A Study Of Social Adaptability In Patients With Tuberculous Empyema Having Pleural Decortication

ObjectivesThis study was to investigate the social adaptability in patients with tuberculous empyema having pleural decortication and to understand the difficulties and problems that exist in the process of recovery,so to explore an effective and convenient delivery of health education to help patients recover quickly and improve the quality of life after the operation.MethodsQualitative and quantitative methods were used in the two-phase design.During the first phase the qualitative approach was taken,and finally,35 patients were successfully phone-interviewed who were sampled out of 131 patients who had pleural decortication because of tuberculous empyema using stratified random sampling method.Interview transcripts were analyzed from which the health education booklet and health education clinical pathway were formulated after their contents were validated by medical and nursing experts.The quantitative approach was used in the second phase,and 70 patients with tuberculous empyema were divided into two groups according to the operation time,31 cases as control group accepting the traditional health education,39 cases as observation group receiving health education delivered by well-trained nurses with the help of health education booklet and the clinical pathway for health education in stages.The 36-Item Short-Form Health Survey(i.e.SF-36)was used to measure patients' perceived health condition in the two groups in the period of one week before surgery and one month after discharge,and the results were analyzed using SPSS 19.0 software.Results35 patients were successfully interviewed in the first phase,male to female ratio was 4:1(28:7),the average age was 32 years(s=12.31).Of which,18 cases(51.4%)had pleural decortication,two cases(5.7%)had pleural decortication through thoracoscope,15 cases(42.9%)had pleural decortication and other surgical operations.There were 70 patients in the second phase,of which 31 as control group with the average age as 30.16 years(s=2.57),39 cases as the observation group with the average age as 33.15 years(s=2.41).First,the content analysis shows that the social adaptation occurred in the following four thematic aspects in patients with tuberculous empyema having pleural decortication.Theme One.Physical Discomfort:The mainly forms were incision discomfort after surgery(the feeling of numbness around incision,pain,dull pain and scar formation),sleeping disorder(easy to wake up or difficult to fall asleep),unable to attend the heavy physical activity before lung function recovery,gastrointestinal and allergic reactions caused by drug.Theme Two.Psychological reaction:The mainly forms were shame for illness(hide the fact of disease,avoid drug,avoid to communicate with others),concern about the external image(mainly in young patients with incision scar more apparent),economic pressures(mainly in middle-aged or poor economic condition patients),patients role dependence(mainly in adolescent patients).Theme Three.Lack of knowledge:medication knowledge and disease related knowledge deficiency.Some patients don't know the side effects of anti-TB drugs and the infectious of tuberculous empyema,lack the knowledge of postoperative exercise.Theme Four.Adapting strategies:mainly include the self-adaptation,improve disease cognition,strengthen physical exercise,and the support from family and social.Main performance of self-adaptation were changing work environment,adjusting rest time,moderate physical activity.In addition,the understanding and love from family,social respect and support was the spiritual pillar of patients to rehabilitation.Second,the comparison of SF-36 scores.According to the results of the second stage,there were no significant differences(P>0.05)between the two groups of patients in the basic information and scores of SF-36 at the period of one week before surgery.On the contrary,significant differences(P<0.05)were showed up in each of eight areas of quality of life at the period of one month after discharge.ConclusionsThe way of rehabilitation for patients with tuberculous empyema was long and difficult,for they will face the various pressures and challenges from physiological,psychological and social aspects.So they need the understanding and help from hospital,family and society urgently,to help them adapt to the role change,improve social adaptability and speed up the body rehabilitation as soon as possible.The use of Rehabilitation Booklet for Patients with Tuberculous Empyema having Pleural Decortication and clinical pathway for health education,improved the effect of the hospital health education,promoted the patients' rehabilitation process,and improved the quality life of patients.