| ObjectivesMake Investigation on peri-operative life quality of patients with breast cancer undergoing modified radical mastectomy (physiological function, psychological and social adaptation). Try to develop comprehensive nursing intervention program based on theory of adaptive leadership.So as to probe the influence of comprehensive nursing intervention on patients undergoing breast modified radical mastectomy.Methods80 breast cancer patients were selected, who received breast cancer modified radical mastectomy in Ji’nan city from March to October in 2015. They were randomly divided into control group(40)and intervention group (40). Patients in control group were given routine nursing care of breast cancer patients. Patients in the intervention group received comprehensive nursing intervention besides routine nursing.Life quality,psychological stress,(anxiety, self-esteem) and social adaptation (self-efficacy and medical coping) of patients in two groups were investigated respectively before and after the intervention.Joint activity of the affected limbs of the shoulder, and circumference of the affected upper limb were measured repeatedly on preoperative 1 day, postoperative day 1,5,10,14 to analyze the effect of nursing intervention.Survey instruments, including general situation questionnaire, breast cancer patients quality of life volume table (FACT-B), anxiety self rating scale (SAS) and self-esteem scale (SES), self efficacy scale (GSES), medical coping style scale (mcmq). Using SPSS 17.0 statistical software to analyze the data, including statistical description, independent samples test, paired samples test, x2 test and repeated measurement analysis of variance, etc.Results1. No statistical significance on general demographic information (age, educational level, occupation, family income per month, place of residence, etc.) and clinical data (operation mode and clinical staging) between the intervention group and the control group (P> 0.05).2.Comparison of Life quality, anxiety, self-esteem, self efficacy and medical coping status between the intervention group and the control group before intervention.(1)Life quality:total score of life quality of intervention group 98.48 ±14.81, 95.80±7.73 in the control group. No statistical difference on the total score of life quality and living conditions, social family, emotional status, functional status, additional attention to the dimension of the score between the two groups (P> 0.05).(2)Psychological stress:anxiety score:intervention group 33.15±6.97,33.53±3.77 in the control group. Self esteem score:intervention group 30.35±4.39, control group 28.85±5.48. No statistical difference on anxiety and self-esteem between the intervention group and the control group(P>0.05).(3)Social adaptation:self efficacy score:27.53±5.64 in intervention group,25. 80±3.36 in control group.Medical face score:intervention group 18.08±2.75,18.45 ±3.07 in the control group; medical avoidance score:17.38±2.20 in the interventi on group,16.58±1.47 in the control group; medical yield score:7.90±2.37 in the intervention group,7.68±1.94 in the control group. No statistical difference on the scores of self-efficacy scores between the intervention group and the control group, as well as the dimensions of medical face, medical avoidance and medica 1 yield(P>0.05).3. Comparison of Life quality, anxiety, self-esteem, self efficacy and medical coping status between the intervention group and the control group after intervention.(1)Quality of life:total score of quality of life, intervention group 107.58±14. 71,83.98±5.74 in the control group. While the various dimensions of quality of li fe score:living conditions, the intervention group21.53±3.62,controlgroup 16.43±1. 28;socialand family, intervention 22.50±3.41,control group 17.93±247; emotional state, intervention group 18.00±3.34, control group 13.23±1.53; function state,int ervention 19.90±4.46, controls 16.28±1.92;pay more attention to the additional int ervention group 25.65±3.77, the control group 20.13±1.56. The scores of quality of life of the intervention group were higher than those of the control group, a nd the difference was statistically significant (P<0.05).(2)Activity of shoulder and circumference of the upper limb:①activity of shoulder:on preoperative 1 day, postoperative 1 day,5 days,10 days,14 of patients with shoulder joint flexion, extension, abduction function were measured, repeated measures analysis of variance showed the intervention group patients with shoulder joint function recovered better than those in control group, the difference was statistically significant (P<0.001). ②circumference of the upper limb:on the preoperative 1 day, postoperative 1 day,5 days,10 days,14 days, repeated measurement of limb circumference no statistical difference between two groups (P>0.05).(3)Anxiety score:intervention group 28.88±5.57,34.88±2.57 in the control group, the score of the intervention group was lower than the control group, the difference was statistically significant(P<0.05). Self esteem score:the intervention group was 32.25±4.80, the control group was 25.85±2.85, self-esteem score of the intervention group patients was higher than the control group, the difference was statistically significant (P<0.05).(4)Self efficacy score:the intervention group was 31.55±5.56, the control group was 23.98±2.15.Score of the intervention group was higher than the control group and the difference was statistically significant (P<0.05). Medical coping:medicine dimension, score of the intervention group was 20.30±2.78, score of the control group was18.38±1.96, score on medicine dimension of the intervention group is higher than that of the control group. The difference is statistically significant (P<0.05).But no statistically significance on medical avoidance and medical yielding dimension scores between the intervention group and the control group(P> 0.05).4.Comparison of life quality, anxiety, self-esteem,self-efficacy and medical coping within the group before and after the intervention.(1)In intervention group,life quality score and family and social dimensions, functional dimension scores were higher than those before intervention. The difference was statistically significant(P<0.05); living conditions, emotional and pay more attention to the additional dimension scores increased after intervention.But the difference was not statistically significant (P>0.05). Scores of self-esteem, self-efficacy and medicine, medicine face avoidance dimension improved in the intervention group than before intervention, while the anxiety score reduce. The differences were statistically significant (P<0.05). The score of medical yield was lower than before, but the difference was not statistically significant(P>0.05).(2)There was no significant difference on life quality(P>0.05)In the control group.But there was a trend of decrease in the total score of life quality. The scores of social family in each dimension were significantly higher than that before operation, while the living condition, the emotional state and the additional concern reduced. The difference was statistically significant (P<0.05). No statistical difference on scores of patients anxiety, self-esteem, self-efficacy, medicine yield, (P>0.05). The difference of scores of dimensions on medical confrontation and medical avoidance were statistically in the control group,before an after surgery (P<0.05).Conclusions1.The age of the patients with brest cancer has an obvious trend to be yong, most patients at the age between 40-49. Anxiety symptoms in patients with breast cancer were prominent and self-esteem and self-efficacy level was low. Yield response was the main way of breast cancer patients to deal with.2. The overall life quality of patients with breast cancer during perioperative period was poor. The comprehensive nursing intervention based on the theory of adaptive leadership can improve the life quality of patients with breast cancer during perioperative period.3.The comprehensive nursing intervention based on the theory of adaptive leadership, which is suitable for clinical nursing practice in China, can be widely promoted in the future. |
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