| Objective:To evaluate the status of health promoting behaviors,self-control and ego-depletion in patients patients with coronary heart disease,and explore the mechanism of ego-depletion on health promoting behaviors.To appraise the effect of narrative therapy on ego-depletion of patients with coronary heart disease,verify the change of its health promoting behavior,and provide practical basis for clinical treatment practice of patients with coronary heart disease and secondary prevention of chronic diseases.Methods:This study was divided into two parts.Study one researched the mechanism of ego-depletion effect on health promoting behavior in patients with coronary heart disease from February to July in 2018 at a three-grade hospital cardiology inpatient in Chengde by using convenience sampling.It selected 277 cases of patients with coronary heart disease(CHD)for their abilities of self-control and ego-depletion status,health promotion behavior level.These variable results was based on the questionnaire survey for constructing execution of patients with coronary heart disease(CHD)health promotion behavior model and using Bootstrap methods the AMOS software validation.Study two make use of narrative therapy psychological nursing intervention for coronary heart disease by means of purposive sampling.On the basis of study one,164 cases of patients with coronary heart disease were selected with informed consent.This study was randomly divided into experimental group(n=82 cases)and control group(n=82 cases).Control group carried out psychological nursing intervention,experimental group carried out narrative therapy psychological nursing intervention.Interventions in both groups was completed during hospitalization and hospital review.We used Self-Regulatory Fatigue Scale and health promoting lifestyle profile-?to access the two groups before and 3 months after intervention.As for statistical methods,measurement data was represented by mean±standard deviation((?)±s).Numeric data was described in terms of frequency and percentage.Independent sample t test was used for comparison between two groups,anova was used for comparison between multiple groups,and Bonferroni method was used for comparison between two groups.Pearson correlation analysis was used to analyze the correlation between the variables.Independent sample t test was used to compare the total score of self-control,ego-depletion,health promotion behavior and each dimension between the two groups,paired t test was used to compare the difference between the two groups.Statistical analysis using SPSS22.0 statistical software package for the analysis of the data.Using a bilateral test,test level?=0.05.Results:Study 1 the mechanism of self-depletion effect on health-promoting behavior in patients with coronary heart disease:1.The total mean score of self-control(57.71±5.93),ego-depletion(46.34±6.27)and health-promoting behavior(112.21±12.12)in patients with coronary heart disease.2.There were no statistically significant differences in health promotion behaviors among patients with different gender,age,marital status,medical payment methods,carers and complications of coronary heart disease(P>0.05).However,there were statistically significant differences in health promotion behaviors among CHD patients with different levels of education,occupation,residence and family income per capita(P<0.05).3.There was a negative correlation between self-control and ego-depletion(r=-0.678~-0.125,P<0.05),a positive correlation between self-control and health-promoting behavior(r=0.115~0.353,P<0.05),and a negative correlation between ego-depletion and health-promoting behavior(r=-0.700~-0.112,P<0.05)in CHD patients.4.Structural equation model analysis:(1)The self-control impulse system and the control system positively predicted the level of health-promoting behavior,the normalized path coefficients are 0.35(P<0.001)and 0.38(P<0.043).(2)The self-controlling impulse system and control system predict ego-depletion directly and negatively,the normalized path coefficients are-0.81(P<0.001)and-0.19(P<0.002).(3)The ego-depletion directly and negatively predicts the level of health-promoting behavior,the normalized path coefficient is-0.39(P<0.049).(4)The self-control of patients with coronary heart disease indirectly and positively predicted the level of health-promoting behavior with ego-depletion as the mediating variable,the normalized path coefficients are-0.39*-0.81=0.32 and-0.39*-0.19=0.07,the total effect coefficients of self-control on the level of health-promoting behavior are 0.32+0.35=0.67 and 0.07+0.38=0.45.It shows that ego-depletion plays a partial mediating role in the influence of self-control on the level of health-promoting behavior,the mediating effect accounted for 47.76% and 15.6%of the total effect.Study 2 effect evaluation of narrative therapy on health promoting behavior and ego-depletion in patients with coronary heart disease after PCI surgery:1.There were no statistically significant differences between the two groups in gender,age,education,occupation,marital status,residence,family income,medical expenses,primary carers and complications[?~2=(0.051?14.516),P=(0.311?0.830)],the two groups are comparable(P>0.05).2.Before the intervention,there was no significant difference in the total score of health promotion behavior between the experimental group and the control group,and the results were not statistically significant(t=-2.582?2.264,P>0.05).After the intervention,the difference between two groups in the HPLP-?scale of interpersonal relationship,health responsibility,nutrition,sports,stress management,and spiritual growth were statistically significant(t=-7.895?1.042,P<0.05).3.Before the intervention,there was no significant difference between the experimental group and the control group in the total score of ego-depletion and each dimension,and the results were not statistically significant(t=0.186?1.691,P>0.05).After the intervention,there were statistically significant differences between the two groups in all dimensions and total scores of the SRF-S scale(t=3.600?7.660,P<0.05).4.Two groups of patients before and after the intervention of health promotion behavior levels were increased.The difference between control group was statistically significant in the HPLP-?scale of interpersonal relationship,health responsibility,nutrition,sports on the various dimensions and the total score of comparison(t=-19.811?-4.790,P<0.05)The difference between experimental group was statistically significant in HPLP-?interpersonal relationship,health responsibility,nutrition,stress management,sports,and spiritual growth on the various dimensions and the total score of comparison(t=-29.880?2.265,P<0.05).5.The total scores of ego-depletion and each dimension of the control group were compared before and after the intervention,and the difference was not statistically significant(t=-0.723?1.332,P>0.05).After the intervention,the total scores of ego-depletion and the score of each dimension in the experimental group were lower than before the intervention,and the difference before and after the intervention was statistically significant(t=6.113?15.707,P<0.05).Conclusions:1.The health-promoting behaviors of CHD patients were at the medium level and the patients were in a state of ego-depletion.Ego-depletion plays a partial mediating role between self-control and health-promoting behavior.2.The disease management of patients with coronary heart disease requires self-control ability,and long-term self-control makes patients in a state of ego-depletion,thus affecting the level of patients'health promotion behavior.3.We used narrative therapy for psychological nursing intervention of patients to enhance patients'ability to manage the disease,further help them form health-promoting behavioral lifestyle by reducing the patients'ego-depletion state.Meanwhile,narrative therapy also helps patients learn new things about their illness and themselves.They are more proactive in coping with various risk factors of coronary heart disease and adopting health-promoting behaviors. |
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