Influence of nursing intervention based on Acceptance and Commitment Therapy on stigma in patients with colorectal cancer stoma

目的:探讨基于接纳承诺疗法的护理干预对结直肠癌造口病人病耻感的影响.方法:根据随机数字表法将2018年11月—2020年8月60例结直肠癌造口病人分为对照组和观察组各30例,对照组行常规护理,观察组在常规护理基础上给予基于接纳承诺疗法的护理.随访3个月,采用社会影响量表(SIS)、造口适应量表(OAI-23)、造口病人生活质量量表(Stoma-QOL)评估两组病人干预前后病耻感、造口护理的适应性、生活质量,采用修订的造口自我护理量表(SSCS-ESV)评估两组病人造口更换熟练率,采用院内自制量表调查两组病人的护理满意度.结果:两组病人干预后SIS各维度评分均降低且观察组低于对照组(P<0.05);两组病人干预后OAI-20量表中持续担忧维度得分均降低且观察组低于对照组,积极生活态度、接受维度得分均升高且观察组高于对照组(P<0.05);两组病人干预后Stoma-QOL各维度得分均升高且观察组高于对照组(P<0.05);观察组病人造口袋更换熟练率和护理满意率均高于对照组(P<0.05).结论:基于接纳承诺疗法的护理干预能帮助结直肠癌造口病人重建心理,缓解病人的病耻感,提高病人自我护理能力,改善病人生活质量,提高病人的护理满意度.

Objective: To explore the effect of nursing intervention based on acceptance and commitment therapy on the sense of stigma in patients with colorectal cancer and stoma. Methods: According to the random number table method, 60 patients with colorectal cancer and stoma from November 2018 to August 2020 were divided into a control group and an observation group with 30 cases in each group. The control group received routine care, and the observation group was given care based on acceptance and commitment therapy on the basis of routine care. After 3 months of follow-up, the social impact scale (SIS), stoma adaptation inventory (OAI-23), and stoma patient quality of life scale (Stoma-QOL) were used to evaluate the sense of stigma, adaptability of stoma care, and quality of life of the two groups of patients before and after the intervention. The revised stoma self-care scale (SSCS-ESV) was used to evaluate the proficiency of stoma replacement in the two groups of patients. The hospital-made scale was used to survey the two groups of patients. Results: After the intervention, SIS scores decreased in all dimensions in both groups, with the observation group showing lower scores than the control group (P < 0.05). OAI-20 scores on the persistent worry dimension decreased in both groups, with the observation group showing lower scores than the control group, while scores on the positive attitude and acceptance dimensions increased, with the observation group showing higher scores than the control group (P < 0.05). Stoma-QOL scores increased in all dimensions in both groups, with the observation group showing higher scores than the control group (P < 0.05). The proficiency rate of ostomy bag changes and nursing satisfaction rates in the observation group were higher than those in the control group (P < 0.05). Conclusion: Nursing intervention based on acceptance and commitment therapy can help colorectal cancer stoma patients rebuild their mental health, alleviate their stigma, enhance their self-care abilities, improve their quality of life, and enhance their nursing satisfaction.