| Objective:To construct a nursing program based on evidence-based approach that can improve patients’ anxiety and depression,promote patients’ physical function and improve their quality of life in the perioperative period of laryngeal cancer patients.After that,to conduct preliminary clinical practice application,and to evaluate their effectiveness through clinical application,so as to provide nurses with a systematic,scientific and standardized perioperative nursing program for laryngeal cancer patients.Methods:1.A systematic search was conducted for clinical research reports related to perioperative care for laryngeal cancer.The literature was analyzed and evaluated to select the content of entries related to perioperative nursing interventions and health guidance for patients with laryngeal cancer,and to integrate the evidence from the literature to provide theoretical support for program construction.2.Using a phenomenological research method,a semi-structured interview was conducted with laryngeal cancer patients.The interviews were used to learn about the patients’ situation,collect information to obtain the current status and their concerns in perioperative and related needs of the patients with laryngeal cancer and to grasp psychological state of the patients during the perioperative period.3.After forming a preliminary perioperative nursing program for laryngeal cancer patients that meets clinical reality based on the literature evidence and interview results,an expert meeting of 15 experts with certain influence in this academic field was organized to discuss the entries and details of the program as well as its importance and feasibility.To synthesize the expert opinions,refine the care program according to the discussion results,to determine the intervention contents of the perioperative nursing program,and to construct the perioperative nursing program for laryngeal cancer patients.4.A preliminary clinical trial was conducted to apply the constructed perioperative nursing program for the intervention.A non-randomized concurrent controlled experiment with a convenience sampling method was used to select patients who met the inclusion criteria for the study among patients with laryngeal cancer undergoing surgical treatment in the Department of Otolaryngology,Head and Neck Surgery of a tertiary hospital in Shanxi Province,in which the control group was given traditional perioperative care for laryngectomy in the Department of Otorhinolaryngology,and the test group was cared for using the constructed nursing program.The quality of life scores,anxiety and depression scores of the subjects were used as evaluation indicators to evaluate the each groups before and after the intervention.Those met the normal distribution the t-test for comparison of two independent samples was used for measures that,and the Mann-Whitney rank sum test was used for those that did not.About the comparison of rates,composition ratios,etc.were carried out using the chi-square test or Fisher’s exact probability method.Results:1.Through the summary of evidence and extracting the content of nursing entries through literature studies from literature studies,interviews with patients and organizing expert meeting discussions,the nursing program for laryngeal cancer patients in the perioperative period was finally constructed.The program covers six major areas,including psychological care,pain assessment,dietary care,tracheotomy care,language rehabilitation guidance and discharge guidance,with a total of 40 entries.2.By comparing the general information of the two groups of study participants,the data of the two study groups were comparable at baseline,there had no statistically significant differences in general information between these two groups(P>0.05).The data met normal distribution that on quality of life,SAS and SDS scores of the two groups at two time points before and after the intervention and were compared using t-test for comparison of two independent samples.The results showed that the differences were not statistically significant in terms of quality of life,SAS and SDS scores between the two groups before the intervention(P>0.05).After implementing the intervention,the test group had higher scores than those of the control group in total quality of life(t=7.294,P<0.001).About SAS(t=-2.650,P=0.016)and SDS(t=-3.473,P=0.002)scores,the test group had statistically significant lower than those of the control group(P<0.05).When comparing the quality of life scores in each dimension of the two study groups,the test group scored significantly higher than the control group in these four dimensions:physical function(t=3.778,P=0.001),psychological function(t=4.210,P<0.001),social function(t=2.222,P=0.036)and head and neck cancer-specific module(t=4.409,P<0.001),while the test group patients scored higher than the control group in the common symptoms module,but the difference was not significant(t=1.851,P=0.077).Conclusion:1.This study followed the guidance of evidence-based theory and combined evidence from literature studies,the needs of laryngeal cancer patients,and the experience and opinions of clinical experts to systematically construct a perioperative nursing program for the laryngeal cancer patients,which is scientifically and feasible and can be used to carry out clinical practice.2.Through preliminary clinical practice application,the results prove that the perioperative nursing program for laryngeal cancer patients constructed in this study is conducive to improving patients’ organic functions and adverse symptoms,and to improving the quality of life of laryngeal cancer patients and improving their anxiety and depression. |
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