| Objective: To explore the actor and partner effects of perceived stress and dyadic coping on the quality of life of couples by analyzing the relationship between the quality of life,perceived stress and dyadic coping of patients with permanent enterostomy and their spouses,and provide a theoretical basis for actively carrying out the "couple-centered" dyadic intervention research in nursing field in thefuturetoimprovethehealthandqualityoflifeofpatients,spousesandthewholefamily.Methods: Patients with permanent enterostomy and their spouses who underwent colorectal cancer surgery in five Grade-ATertiary Hospital in Jilin Province from September 2019 to November 2020 were selected as the research objects by using convenience sampling.General information questionnaire,the short-form 36 health survey scale,the chinese perceived stress scalesand the dyadic coping inventory were adopted.SPSS26.0 and AMOS 17.0 software were used for data analysis.Descriptive analysis,t-test,pearson correlation analysis and actor-partner interdependence model wereusedforstatisticalanalysis.P< 0.05 wasstatisticallysignificant.Results:(1)Quality of life,perceived stress and dyadic coping of patients with permanent enterostomy and their spouses: Patients with permanent enterostomy and their spouses’ average scores of quality of life were 432.39 ± 118.04 and 416.57 ± 107.30,respectively.Both patients and their spouses had lower scores in the crowds of age over 70,with low education level,average monthly family income less than 1000 yuan,general marital relationship,suffering from chronic diseases,1～3 months after stoma,complete inability to take care of their stoma and complications of colostomy.In addition to the above-mentioned common parts,patients had lower quality of life scores in terms of irregular defecation and monthly cost over 300 yuan in purchasing stoma products,while their spouses had lower quality of life scores in terms of decreased postoperative sexual life.Patients with permanent enterostomy andtheir spouses’ average scores of perceived stresswere 31.67 ± 5.71 and 32.71 ± 5.30,respectively.Both the patients and their spouses had higher scores of perceived stress in the crowds of low educational level,low average monthly family income,general marital relationship,partial or complete inability to take care of their stoma.In addition to the above-mentioned common parts,patients had higher scores of perceived stress in terms of 1～3 months after stoma,suffering from chronic diseases and complications of colostomy,while their spouses had higher score of perceived stress in term of 1～3 month after stoma.Patients with permanent enterostomy and their spouses’ average scores of dyadic coping were 102.51±8.52 and 101.14±7.65,respectively.Both the patients and their spouses had lower scores of dyadic coping in the crowds of low educational level,average monthly family income less than 1000 yuan,general marital relationship,suffering from chronic diseases,and 1 month after stoma.In addition to the above-mentioned common parts,patients had lowerscoresofdyadiccopingintermofcompleteinabilitytotakecareoftheirstoma.(2)Differences in quality of life,perceived stress and dyadic coping between patients with permanent enterostomy and their spouses: In terms of quality of life,the patient’s total quality of life,vitality,and mentalhealth scoreswere higherthan thoseoftheir spouses(t=2.035～5.947,P﹤0.05),andtheir physical functioning,social functioning scores were lower than those of their spouses(t=-2.089～-2.069,P﹤0.05);In terms of perceived stress,the score of the patient was lower than that of the spouse(t=-2.340,P ﹤0.05);In terms of dyadic coping,the patient’s stress communication,negativedyadic coping scoreswere higher thanthose of their spouses(t=4.805～9.592,P﹤0.05),andthedelegateddyadiccopingscoreislowerthanthatofthespouse(t=-14.852,P﹤0.05).(3)Relationship between the quality of life,perceived stress,and dyadic coping of patients with permanent enterostomy and their spouses:The patients’ score of quality of life was positively correlated with that of their spouses(r = 0.646,P< 0.01).The patients’ perceived stress score was positively correlated with that of their spouses(r=0.513,P< 0.01).The patients’ stress communication,supporting dyadic coping,delegated dyadic coping,negative dyadic coping and common dyadic copingwerepositivelycorrelatedwiththoseoftheirspouses(r = 0.378～0.519,P<0.01).(4)Analysis of actor and partner effects of influencing factors on patients with permanent enterostomy and their spouses’ quality of life:In terms of actor effect,patients and their spouses’ stress communication,supportive dyadic coping,delegated dyadic coping and common dyadic coping could positively predicttheir own quality of life(P< 0.05),while perceived stress and negative dyadic coping could negatively predict their own quality of life(P< 0.05).In terms of partner effect,patients and their spouses’ stress communication,supportive dyadic coping,delegated dyadic coping and common dyadic coping could positively predict the other’s quality of life(P< 0.05),while perceived stressandnegativedyadiccopingcouldnegativelypredicttheother’squalityoflife(P< 0.05).Conclusion:(1)The quality of life of patients with permanent enterostomy and their spouses is at a relatively low level,and remains to be improved.Whether it is the patient or the spouse,the older their age,the lower their educationlevel,the lower the monthly family income,the general relationshipbetween the husband and the wife,the chronic disease,the shorter the time after the stoma,and the complete inability to take care of the stoma at all are factors that affect the quality of life of the patient and spouse.In addition to the above-mentioned common parts,Irregular defecation and the higher the monthly cost of purchasing stoma supplies are the influencing factors of the patient’s quality of life,while the reduction of the patient’s postoperative sex life is the influencing factor of the spouse’s quality of life.Therefore,when providing nursing services,we should also pay attention to individual differenceswhileconsideringthecommonparts.(2)Patients with permanent enterostomy have higher scored than their spouses in the total score of quality of life,vitality,mental health,stress communication and negative dyadic coping,but lower in physicalfunctioning,socialfunctioning,perceivedstressanddelegateddyadiccoping.(3)The quality of life,perceived stress and dyadic coping of patients with permanent enterostomy and their spouses are correlated with each other.The quality of life of patients with permanent enterostomyand their spouses are affected by their own perceived pressure and dyadic coping.The higher the pressure communication,supporting dyadic coping,delegated dyadic coping and common dyadic coping between patients and their spouses,the higher the quality of life of themselves and their spouses.The higher the perceived pressure and negative dyadic coping of patients and spouses,the lower the quality of life of themselves and their spouses.It is recommended that when conducting research and actual disease control on permanent enterostomyand patients and spouses with special health management needs,medical staff should treat patients and spouses as a whole and formulate effective "couple-centered" chronic disease health interventions to improve the health and quality of lifeofpatients,spousesandtheentire family. |
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