目的 探讨乳腺癌失眠患者在失眠过程中所采取的应对策略及其效果.方法 采用质性研究方法,以半结构式的开放性访谈问卷对31例乳腺癌失眠患者进行深入访谈,并运用内容分析法进行资料分析.结果 乳腺癌失眠患者的显性失眠应对策略主要包括饮食调整、行为调整、改善睡眠环境、睡眠时间调整和寻求专业帮助等.患者针对具体的应对策略形成了自己独特的条件有效或条件无效的应对策略认知.对于应对策略信息的实践主要与该信息来源的权威性、初次实践的成效以及以往的经验有关.结论 乳腺癌失眠患者在失眠过程中经历了反复的失眠应对策略摸索阶段.医护人员应了解乳腺癌失眠患者在自行应对失眠过程中所采取过的应对策略及其对失眠的认知和态度,以促进对失眠患者的早期发现和正确指导.

AIMS AND OBJECTIVES:This study aimed to explore the experiences and factors associated with insomnia in Chinese breast cancer survivors.BACKGROUND:Insomnia is a common and significant symptom in breast cancer survivors. Quantitative studies are unable to describe the experience of insomnia and the sleep-associated factors from a personal point of view. A profound understanding of the experience of insomnia in breast cancer survivors can provide information for health workers and caregivers to allow them to provide more effective support.DESIGN:A descriptive qualitative research was adopted.METHODS:In-depth interviews were conducted with 22 insomniac breast cancer survivors. A qualitative content analysis was used to analyse the data.RESULTS:Three themes emerged concerning the experiences of insomnia, including sleep neglect, insomnia perception and insomnia anxiety. Participants reported their own opinions on three insomnia-associated factors, including factors associated with hospitalisation, factors associated with breast cancer and the therapies and too much attention placed on sleep.CONCLUSIONS:Survivors would neglect their sleep problems in the early stage after diagnosis. When they became aware of their sleep problems, they were inclined to worry too much and sought help from traditional Chinese medicine. Anticipatory sleep anxiety, excessive negative cognitive activities and insomnia became a vicious circle for insomniac breast cancer survivors.RELEVANCE TO CLINICAL PRACTICE:The findings provide detailed information to help nurses understand the experiences of breast cancer survivors with insomnia. Nurses could provide proper care to help prevent insomnia or improve sleep.

目的 调查乳腺癌术后患者的自我形象与经验性回避状况,并探讨二者之间的相关性.方法 采用乳腺癌患者生活质量测定量表、接纳与行动问卷对112例乳腺癌术后患者进行调查.结果 乳腺癌术后患者自我形象得分为(77.01±16.86)分,经验性回避得分为(15.95±8.90)分.经验性回避、家庭人均月收入、复发或转移为乳腺癌术后患者自我形象的影响因素.结论 医护人员应采取相应的心理干预措施,促进患者减少经验性回避行为,提高自我形象水平,同时积极治疗家庭人均月收入较低、复发或转移的患者.

乳腺癌是女性最常见的恶性肿瘤之一,发病率位居女性恶性肿瘤的首位[1].乳腺癌疾病及其治疗严重影响患者的身体外观,如手术导致的乳房缺损不仅破坏躯体的完整性,而且会降低女性特有的魅力;另外,乳腺癌的其他治疗,如化疗引起脱发、放疗引起皮肤损伤等也在一定程度上影响患者的身体外观,造成患者体像水平降低.体像(Body Image),又有学者将其翻译为自我形象、身体意象,指一个人对自己身体外表的主观印象,是通过自我观察和观察别人对自己身体的反应而建立起来的[2].

Objective:To develop and preliminarily verify the psychological intervention program on body image of rehabilitative breast cancer survivors. Methods: Acceptance and Commitment Therapy and group psychological intervention were taken as main theoretical basis to develop the group acceptance and commitment intervention program on body image of rehabilitative breast cancer survivors. To implement the intervention program, rehabilitative breast cancer survivors were investigated by the Body Image after Breast Cancer Questionnaire (BIBCQ), Acceptance and Action Questionnaire (AAQ). Results:The group acceptance and commitment intervention program on body image of rehabilitative breast cancer survivors was formed and enforceable after preliminary veriifcation. Conclusion:The group acceptance and commitment intervention program on body image of rehabilitative breast cancer survivors can be used to help patients to improve their body images in clinic.

Objective To explore the effect of large group psychological intervention mode on coping style of patients with breast can-cer. Methods 420 patients with breast cancer participated in the Rukang Salon, a large group psychological intervention, were investigated with the Simplified Coping Style Questionnaire and self-administrated questionnaire before and after intervention, respectively. Results The score of coping style of the patients significantly improved after the intervention (P<0.01). Conclusion It is effective in the large group psy-chological intervention on coping style of patients with breast cancer, more often in positive coping style and less in negative coping style.

Objective To investigate the life satisfaction and its related factors in primary caregivers of breast cancer patients. Methods The Life Satisfactory Index A (LSIA) and self-administrated questionnaire were used. The life satisfaction between breast cancer patients' primary caregivers and breast benign patients' primary caregivers were compared. The factors of the life satisfaction in primary caregivers of breast cancer patients were analyzed. Results The life satisfaction was poorer in the breast cancer patients' primary caregivers than in the breast benign patients' primary caregivers (P<0.01). The life satisfaction in the breast cancer patients' primary caregivers was correlated with the stage of breast cancer, course of disease, primary caregivers' age and family monthly income (P<0.05). Conclusion The life satisfaction in breast cancer patients' primary caregivers is worse and is related with stage of breast cancer, course of disease, primary caregivers' age and family monthly income.

目的 探讨康复期乳腺癌患者创伤后成长状况及其影响因素,以便更好地指导临床护理工作.方法 采用创伤后成长量表对153例康复期乳腺癌患者进行问卷调查.结果 康复期乳腺癌患者创伤后成长量表得分为(75.42±3.20)分,分数转化后发现,患者欣赏生活维度得分最高,精神改变维度得分最低.经多元线性逐步回归分析,病程、人均月收入、疾病分期和其他慢性病为康复期乳腺癌患者创伤后成长的影响因素.结论 医护人员应采用各种心理干预方式尽可能帮助患者度过疾病诊断后的早期阶段,促进创伤后成长的发展,为乳腺癌患者建立战胜疾病的信心,同时积极治疗患者合并的其他慢性病.