| Objective:To explore the impact of short-term structural psychological care on the psychological toughness,stigma,anxiety and depression of patients with colorectal cancer with enterostomy.Methods:From August 2019 to December 2020,70 patients who underwent enterostomy in the gastrointestinal surgery department of a tertiary hospital in Guizhou Province were selected as the research objects,and they were randomly divided into a control group and a test group with 35 cases each.Control group: Face-to-face psychological counseling for enterostomy patients before and after surgery and distribute the "Gastrointestinal Surgery Enterostomy Nursing Manual of a Class III Hospital in Guizhou Province".Experimental group: Implement short-term structural psychological care on the basis of routine care.(1)Establish an intervention group with clear division of labor;(2)Determine the intervention method,form,location and time.The specifics are as follows: Phase I-First acquaintance with the enterostomy(preoperative):(1)Use various forms of "one-on-one" oral presentations,video broadcasts and other forms to teach patients about health,alleviate their anxiety and anxiety;(2)Teach patients to relax Training techniques,and evaluating and checking the patient’s mastery;(3)Introduce three coping methods: active behavior,active cognition,and avoidance,and encourage patients to adopt active coping methods;(4)Provide patients with psychological support in time.The second stage-adaptation to the intestinal stoma(3 days after the operation to discharge):(1)Play the enterostomy care video to strengthen the patient’s mastery,and further evaluate the mastery;(2)Guide the patient to relax training: play audio to guide the patient to imagine a beautiful picture;Progressive muscle relaxation training from bottom to top;lip-reducing abdominal breathing training;(3)Guided coping skills training: Assess the existing problems of patients at this stage and explain the correct coping methods;(4)Encourage patients to communicate actively and increase social support.The third stage-home enterostomy selfmanagement(1 month after discharge):(1)Continue to instruct patients on diet,stoma care,behavior training,coping skills training,etc.through the phone and We Chat platform;(2)Through case sharing,enterostomy Give psychological support to the patient’s existing problems in ways such as oral stories and encouraging participation in daily activities.The mental resilience score,stigma score and anxiety and depression scores of patients were collected before the intervention,at discharge,15 days after discharge,and 1 month after discharge.Results:1.Comparison of mental toughness scores and scores of various dimensions between the two groups of patients at different time points:Repeated measures analysis of variance found that the time effect,processing effect,and interaction effect of the mental resilience scores before intervention,at discharge,15 days after discharge,1 month after discharge in the two groups of patients and the scores of each dimension were statistically significant(P < 0.05).After comparison between the groups,the two groups of patients before the intervention The total score and the scores of each dimension were not statistically different(P > 0.05).There was no significant difference in the self-improvement and optimism scores between the two groups at the time of discharge(P > 0.05),and the mental toughness score and the toughness score were statistically different.Significance(P < 0.05);There was no statistically significant difference in the scores of optimism between the two groups of patients 15 days after discharge(P > 0.05),and the scores of mental toughness,toughness and self-strength were statistically significant(P < 0.05).Discharge 1 The monthly mental resilience score and the scores of all dimensions were statistically significant(P < 0.05).After pairwise comparisons within the group,there was no significant difference in optimism scores between patients in the control group when they were discharged from the hospital,15 days after discharge and before the intervention(P > 0.017),and there were statistical differences in the scores of the CD-RISC total score,toughness,and self-strength.Significance(P < 0.017);comparison between discharge 1 month and before intervention,there was no statistically significant difference in optimism dimension scores(P > 0.017),and the difference in CD-RISC total score,tenacity and self-strength dimension scores was statistically significant(P < 0.017).Compared with those before the intervention,the test group patients showed no statistically significant difference in the scores of optimism and self-strength(P > 0.017),and the difference between the total score of CD-RISC and the score of toughness was statistically significant;15 days after discharge and 1 after discharge The difference between the total score of CD-RISC and the scores of each dimension was statistically significant between a month and before intervention(P <0.017).2.Comparison of stigma scores and scores of various dimensions between the two groups of patients at different time points:The repeated measure’s analysis of variance found that the time effect,processing effect and interaction effect of the total scores of stigma before intervention,at discharge,15 days after discharge,1 month after discharge in the two groups of patients and the scores of each dimension were statistically significant(P < 0.05).After comparison between the two groups,the two groups of patients Before the intervention,the total score of stigma and the scores of each dimension were not statistically significant(P > 0.05).There was no significant difference in the scores of economic discrimination,intrinsic shame and social isolation between the two groups of patients at the time of discharge(P >0.05).The difference between the stigma score and the social exclusion dimension score was statistically significant(P < 0.05);the stigma score and scores of each dimension were statistically significant at 15 days after discharge and 1 month after discharge(P < 0.05).After pairwise comparisons within the group,when the control group patients were discharged from the hospital,15 days after discharge and before the intervention,there was no statistically significant difference in the scores of economic discrimination,intrinsic shame,and social isolation(P > 0.017).The total score of SIS and social exclusion were not statistically significant.The score difference was statistically significant(P < 0.017);there was no statistically significant difference in the total SIS score and the scores of each dimension one month after discharge from the hospital and before the intervention(P >0.017).Comparing the scores of each dimension when the patients in the experimental group were discharged from the hospital and before the intervention,there was no statistically significant difference in the scores of each dimension(P > 0.017),and the difference in the total SIS score was statistically significant(P < 0.017);There was no statistically significant difference in the scores of the intrinsic shame dimension(P >0.017),and the differences in the scores of the SIS total score,social exclusion,and social isolation were statistically significant(P < 0.017);1 month after discharge from the hospital and before the intervention,the total SIS There were statistically significant differences in scores and scores of each dimension(P < 0.017).3.Comparison of anxiety and depression scores of the two groups of patients at different time points:The repeated measures analysis of variance found that the time effect,treatment effect and interaction effect of the HADS total score and anxiety and depression scores of the two groups of patients before intervention,at discharge,15 days after discharge,1 month after discharge were statistically significant(P < 0.05).After comparison between the groups,the total HADS score before intervention There were no statistically significant differences in the scores and anxiety and depression scores(P > 0.05).The differences in HADS total scores and anxiety and depression scores at discharge,15 days after discharge,and 1month after discharge were statistically significant(P < 0.05).After pairwise comparisons within the group,when the control group patients were discharged from the hospital and before the intervention,there was no statistically significant difference in HADS total score and anxiety score(P > 0.017),and the difference in depression score was statistically significant(P < 0.017);15 days after discharge,Comparing between discharge 1 month and before intervention,there was no statistically significant difference in depression score(P > 0.017),and the difference between HADS total score and anxiety score was statistically significant(P < 0.017).Compared with the pre-intervention at different time points after intervention,the difference in HADS total score,anxiety and depression scores of patients in the experimental group was statistically significant(P < 0.017).4.Before the intervention,at discharge,15 days after discharge,and 1 month after discharge,stigma was negatively correlated with mental resilience scores;before intervention,at discharge,15 days after discharge,and 1 month after discharge,stigma was positively correlated with anxiety and depression scores;Psychological toughness was negatively correlated with anxiety and depression scores before intervention,at discharge,15 days after discharge,and 1 month after discharge.Conclusion:Short-term structural psychological care can improve the mental resilience of patients with colorectal cancer after enterostomy,and reduce Stigma level and relieve anxiety and depression. |
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