| Objective:To construct a continuous nursing model for advanced lung cancer patients undergoing chemotherapy based on the current situation and needs of.continuous nursing in China,and to evaluate the effect of this model on quality of life,sleep quality,anxiety,depression and pain in patients.To explore a more effective,standardized and reasonable medical and nursing service model for patients with advanced lung cancer undergoing chemotherapy,so as to improve the quality of medical and nursing service,and provide reference for the construction of a more scientific and humanized medical and nursing service model.Methods:This study was divided into two parts:in the first part,according to the actual situation of the current Chinese medical system,on the basis of reading a lot of literature and interviewing clinical experts,the research group discussed the formulation of a preliminary plan for continuous nursing of patients with advanced lung cancer undergoing chemotherapy.After two rounds of Delphi expert letters,we determined the continuous nursing plan for patients with advanced lung cancer chemotherapy.In the second part,to test the actual clinical effect of the scheme,80 patients who were diagnosed as advanced lung cancer by pathology and received chemotherapy in the respiratory ward of a Grade 3A Hospital in Jinan from April to October 2018 were selected as the research subjects.40 patients in the eastern ward were selected as the control group for routine nursing of lung cancer.The other 40 patients in the western ward were selected as the observation group.In addition to the routine nursing of lung cancer,continuous nursing was given during the intermission of chemotherapy after discharge,and the patients were followed up for 2 months.Two groups of patients in stage baseline T1 and T2 4 cycles of chemotherapy before 1 day,the general data,quality of life,anxiety and depression,sleep quality and pain score were collected by self-made general data questionnaire,Lung Cancer Therapeutic function scale(FACT-L),Hospital anxiety and Depression scale((HADS)),Pittsburgh Sleep quality Index((PSQI))and pain Digital score((NRS)).SPSS21.0 statistical software was used to analyze the collected data,Descriptive analysis,chi-square test,paired sample t-test,independent sample t-test and other statistical analysis methods were used.Results:The first part:After two rounds of expert correspondence,the continuous nursing plan for patients with advanced lung cancer chemotherapy was finally formed,including 5 first-level indexes,30 second-level indexes and 73 third-level indexes,in which the average importance of the first-level index was 4.42-4.83.the coefficient of variation is between 0.08 and 0.13,the average importance of the second index is between 3.63 and 4.83,and the coefficient of variation is between 0.08 and 0.21.The average importance of the third-level index is between 3.67 and 4.92,and the coefficient of variation is between 0.06 and 0.22,which accords with the retention and screening criteria of the index.The second part:1.The patients who completed this study included 39 patients in the intervention group and 39 patients in the control group.In T1 baseline phase,there was no significant difference in general data,quality of life,anxiety and depression score,sleep quality and pain score between the two groups(P>0.05).2.Quality of life:it was found that in stage T2,the scores of physiological status,emotional status,functional status and total score of quality of life in the observation group were higher than those in the control group(P<0.05).There was no significant difference between social and family status and other dimensions of concern(P>0.05).According to the intra-group comparison between the two groups before and after intervention,it was found that there was no significant difference in the social and family status scores of T2 patients in the observation group compared with those before intervention(P>0.05).The other four dimensions and the total score of quality of life were significantly higher than those in T1(P<0.05).In the control group,the total scores of functional status and quality of life in T2 were significantly higher than those in T1(P<0.05),but there was no significant difference in other dimensions(P>0.05).3.Anxiety and depression:it was found that the scores of anxiety and depression in the T2 observation group were lower than those in the control group(P<0.05).The intra-group comparison of the two groups before and after intervention showed that the scores of anxiety and depression in the T2 observation group were significantly lower than those before intervention(P<0.05),and the anxiety scores in the control group were significantly lower than those before intervention(P<0.05).There was no significant change in the control group before and after intervention(P>0.05).4.Sleep quality:in stage T2,there was no significant difference in the scores of sleep disorder and hypnotics between the observation group and the control group(P>0.05).The scores of sleep quality,sleep latency,sleep time,daytime dysfunction,sleep efficiency and the total score of sleep quality in the observation group were significantly lower than those in the control group(P<0.05).According to the intra-group comparison between the two groups before and after intervention,it was found that the scores of all sub-dimensions and total scores of sleep quality in the observation group decreased significantly,and the difference was statistically significant(P<0.05).The total score of sleep quality in the control group was significantly lower than that before intervention(P<0.05),but there was no significant difference in other subdimensions(P>0.05).5.Pain score:the pain score of T2 stage in the observation group was significantly lower than' that in the control group(P<0.05),and the pain score in T2 stage was significantly lower than that in T1 baseline stage(P<0.05).The pain score in T2 stage was significantly lower than that in control group(P<0.05).The pain score in T2 stage was significantly lower than that in T1 baseline stage(P<0.05).Conclusion:1.The continuous nursing model for chemotherapy patients with advanced lung cancer constructed in this study was established on the basis of a large number of lite rature reading,interviews with clinical experts and expert letter consultation,which is feasible and scientific.2.Continuous nursing is beneficial for out-of-hospital patients with advanced lung cancer undergoing chemotherapy to get continuous medical care service.Through the development of health education,patients could get professional and convenient guidance without leaving home,which improved the ability of symptom identification and management of patients.Their self-care ability and treatment confidence,their quality of life were also improved.Continuous nursing has been generally recognized and accepted by patients.2.The continuous nursing model of advanced lung cancer chemotherapy patients was applied to intermittent lung cancer chemotherapy patients.Through the promotion of lung cancer and chemotherapy-related knowledge and skills,the patient's self-care ability and treatment confidence were improved,reduced the patient's symptom distress and anxiety depression level,improved the sleep quality of patients and quality of life.The continuous care model constructed in this study was reasonable and effective,and has been widely recognized and accepted by patients. |
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