思维导图式健康教育对肠造口患者术后自我护理能力的影响

刘全丽; 张婕; 张静; 霍蕊

doi:10.16766/j.cnki.issn.1674-4152.002662

思维导图式健康教育对肠造口患者术后自我护理能力的影响

doi: 10.16766/j.cnki.issn.1674-4152.002662

刘全丽^{1, 2},
张婕²,
张静²,
霍蕊^1, ,

1.
蚌埠医学院第一附属医院胃肠外科，安徽蚌埠 233004
2.
蚌埠医学院护理学院，安徽蚌埠 233030

基金项目:

安徽高校人文社会科学研究项目 SK2020A0365

详细信息

通讯作者:
霍蕊, E-mail: huorui800914@163.com

中图分类号: R473.6 R656.6
计量
- 文章访问数: 128
- HTML全文浏览量: 51
- PDF下载量: 6
- 被引次数: 0
出版历程
- 收稿日期: 2022-02-14
- 网络出版日期: 2022-11-29

The influence of mind mapping schema health education on postoperative self-care ability of patients with enterostomy

LIU Quan-li^{1, 2},
ZHANG Jie²,
ZHANG Jing²,
HUO Rui^{1
, ,}

1.
Department of Gastrointestinal Surgery, the First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui 233004, China

摘要

摘要: 目的探讨思维导图式健康教育对直肠癌术后行肠造口的患者术后自我护理能力以及造口周围皮肤并发症的影响，旨在提高患者居家自我护理造口的能力，减少造口并发症的发生。方法前瞻性纳入2021年1—9月在蚌埠医学院第一附属医院胃肠外科接受直肠癌根治术并行肠造口的79例患者，采用随机数字表法将患者分为对照组(39例)及观察组(40例)。对照组采用常规造口健康教育，包含造口相关护理知识、生活指导、并发症处理及出院指导等，观察组在常规健康教育的基础上融合思维导图宣教。采用造口自我护理能力量表于出院当日、出院1个月和3个月时分别评估患者对造口的自我护理能力，并记录患者出院后造口周围皮肤并发症的发生情况。结果 2组患者出院当日造口自我护理能力评分差异无统计学意义(P>0.05);观察组与对照组出院1个月[(53.13±2.65)分vs. (47.77±2.44)分]及出院3个月[(58.80±2.60)分vs. (54.92±2.66)分]自我护理能力评分差异有统计学意义(均P < 0.01)。对照组与观察组出院1个月(21人vs. 12人, χ²=4.617，P=0.032)及出院3个月(15人vs. 7人, χ²=4.318，P=0.038)造口并发症发生例数差异均有统计学意义(均P < 0.05)。观察组与对照组住院满意度分别为95.0%(38/40)及76.9%(30/39)，差异有统计学意义(χ²=5.384，P=0.020)。结论思维导图式健康教育能改善肠造口患者术后居家自我护理造口的能力，减少术后造口并发症的发生，提高住院期间满意度。
- 思维导图 /
- 肠造口 /
- 自理能力
Abstract: Objective To investigate the effect of mind map schema health education on postoperative self-care ability and skin complications of patients undergoing enterostomy after rectal cancer operation, so as to improve the ability of self-care at home and reduce the occurrence of complications. Methods Patients undergoing radical colorectal cancer surgery with enterostomy in the Gastrointestinal Surgery Department of First Affiliated Hospital of Bengbu Medical College from January to September 2021 were prospectively enrolled. They were divided into control group (39 cases) and observation group (40 cases) using random numbers method. The control group received routine ostomy health education, including ostomy-related nursing knowledge, life guidance, complication management and discharge guidance, while the observation group received routine health education combined with mind map education. The patients'ability of self-care for ostomy was evaluated by the ostomy self-care ability scale at discharge day, one month and three months. The occurrence of skin complications around ostomy after discharge was recorded. Results There was no significant difference in the ostomy self-care ability score between the two groups on discharge day (P>0.05). The self-care ability scores of the observation group and the control group were statistically significant after discharge for one month [(53.13±2.65) points vs. (47.77±2.44) points] and three months [(58.80±2.60) points vs. (54.92±2.66) points, all P < 0.01]. In terms of ostomy complications, there were statistically significant differences between the control group and the observation group in the number of cases of complications after discharge for one month (21 vs. 12, χ²=4.617, P=0.032) and three months (15 vs. 7, χ²=4.318, P=0.038). The hospitalization satisfaction of the observation group and the control group was 95.0% (38/40) and 76.9% (30/39), respectively, with statistical significance (χ²=5.384, P=0.020). Conclusion Mind mapping schema health education can improve the ability of patients with enterostomy to take care of their stoma at home, reduce the occurrence of stoma complications, and improve satisfaction during hospitalization.
- Mind mapping /
- Enterostomy /
- Self-care ability

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图 1 造口袋倾倒

Figure 1. Dumping of ostomy bag

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图 2 造口袋更换

Figure 2. Replacement of ostomy bag

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图 3 造口患者日常生活指导

Figure 3. Daily living instruction for patients with stoma

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图 4 造口并发症表现及处理

Figure 4. Presentation and management of ostomy complications

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表 1 2组结直肠癌根治术患者一般资料比较[例(%)]

Table 1. Comparison of general data between the two groups of patients undergoing radical resection of colorectal cancer [cases (%)]

项目	类别	对照组(n=39)	观察组(n=40)	统计量	P值
年龄(x±s, 岁)		60.69±7.92	60.20±9.33	0.251^a	0.802
性别[例(%)]	男性	31(79.5)	30(75.0)	0.226^b	0.635
	女性	8(20.5)	10(25.0)
文化程度[例(%)]	文盲	8(20.5)	11(27.5)	-0.336^c	0.737
	小学	18(46.2)	15(37.5)
	初中	8(20.5)	10(25.0)
	高中及以上	5(12.8)	4(10.0)
婚姻状况[例(%)]	已婚	37(94.9)	39(97.5)	0.001^b	0.982
	未婚/丧偶	2(5.1)	1(2.5)
职业[例(%)]	农民	28(71.8)	28(70.0)	2.210^b	0.530
	工人	8(20.5)	10(25.0)
	教师	0(0.0)	1(2.5)
	退休人员	3(7.7)	1(2.5)
家庭人均收入[例(%)]	< 1 000元	6(15.4)	4(10.0)	-1.133^c	0.257
	1 000~3 000元	20(51.3)	18(45.0)
	>3 000元	13(33.3)	18(45.0)
长期居住地[例(%)]	农村	31(79.5)	29(72.5)	0.528^b	0.468
	城镇	8(20.5)	11(27.5)
住院时间[例(%)]	≤15 d	38(97.4)	36(90.0)	0.801^b	0.371
	>15 d	1(2.6)	4(10.0)
造口类型[例(%)]	永久性	17(43.6)	19(47.5)	0.122^b	0.727
	临时性	22(56.4)	21(52.5)
注：^a为t值，^b为χ²值，^c为Z值。

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表 2 2组结直肠癌根治术患者自我护理意愿得分比较(x±s, 分)

Table 2. Comparison of self-care intention score between two groups of patients undergoing radical resection of colorectal cancer (x±s, points)

组别	例数	自我护理意愿
组别	例数	出院当日	出院1个月	出院3个月
对照组	39	33.87±1.89	35.64±1.44^a	38.23±2.16^a
观察组	40	33.90±2.26	37.73±1.87^a	39.80±2.14^a
t值		0.060	5.543	3.246
P值		0.952	< 0.001	0.002
注：F_组别=22.968，P < 0.001;F_时间=132.144，P < 0.001;F_交互=5.731，P=0.004。与出院当日比较，^aP < 0.05。

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表 3 2组结直肠癌根治术患者自我护理知识得分比较(x±s, 分)

Table 3. Comparison of self-care knowledge scores between two groups of patients undergoing radical resection of colorectal cancer (x±s, points)

组别	例数	自我护理知识
组别	例数	出院当日	出院1个月	出院3个月
对照组	39	9.72±1.36	10.97±1.87^a	12.79±1.69^a
观察组	40	9.90±1.10	12.03±1.37^a	14.25±1.86^a
t值		0.655	2.855	3.634
P值		0.514	0.006	0.001
注：F_组别=17.339，P < 0.001;F_时间=118.065，P < 0.001;F_交互=3.613，P=0.029。与出院当日比较，^aP < 0.05。

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表 4 2组结直肠癌根治术患者自我护理技能得分比较(x±s, 分)

Table 4. Comparison of self-care skill scores of patients undergoing radical resection of colorectal cancer between 2 groups (x±s, ponits)

组别	例数	自我护理技能
组别	例数	出院当日	出院1个月	出院3个月
对照组	39	0.67±0.48	2.36±0.99^a	4.33±0.48^a
观察组	40	0.70±0.46	3.38±0.84^a	4.78±0.42^a
t值		0.315	4.939	4.661
P值		0.754	< 0.001	< 0.001
注：F_组别=43.848，P < 0.001;F_时间=649.335，P < 0.001;F_交互=10.519，P < 0.001。与出院当日比较，^aP < 0.05。

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表 5 2组结直肠癌根治术患者自我护理能力总得分比较(x±s, 分)

Table 5. Comparison of total score of self-care ability in patients with radical resection of colorectal cancer between 2 groups (x±s, points)

组别	例数	自我护理能力
组别	例数	出院当日	出院1个月	出院3个月
对照组	39	44.26±2.28	47.77±2.44^a	54.92±2.66^a
观察组	40	44.50±2.58	53.13±2.65^a	58.80±2.60^a
t值		0.444	9.328	6.547
P值		0.658	< 0.001	< 0.001
注：F_组别=79.678，P < 0.001;F_时间=514.852，P < 0.001;F_交互=22.858，P < 0.001。与出院当日比较，^aP < 0.05。

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表 6 2组结直肠癌根治术患者不同时间点并发症发生例数比较[例(%)]

Table 6. Comparison of complications at different time points between the two groups after radical resection of colorectal cancer [cases (%)]

组别	例数	出院1个月末	出院3个月末
对照组	39	21(53.8)	15(38.5)
观察组	40	12(30.0)	7(17.5)
χ²值		4.617	4.318
P值		0.032	0.038

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参考文献(27)

[1]	SUNG H, FERLAY J, SIEGEL R L, et al. Global cancer statistics 2020: Globocan estimates of incidence and mortality worldwide for 36 cancers in 185 countries[J]. CA Cancer J Clin, 2021, 71(3): 209-249. doi: 10.3322/caac.21660
[2]	KIM S, KIM M H, OH J H, et al. Predictors of permanent stoma creation in patients with mid or low rectal cancer: Results of a multicentre cohort study with preoperative evaluation of anal function[J]. Colorectal Dis, 2020, 22(4): 399-407. doi: 10.1111/codi.14898
[3]	GIORDANO V, NICOLOTTI M, CORVESE F, et al. Describing self-care and its associated variables in ostomy patients[J]. J Adv Nurs, 2020, 76(11): 2982-2992. doi: 10.1111/jan.14499
[4]	余金素, 董斌. 围手术期健康教育路径对髋关节置换术患者早期功能锻炼依从性影响[J]. 安徽医学, 2018, 39(3): 346-348. 余金素, 董斌. 围手术期健康教育路径对髋关节置换术患者早期功能锻炼依从性影响[J]. doi: 10.3969/j.issn.1000-0399.2018.03.031
[5]	王爱华, 方方, 李萍, 等. 医护联合健康教育在结直肠手术患者恢复过程中的应用[J]. 齐鲁护理杂志, 2019, 25(4): 92-94. doi: 10.3969/j.issn.1006-7256.2019.04.035 WANG A H, FANG F, LI P, et al. Application of combined health education in the recovery of patients undergoing colorectal surgery[J]. Journal of Qilu Nursing, 2019, 25(4): 92-94. doi: 10.3969/j.issn.1006-7256.2019.04.035
[6]	GOSSACK-KEENAN K, DE WIT K, GARDINER E, et al. Showing your thinking: Using mind maps to understand the gaps between experienced emergency physicians and their students[J]. AEM Educ Train, 2020, 4(1): 54-63. doi: 10.1002/aet2.10379
[7]	中华人民共和国国家卫生健康委员会. 中国结直肠癌诊疗规范(2020年版)[J]. 中华外科杂志, 2020, 58(8): 561-585. doi: 10.3760/cma.j.cn112139-20200518-00390 National Health Commission of the People's Republic of China. Chinese protocol of diagnosis and treatment of colorectal cancer (2020 edition)[J]. Chinese Journal of Surgery, 2020, 58(8): 561-585. doi: 10.3760/cma.j.cn112139-20200518-00390
[8]	BERTI-HEARN L, ELLIOTT B. Colostomy care: A guide for home care clinicians[J]. Home Healthc Now, 2019, 37(2): 68-78. doi: 10.1097/NHH.0000000000000735
[9]	孟晓红, 徐洪莲. 中华护理学会成人肠造口护理团体标准要点解读及思考[J]. 上海护理, 2021, 21(6): 1-4. doi: 10.3969/j.issn.1009-8399.2021.06.001 MENG X H, XU H L. Interpretation and thinking on nursing care for adult stoma patients issued by Chinese Nursing Association[J]. Shanghai Nursing, 2021, 21(6): 1-4. doi: 10.3969/j.issn.1009-8399.2021.06.001
[10]	闫媛媛, 王斌全, 王梦瑶, 等. 2015年—2020年肠造口护理临床实践指南的质量评价[J]. 护理研究, 2021, 35(7): 1267-1272. https://www.cnki.com.cn/Article/CJFDTOTAL-SXHZ202107031.htm YAN Y Y, WANG B Q, WANG M Y, et al. Quality appraisal of clinical practice guidelines related to ostomy nursing from 2015 to 2020[J]. Chinese Nursing Research, 2021, 35(7): 1267-1272. https://www.cnki.com.cn/Article/CJFDTOTAL-SXHZ202107031.htm
[11]	熊荣春, 徐晶晶, 仇晓溪. 凸面造口产品使用的国际专家共识在结直肠癌术后造口患者皮肤管理中的应用[J]. 中西医结合护理(中英文), 2020, 6(4): 74-77. https://www.cnki.com.cn/Article/CJFDTOTAL-ZXHL202004019.htm XIONG R C, XU J J, QIU X XI. Application of convexity expert consensus on the skin around the stoma of patients with colorectal cancer[J]. Journal of Clinical Nursing in Practice, 2020, 6(4): 74-77. https://www.cnki.com.cn/Article/CJFDTOTAL-ZXHL202004019.htm
[12]	封蔓, 曹松梅, 解红锋, 等. 肠造口病人造口旁疝非手术预防及管理的最佳证据总结[J]. 护理研究, 2021, 35(17): 3042-3047. doi: 10.12102/j.issn.1009-6493.2021.17.007 FENG M, CAO S M, XIE H F, et al. Best evidence summary of nonsurgical prevent ion and management of paras tomal hernia in enterostomy patients[J]. Chinese Nursing Research, 2021, 35(17): 3042-3047. doi: 10.12102/j.issn.1009-6493.2021.17.007
[13]	司龙妹, 刘飞, 张佩英, 等. 造口患者围手术期健康教育的最佳证据总结[J]. 中华护理杂志, 2021, 56(3): 452-457. doi: 10.3761/j.issn.0254-1769.2021.03.024 SI L M, LIU F, ZHENG P Y, et al. Evidence summary of perioperative health education for patients undergoing ostomy surgery[J]. Chinese Journal of Nursing, 2021, 56(3): 452-457. doi: 10.3761/j.issn.0254-1769.2021.03.024
[14]	王艳秋. 以奥马哈系统为框架的延续护理在永久性结肠造口患者中的应用研究[D]. 蚌埠: 蚌埠医学院, 2017. WANG Y Q. Application of Omaha System-based continuous care in patients with permanent colostomy[D]. Bengbu: Bengbu Medical College, 2017.
[15]	韩褀, 徐晨, 王荣华, 等. 某市出院病人护理满意度调查及影响因素分析[J]. 护理研究, 2019, 33(14): 2540-2542. doi: 10.12102/j.issn.1009-6493.2019.14.044 HAN Q, XU C, WANG R H, et al. Survey on satisfaction of nursing care and analysis of influencing factors among discharged patients in a city[J]. Chinese Nursing Research, 2019, 33(14): 2540-2542. doi: 10.12102/j.issn.1009-6493.2019.14.044
[16]	李士红. 加速康复外科理念在普外科围术期护理中的应用现状与展望[J]. 齐鲁护理杂志, 2019, 25(4): 1-4. https://www.cnki.com.cn/Article/CJFDTOTAL-QLHL201904002.htm LI S H. Current situation and prospect of the application of the concept of accelerated rehabilitation surgery in perioperative nursing of general surgery[J]. Journal of Qilu Nursing, 2019, 25(4): 1-4. https://www.cnki.com.cn/Article/CJFDTOTAL-QLHL201904002.htm
[17]	李涛. 基于加速康复外科理念的健康教育下结直肠癌患者出院准备度及出院指导质量现状调查[J]. 中国肛肠病杂志, 2021, 41(2): 58-60. https://www.cnki.com.cn/Article/CJFDTOTAL-GCBZ202102025.htm LI T. Status quo survey on readiness for hospital discharge and quality of discharge teaching behind colorectal cancer patients received health teaching directed by idea of ERAS[J]. Chinese Journal of Coloproctology, 2021, 41(2): 58-60. https://www.cnki.com.cn/Article/CJFDTOTAL-GCBZ202102025.htm
[18]	周桂兰, 洪菁, 苏梅芳, 等. 造口病人居家自我护理缺陷的现状调查及分析[J]. 护理研究, 2019, 33(1): 157-159. https://www.cnki.com.cn/Article/CJFDTOTAL-SXHZ201901039.htm ZHOU G L, HONG J, SU M F, et al. Status quo investigation and analysis of home self-care defects in patients with stoma[J]. Chinese Nursing Research, 2019, 33(1): 157-159. https://www.cnki.com.cn/Article/CJFDTOTAL-SXHZ201901039.htm
[19]	孙文环, 边瑞军. 思维导图健康教育模式对学龄期手足口病患儿家属疾病认知水平及行为干预的影响[J]. 医学临床研究, 2019, 36(3): 559-560. doi: 10.3969/j.issn.1671-7171.2019.03.052 SUN W H, BIAN R J. Effects of mind mapping health education model on disease cognition level and behavioral intervention of family members of school-age children with hand, foot and mouth disease[J]. Journal of Clinical Research, 2019, 36(3): 559-560. doi: 10.3969/j.issn.1671-7171.2019.03.052
[20]	张宏伟, 魏俊霞. 基于思维导图模式的护理干预策略在老年原发性高血压患者中的应用[J]. 河南医学研究, 2021, 30(2): 354-356. https://www.cnki.com.cn/Article/CJFDTOTAL-HNYX202102066.htm ZHANG H W, WEI J X. Application of nursing intervention strategy based on mind map model in elderly patients with essential hypertension[J]. Henan Medical Research, 2021, 30(2): 354-356. https://www.cnki.com.cn/Article/CJFDTOTAL-HNYX202102066.htm
[21]	周佳星, 王益平, 杨雪, 等. 五音疗法结合思维导图的风险预警健康教育方案在老年高血压病人中的应用[J]. 护理研究, 2021, 35(10): 1827-1830. https://www.cnki.com.cn/Article/CJFDTOTAL-SXHZ202110026.htm ZHOU J X, WANG Y P, YANG X, et al. Application of health education program on risk warning based on five-tone therapy combined with mind map in elderly hypertensive patients[J]. Chinese Nursing Research, 2021, 35(10): 1827-1830. https://www.cnki.com.cn/Article/CJFDTOTAL-SXHZ202110026.htm
[22]	GIALAMAS E, MEYER J, ABBASSI Z, et al. The use of a stoma rod/bridge to prevent retraction: A systematic review[J]. J Wound Ostomy Continence Nurs, 2021, 48(1): 39-43.
[23]	陈海婷, 蔡朋株, 梁霞, 等. 成人肠造口患者造口周围刺激性皮炎预防与管理循证实践[J]. 护士进修杂志, 2021, 36(19): 1729-1734. https://www.cnki.com.cn/Article/CJFDTOTAL-FSJX202119001.htm CHEN H T, CAI P Z, LIANG X, et al. Evidence-based practice of prevention and management of peristomal irritant dermatitis in adult patients with enterostomy[J]. Journal of Nurses Training, 2021, 36(19): 1729-1734. https://www.cnki.com.cn/Article/CJFDTOTAL-FSJX202119001.htm
[24]	高仁玉, 余海云, 李海波. 基于思维导图的循证护理方法在回肠膀胱术中的应用效果[J]. 安徽医学, 2019, 40(04): 463-466. https://www.cnki.com.cn/Article/CJFDTOTAL-AHYX201904033.htm GAO R Y, YU H Y, LI H B. Application effect of evidence-based nursing method based on mind mapping in ileal bladder surgery[J]. Anhui Medical Journal, 2019, 40(04): 463-466. https://www.cnki.com.cn/Article/CJFDTOTAL-AHYX201904033.htm
[25]	范婧慧, 孙璇, 汪厚术. 回肠造口患者基于思维导图健康教育的效果观察[J]. 护理学报, 2019, 26(20): 69-73. https://www.cnki.com.cn/Article/CJFDTOTAL-NFHL201920024.htm FAN J H, SUN X, WANG H S. Effect of health education based on mind map for ileostomy patients[J]. Journal of Nursing, 2019, 26(20): 69-73. https://www.cnki.com.cn/Article/CJFDTOTAL-NFHL201920024.htm
[26]	姚呈. 思维导图在膀胱癌尿路造口患者健康教育中的应用[D]. 昆明: 昆明医科大学, 2019. YAO C. Application of mind mapping in health education of bladder cancer urostomy patients[D]. Kunming: Kunming Medical University, 2019.
[27]	汪蕾, 李阿文, 卢姗, 等. 思维导图在回肠膀胱造口患者围手术期健康教育中的应用效果[J]. 中华全科医学, 2021, 19(9): 1535-1538, 1614. doi: 10.16766/j.cnki.issn.1674-4152.002105 WANG L, LI A W, LU S, et al. The application of mind mapping in health education of perioperative with ileal bladder stoma[J]. Chinese Journal of General Practice, 2021, 19(9): 1535-1538, 1614. doi: 10.16766/j.cnki.issn.1674-4152.002105