the experimental group(107.12±14.27)was significantly(P<0.05)higher than that in the control group(83.16±15.76);the scores of four dimensions of self-care ability in the experimental group were significantly(P<0.05)higher than those in the control group;from the comparison of grading level,the self-care ability in the experimental group was significantly(P<0.05)higher(34%)than that of the control group(8.2%).Compared with the experimental group before and after intervention,the total score of self-care ability and the score of four dimensions were significantly(P < 0.05)improved,and the grading level and the percentage of self-care ability in the higher level were significantly(P < 0.05)increased.The comparison before and after intervention in the control group showed that the scores of total self-care ability,self-care skills and health knowledge level were significantly(P < 0.05)higher than those before operation;there was no significant difference between the scores of self-concept and self-care responsibility(P > 0.05).The total level of self-care ability and self-care skills were improved compared with those before operation,the difference was statistically significant(P < 0.05).The level of self-concept and self-care responsibility decreased compared with those before operation,the difference was statistically significant(P < 0.05).The overall level of health knowledge had little change.5.After nursing intervention,the total comfort score of the experimental group increased from(76.44±7.7)to(89.90±4.88),and that of the control group increased from(78.22 ±8.80)to(82.04±6.14).The general comfort of the two groups statistically(P < 0.05)increased compared with that before intervention;from four dimensions,in the experimental group,four dimensional scores were significantly(P < 0.05)higher than those before intervention.While in the control group,there was no significant difference between the two dimensions of psychological comfort and social and cultural comfort(P > 0.05).Physical comfort and environmental comfort were statistically(P < 0.05)higher than those before intervention.The total scores of comfort and the scores of each dimension in the experimental group were statistically(P < 0.05)higher than those of the control group.Conclusion: 1.After self-oral nursing,patients with gastric cancer after operation have greatly reduced the incidence of xerostomia,halitosis,parched lips and pharyngalgia,improved oral cleanliness and prevented the occurrence of oral infection,and the incidence of nausea and tension in the nursing process is low,alleviating the pain of patients,and the comfort rate of patients is high.2.Implement the concept of "Enhanced Recovery After Surgery".Self-oral nursing promotes early postoperative activities,shortens the first time out of bed and anal exhaust,reduces the incidence of abdominal distension and complications,and speeds up the recovery of patients.3.The self-care ability of patients with gastric cancer is generally at a medium level,and the overall level of self-care skills and health knowledge is obviously low.We should strengthen health education in this regard.4.Self-oral care can significantly improve the self-care ability of gastric cancer patients,reduce the occupation of medical resources,and make patients return to society better.5.Self-oral nursing practices the concept of "patient-centered" holistic nursing,alleviates patients' pain,improves patients' intrinsic self-worth,and improves patients' comfort after gastric cancer surgery. |
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