目的 探讨以家庭为中心的赋权干预对提高军队离退休老干部生活质量和减轻家庭主要照顾者照护负担的影响.方法 选取 2020 年 6 月至 2021 年 5 月在海军军医大学第一附属医院虹口院区住院治疗的 102 例离退休老干部及其主要照顾者作为研究对象,根据患者治疗意愿的不同将其分为对照组(n=50)和干预组(n=52).对照组给予常规护理,干预组在对照组的基础上采取家庭赋权干预方案.比较 2 组患者生活质量、服药依从性以及家庭主要照顾者照顾负担.结果 2 组患者干预前生活质量、家庭主要照顾者照护负担评分比较差异无统计学意义(P>0.05);干预后,干预组生活质量(生理职能、躯体疼痛、总体健康、活力、社会功能、情感职能、精神健康)各维度评分均高于对照组,差异有统计学意义(P<0.05);干预组家庭主要照顾者照护负担低于对照组,差异有统计学意义(P<0.05);干预组患者服药依从性(82.7％)高于对照组(62.0％),差异有统计学意义(P<0.05).结论 在军队离退休老干部及其主要照顾者中实施以家庭为中心的赋权干预,能够有效改善其生活质量,提升其服药依从性及减轻家庭照护负担.

通过总结海上移动医疗保障的护理工作经验，构建新形势下海上移动医疗保障护理队伍模式，完善人员培训方案、海上伤员战术医疗后送方案及海上移动医疗保障护理方案，有利于提高海军护理人员海上移动卫勤保障能力。

Objective:To construct a narrative nursing intervention program for patients with advanced lung cancer undergoing chemotherapy based on the meaning in life theory, so as to alleviate the negative psychology of patients and improve the meaning in life of patients.Methods:Using a mixed research design, based on the literature study and qualitative interview, the first draft of narrative nursing intervention program for patients with advanced lung cancer undergoing chemotherapy was constructed based on the theory of meaning in life. From June to September 2021, the Delphi method was used to conduct 2 rounds experts consultations among 15 experts from 8 hospitals, and the items were revised according to the expert′s advice.Results:The experts positive coefficients of the 2 rounds consultations were 83.33% and 100.00%, the expert authority coefficient was 0.88, and the Kendall coefficients of importance were 0.183 and 0.215, and the operational Kendall coefficients were 0.234 and 0.363. Finally, a narrative nursing intervention program for lung cancer patients based on the theory of meaning in life was formed. It included four modules: narrative theme, narrative content, narrative interview outline and homework assignment/auxiliary measures. It was performed 7 times in each chemotherapy cycle.Conclusions:The construction process of narrative nursing intervention program for patients with advanced lung cancer undergoing chemotherapy based on the theory of meaning in life is rigorous, scientific and practical and can be used to guide clinical psychological nursing intervention for patients with advanced diseases and enrich the way to seek the meaning in life of patients

目的 调查慢性阻塞性肺病(COPD)患者稳定期自我管理效能困境的真实体验,为提高患者的自我管理效能,深入开展临床COPD自我管理干预的研究提供参考.方法 采用现象学研究方法,选取2020年9月至2021年1月于上海市某三级甲等医院呼吸内科病房次日出院的18名患者进行半结构式访谈,采用Colaizzi七步分析法分析资料提炼主题.结果 稳定期COPD患者主要有6大类自我管理效能困境,包括:居家自我管理认知困境、居家自我管理技能困境、负性情绪困境、日常生活困境、家庭/工作压力困境、脱离医护及家人监督的困境.结论 COPD患者居家期间自我管理任务重压力大,了解造成患者自我管理效能困境的原因,利于医护向患者提供更有效的支持和帮助,提高自我管理效能,进而提升患者自我管理行为.

Objective:To explore the impact of narrative nursing on the meaning and quality of life in chemotherapy patients with advanced lung cancer.Methods:A total of 86 chemotherapy patients with advanced lung cancer hospitalized in the Oncology Department of Shanghai Pulmonary Hospital Affiliated to Tongji University from October 2020 to November 2021 were selected and divided into control group with 42 cases and narrative group with 44 cases by random number table method. The control group was treated with routine nursing of patients with tumor chemotherapy while the narrative group was implemented on narrative nursing intervention as well as routine nursing. A total of 12 to 14 times, each chemotherapy period was 7 times. The effect of the intervention was assessed by Meaning in Life Scale for Advanced Cancer Patients (MiLS)、Chinese Version of the Functional Assessment of Cancer Therapy-Lung(FACT-L 4.0) and Distress Thermometer (DT) before intervention, 1 week, 3 weeks and 2 months after intervention.Results:Forty cases in the control group and 42 cases in the narrative group were involved in the statistical analysis. Two months after intervention, the total score of MiLS, the score of the will to search for meaning, the meaning of life and satisfaction,existential frustration, life control, suffering tolerance and death acceptance in the control group were (98.60 ± 9.17), (14.90 ± 1.91), (13.38 ±2.62), (16.40 ± 2.73), (26.48 ± 3.19), (14.30 ± 1.68), (13.15 ± 3.07) points, which were significantly lower than those in the narrative group (112.02 ± 9.73), (16.45 ± 2.24), (16.31 ± 1.96), (19.40 ± 2.42), (28.76 ±3.48), (16.14 ± 1.82), (14.95 ± 2.39) points, and the difference were statistically significant ( t value were -6.42 --2.98, all P<0.01), and the main effect between groups and time were statistically significant ( F values were 2.76-24.47, all P<0.05). Two months after intervention, the total score of FACT-L, social/family status, emotional status, functional status and lung cancer specific module in control group were (90.75 ± 11.65), (18.58 ± 3.75), (15.65 ± 3.85), (13.48 ± 3.34), (22.00 ± 4.93) points, which were lower than those in the narrative group (102.12 ± 9.32), (20.36 ± 4.29), (18.10 ± 3.25), (16.74 ± 4.05), (24.80 ±3.83) points, the differences were statistically significant ( t values were-4.89--1.99, all P<0.05), and there was intergroup effect ( F values were 5.14-24.47, all P<0.05). Three weeks and 2 months after intervention, the psychological distress score of control group were (3.88 ± 2.73), (3.60 ± 2.19) points, which were significantly higher than the narrative group (2.52 ± 2.18), (1.90 ± 1.78) points, and the differences were statistically significant ( t=2.50, 3.85, both P<0.05), with a time, groups, interaction effect ( F=15.29, 15.86, 2.80, all P<0.05). Conclusions:Narrative nursing can effectively improve the meaning and quality of life and relieve psychological distress in chemotherapy patients with advanced lung cancer. It is worthy of clinical promotion.

虚拟现实技术(VR)凭借其仿真性、可交互性及沉浸式体验的优势,成为临床教学的新技术手段.VR技术在胸心外科临床教学中的应用效果此前未见报道.该研究选取胸心外科轮转实习的临床医学专业本科学员,随机分为VR辅助教学组和传统多媒体教学组,探讨二者教学效果差异.结果表明,VR组的平均出科考试成绩及主观教学满意度均显著高于传统组(P<0.05);且VR组学员在学习主动性、学习兴趣、学习效果等方面均优于传统组(P<0.05).由此推断,VR技术凭借其技术优势,能显著提高胸心外科临床教学质量,提升学员学习兴趣,可以推广应用.

目的 探讨叙事疗法对肺癌化疗患者癌症复发恐惧感和希望水平的影响.方法 选取2019年10月至2020年10月间海军军医大学附属长海医院虹口院区收治的140例肺癌化疗患者,采用随机数表法分为观察组和对照组,每组70例.对照组患者采用化疗常规护理干预,观察组患者在化疗常规护理干预基础上采用叙事疗法干预.比较两组患者干预前后癌症复发恐惧感、希望水平及护理满意度.结果 干预后,两组患者社会家庭、生理健康和恐惧疾病总分均较干预前降低,且观察组低于对照组,差异均有统计学意义(均P<0.05);两组患者希望水平总分及各维度得分(现实和未来的积极态度、采取积极行动及与他人保持亲密关系)均较干预前上升,且观察组均高于对照组,差异均有统计学意义(均P<0.05).观察组护理满意度为92.9％,高于对照组的75.7％,差异有统计学意义(P<0.05).结论 叙事疗法可外化肺癌化疗患者心理问题,减轻癌症复发恐惧感,增强希望水平及护理满意度.

全球疾病负担相关研究结果显示,慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)位居全球疾病死因的第3位,每年有300万患者死于该疾病[1].2018年国内的相关研究表明,COPD位居中国疾病死因的前三名,由此而产生的人均直接医疗费用范围为483～23917元,占当地人均年收入的33. 33％ ～118. 09％,对家庭及社会医疗资源造成了严重的负担[2].因此,亟待采取相关措施改善COPD患者疾病的进展和转归.随着自我管理项目干预疗法在COPD患者中的不断研究及发展,对患者自我管理效能及时、准确的评估已成为首要任务.在评分的基础上提供有效的自我管理干预措施,对于提高COPD患者的自我管理水平,进而改善疾病的进展和转归意义显著.基于此,研究者着力于对COPD患者自我效能及自我管理行为能力的测评.目前,国内外已有多种较为成熟的测评工具用于测评慢性病患者的自我管理效能.然而其中针对COPD患者的特异性工具较少,且使用时无统一规定,使测评结果不利于参考与比较.因而,在对COPD患者自我管理效能进行测评时选择恰当的特异性测评工具尤为重要.笔者就目前广泛应用于COPD患者的9种自我管理效能测评工具的主要内容、特点及局限性等进行综述,以期为未来开发符合我国国情的COPD患者自我管理效能的特异性工具提供参考依据.