| Objectives To investigate the current situation of the sense of shame of colorectal cancer colostomy patients,analyzed the main influencing factors,and study of the effects of nursing interventions based on PDCA cycle model.Methods 1.Investigation of intestinal stoma stigma and analysis of influencing factors:using the method of convenient sampling,patients with colorectal cancer intestinal stoma in the stoma clinic and gastrointestinal surgery department of the First Affiliated Hospital of Bengbu Medical College were selected from October 2020 to March 2021,and the study subjects were identified according to the inclusion and exclusion criteria.Secondly,a questionnaire was used to collect baseline information from the study subjects,which mainly included: general demographic information,anxiety and depression scale,social influence scale,and comprehension social support scale.Finally,according to the scores of each scale,the level of stigma of patients was evaluated and the main influencing factors were analyzed.2.Intervention study on shame of enterostomy: Patients with colorectal cancer intestinal stoma at moderate to severe level of stigma who were admitted to the gastrointestinal surgery department from March 2021 to January 2022 were selected to collect the general information after obtaining their informed consent and performed baseline survey using a uniform scale;these patients were randomly divided into control and intervention groups,the control group took conventional care and rehabilitation treatment,while the intervention group additionally implemented nursing intervention based on PDCA cycle mode.Before and 4 times intervention and 8 times after the intervention,the social influence scale were respectively conducted to evaluate the level of stigma between the intervention group and the control group and before and after the intervention,and to explore the effect of nursing intervention based on the PDCA cycle model.Results 1.304 questionnaires were distributed during the survey phase of disease stigma,and 297 were returned,with a recovery rate of 97.7%,of which 290 were valid,with an effective rate of 97.6%,including 189 males and 101 females,and patients ranged in age from 29 to 87 years(average 56.05±13.32 years).The results of this study showed that the total score of morbidity stigma of colorectal cancer enterostomy patients was 68.16 ±13.51,which was in the moderate level,and 43.1% of the patients’ morbidity stigma was in the severe range.2.Multiple linear regression analysis showed that five variables,namely degree of self-care,stoma acceptance,social support,presence of stoma complications,and depression and anxiety,were factors influencing the sense of stigma.The correlation analysis between stigma and social support showed that social support and stigma were negatively correlated in patients with colostomy,while the correlation analysis between stigma and anxiety and depression showed that the total score of stigma and the scores of its various dimensions were significantly correlated.Anxiety and depression scores were positively correlated.3.A total of 93 patients with enterostomy completed the stigma intervention.Among them,48 cases in the control group were completed;45 cases in the intervention group were completed.There was no significant difference in the general demographic data such as age,gender and disease characteristics of the two groups of patients(P>0.05),and they were comparable.4.The results of repeated measures variance showed that the intervention effect and time effect of the total stigma score and social exclusion dimension scores were significant(P<0.05);while the intervention effects of economic discrimination,internal shame and social isolation dimension scores were significant(P<0.05).The interaction effects of the total stigma score and the scores of other dimensions were all significant(P<0.05)and except that the interaction between the intervention of the dimension of economic discrimination and the time effect was not statistically significant(P>0.05).Before intervention,there was no significant difference in the total stigma score and the scores of social exclusion,economic discrimination,internal shame and social isolation between the two groups(P>0.05).4 times and 8 times after the intervention,the stigma and the scores of each dimension in the intervention group were lower than those in the control group,with significant differences(P<0.05).It shows that the level of stigma in patients with enterostomy was significantly reduced compared with the control group after comprehensive nursing intervention in PDCA cycle mode.After the intervention,the total score of stigma and the dimensions of social exclusion,economic discrimination,internal shame and social isolation in the intervention group were decreased,but the total score of stigma and the dimensions of social exclusion in the control group were increased(P<0.05)and there was no significant difference in the other aspects before and after the intervention(P>0.05).Conclusions 1.The main factors influencing the sense of stigma in colorectal cancer enterostomy patients were the degree of stoma self-care,acceptance,the presence of complications,as well as the level of social support and anxiety and depression.2.Comprehensive nursing intervention based on PDCA cycle model can effectively reduce the level of stigma in patients with enterostomy.Figure6;Table12;Reference 124... |
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