The Effects Of Narrative Therapy On Stigma Of Patients With Permanent Stoma

ObjectiveDevelop a narrative therapy plan for patients with permanent colostomy,and evaluate the effect of this plan on reducing their stigma and improving their level of psychosocial adaptation level.Method1.From September 2018 to October 2019,96 patients with rectal cancer who underwent Miles surgery for the first time in the Department of Gastrointestinal Surgery and Colorectal Anus Surgery in the First Affiliated Hospital of Zhengzhou University were selected as the research subjects.2.Random numbers generated by Microsoft office Excel 2007 were used for grouping.The intervention group and the control group were given 48 cases each,and the control group was given routine care.The intervention group was added with a perimeter of 8 weeks,once a week and 30 to 45 minutes each Narrative therapy,1 to 4 weeks after discharge,Intervention skills are "externalized dialogue,rewritten dialogue",intervention themes are deconstruction problems,problem externalization,and discovery of special events,the intervention goal is to dispel negative self-identification and experience positive self-worth;5 to 6 weeks after discharge,intervention skill is "reshaped dialogue",intervention themes are reposition yourself and form a two-way identity,the goal of intervention is to reconstruct self-identity;7 to 8 weeks after discharge,intervention skill is " defining ceremony" intervention theme is self-reflection,the intervention goal is to actively face difficulties.3.The data were collected one day before discharge,one month after the intervention,and one month after the intervention,Social Impact Scale(SIS)and Ostomy Adjustment Inventory-20 were used to evaluate the effects of intervention.4.The data were entered into Microsoft office Excel 2007 software in a timely and accurate manner,and the statistical description and hypothesis testing were performed using IBM SPSS Statistics 21.0 statistical software to analyze the effect of narrative therapy.Result1.Excluding withdrawal or lost follow-up cases,a total of 87 patients were intervened and data collection was completed.The drop-out rate was 9.38%.Among the intervention group,there was an abnormal value in the data of one patient.This patient was directly deleted.A total of 86 patients were finally included in the statistical analysis Cases,43 cases in the intervention group and the control group.There was no significant difference in general and disease-related data between the two groups of patients(P>0.05),and the baseline data were comparable.2.Comparison of stigma at the three time points between the intervention group and the control group:The results show that the interaction between the intervention factors and the time factors is statistically significant,F(1.341,56.317)=213.858,P<0.001,and the individual effects and time of the intervention are analyzed separately Individual effect.The single effect of the intervention showed that there was no statistically significant difference in the stigma and the dimensions of the two groups of patients 1 day before hospitalization(P>0.05).Social exclusion,internal shame,social isolation and The difference in stigma was statistically significant(P<0.001),and the difference in economic insecurity was not statistically significant(P>0.05).The effect of time alone showed that the effect of time factors on the stigma and the dimensions of the intervention group and the control group were statistically significant.(P<0.001),the stigma and scores of the three dimensions in the intervention group showed a downward trend,and the difference between the two time points was statistically significant.The control group at three time points had stigma and internal shame,The social isolation dimension is on the rise,and the difference between two time points is statistically significant.3.Comparison of the psychosocial adaptation levels of the intervention group and the control group at three time points:The results show that the interaction between the intervention factor and the time factor is statistically significant,F(1.738,72.976)=152.096,P<0.001.The individual effects of the intervention and the Time alone effect.The single effect of the intervention showed that there was no statistically significant difference in the levels of psychosocial adaptation and dimensions of the two groups of patients 1 day before hospitalization(P>0.05);the levels of psychosocial adaptation and dimensions of the two groups of patients at the end of the intervention and 1 month after the intervention There was statistical significance(P<0.001);the effect of time alone showed that the effect of time factors on the social and psychological adaptation levels and dimensions of the intervention group and the control group was statistically significant(P<0.001).The levels and scores of each dimension showed an upward trend,and the difference between the two time points was statistically significant.The control group at three time points showed a decline in social and psychological adaptation levels and then an upward trend.ConclusionThe narrative therapy for patients with permanent intestinal stoma uses the"externalized dialogue,rewritten dialogue,reshaped dialogue and defining ceremony" intervention technique to help patients to dispel negative self-identification conclusions,reconstruct self-identity,reduce stigma and say goodbye Past and return to the present life,improve the level of social and psychological adaptation.