| Objective1.Through qualitative research on the psychological problems of mothers of children with congenital hand and foot deformities after surgery,the inner emotional process of mothers of children with congenital hand and foot deformities from the birth to the hospital for surgical treatment and later functional rehabilitation was explored.According to the interview data,the subjects were classified,and then the influencing factors of mothers' psychological problems were analyzed.2.Constructing a comprehensive intervention model for the psychological problems of mothers of children with congenital hand and foot deformities based on influencing factors.3.Through clinical application,the effect and significance of the comprehensive intervention model for psychological problems of mothers of children with congenital hand and foot deformities were verified.MethodsThis study is a hybrid design,which consists of three parts.The first part,analysis on the factors of psychological problems of mothers of children with congenital hand and foot deformities:Using qualitative research method and with the help of the interview outline prepared in advance,the semi-structured interview was conducted on the mothers of children with congenital hand and foot deformities who were reexamined in the outpatient department half a year after surgery,and the emotional course of the mothers from the birth of the children,admission to surgery,and functional exercise and rehabilitation was collected.Colaizzi's phenomenological analysis was used to analyze on the factors of psychological problems of mothers of children with congenital hand and foot deformities.The second part,based on the qualitative research results,the Delphi method was used to construct a comprehensive intervention model for the psychological problems of mothers of children with congenital hand and foot deformities.The third part,the application of the comprehensive intervention model in the clinical treatment of psychological problems of mothers of children with congenital hand and foot deformities:According to the standard program for evaluating the efficacy of intervention,the patients were randomized into experimental group and control group.The experimental group adopted the constructed comprehensive intervention model for nursing,and the control group adopted routine nursing measures.POMS-SF?APGAR?HADS surveys were performed on mothers of children with congenital hand and foot deformities of the two groups at admission,1 month after discharge,and 6 months after discharge.Independent sample t test and ?2 test were used for single factor analysis.Analysis of variance was used for repeated measurements.The generalized estimation equation(ordered Logistic regression)was used when the result variables were ordered multi-classification variables,P<0.05 was considered statistically significant to confirm the effect of the constructed comprehensive intervention model in clinical application.Results1.Analysis of factors influencing the psychological problems of mothers of children with congenital hand and foot deformities:from the birth of the children to hospitalization for surgical treatment and the subsequent functional rehabilitation,the mothers have negative psychology such as anxiety and negative mood,which is constantly changing dynamically.The specific manifestations are:pain,remorse and inferiority at birth;obvious anxiety and worry during hospitalization;The lack of skills in the needs of rehabilitation care,and changes in personal behavior and family relationships,are all manifestations of psychological changes in the mothers.2.On the basis of the results of the first part of the study,the comprehensive intervention model for the psychological problems of mothers of children with congenital hand and foot deformities was constructed,and clinical mursing work was carried out by the clinical pathway model.3.The research results of clinical application are as follows:Short form of the Profile of Mood States(POMS-SF)shows:the experimental and control groups both had lower total scores after surgery than before surgery.The TMD scores of the experimental group before surgery,1 month after surgery and 6 months after surgery were:103.24±21.84,98.52±20.52,95.16±22.85;the corresponding TMD scores of the control group were:113.16±21.75?110.12±27.00?107.80±19.93,The total score of the experimental group was lower than that of the control group.Two groups were significantly different by repeated measurement analysis of variance test(P=0.02).Family Adaptation Partnership Growth Affection Resolve(APGAR)shows:although the number of families with severe disorders was decreased in the two groups after surgery,there was no statistically significant difference between the experimental group and the control group in terms of family function score through orderly Logistics regression statistics(P>0.05).Hospital Anxiety and Depression Scale(HADS)shows:In the experimental group,there were 14 cases of no anxiety symptoms,11 cases of possible and obvious symptoms,22 cases of no anxiety symptoms,3 cases of possible and obvious symptoms six months after intervention;In the control group,there were 12 cases of no anxiety symptoms,13 cases of possiole and obvious symptoms,15 cases of no anxiety symptoms,10 cases of possible and obvious symptoms at six months after operation.after intervention,the anxiety symptom score of the experimental group was significantly lower than that of the control group,the scores of anxiety symptoms of the two groups were analyzed by generalized estimation equation and ordered logistic regression analysis,OR=0.477(95%CI 0.246,0.928),The difference was statistically significant(P=0.029).The depression symptom scores of the experimental group and the control group were compared by logistic regression OR=1.309(95%CI0.605,2.834),There was no significant difference between the two groups(P>0.05).ConclusionCongenital hand and foot deformities are common structural deformities of the body surface in newborns.Since the birth of the children,the family relationship has begun to change,and the mothers are facing tremendous psychological and social pressure.The results of this study indicate that from the birth of the children to the period of surgical treatment until the period of postoperative functional recovery,the mothers suffered from negative psychology such as guilt,anxiety and worry and had different psychological pressures in different periods.This negative psychology affects the children's mental health and growth,in the process of raising and caring for the children's mothers,and can easily cause the parent-child relationship adverse effects.Based on the results of the study,using the time between hospitalization and postoperative functional recovery,nurses dynamically assess the psychological problems of the mothers analyze the influencing factors,flexibly use of interventions to provide care and skills to help them reduce the risk.Reducing the negative emotions of the mothers,and improving the mother's anxiety and other negative psychology,has good social significance to promote the healthy growth of children and the positive development of doctor-patient relationship. |
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