The application effect of personal and family self-management theory in patients with leukemia

Leukemia belongs to hematopoietic stem cell malignant proliferative hematological diseases, patients with fever, anemia, bone and joint pain, and the main treatment means to chemotherapy. However, considering the pain of the disease and the toxic side effects of chemotherapy drugs, the negative impact on the patient's own emotions and psychological aspects, not only is not conducive to the prognosis, but also may lead to a significant reduction in their quality of life, therefore, the nursing intervention of leukemia patients after chemotherapy has attracted widespread attention. In the conventional nursing mode, patients are in a passive state throughout the whole process, with low treatment compliance, and the support of relatives is not taken into account. Based on the theory of individual and family self-management (IFSMT), patients' psychological state and behavior are divided into three stages: situation, process and outcome, and the best prognosis is achieved together with the assistance of family members. It is of great significance to improve the quality of life and self-care ability of patients. This study investigated the self-management effect of leukemia patients with IFSMT and achieved some results, which are reported as follows.

1. Data and methods

1.1 General Information

A total of 102 leukemia patients treated in our hospital from January 2015 to December 2018 were selected as the study objects, and were divided into observation group and control group according to random number table method, with 51 cases in each group. Inclusion criteria: ① Complete clinical data; ② Have normal reading and listening skills; (3) Those who voluntarily sign the informed consent; Age ≥18 years old. Exclusion criteria: ① those who received other interventions during the same period; ② People with consciousness and communication disorders; ③ survival time <6 months; ④ follow-up lost contact, quit midway. This study was reviewed and approved by the hospital Medical Ethics Committee. There was no significant difference in gender, age, course of disease, education level and other general data between the two groups (P > 0.05), which was comparable.

Table 1 Comparison of two sets of general data [n (%)]

1.2 Methods

The control group received routine nursing intervention, including health education, diet guidance, drug safety norms, discharge follow-up, etc. Observation group was given IFSMT intervention on the basis of control group, the specific measures are as follows. ① Establish a self-management intervention group: the intervention group consists of clinicians, psychological counselors and responsible nurses. After the admission of patients, according to their psychological state, education level, family situation and disease development, an individualized nursing plan is formulated, and nurses are trained to deepen the nursing concept of IFSMQT, and patients are taken as the focus of nursing work. ② Create the situation: Through the analysis of various data, determine the main reasons for the lack of patients' self-management ability, and then make targeted remediation, carry out disease-related knowledge classroom education, emotional counseling, role playing, etc. ③ Process: Knowledge education can be unified training, including treatment plans, nursing measures, adverse reaction coping methods, etc. After the completion of education, group interviews can be conducted to understand the existing problems at the present stage and their own needs by asking patients questions, encouraging patients to bravely express their negative emotions in a timely manner, and giving recognition. In the interview, patients can also understand their main role in the family. As well as the impact of the disease on the role, timely communication with their families, the rehabilitation process can allow family members to accompany, strengthen doctor-patient cooperation, but also guide family members to effectively communicate with patients, and create a relaxed and warm rehabilitation atmosphere for them. ④ Outcome: Before discharge, patients were provided with health manuals and asked to pay attention to the wechat public account, which could leave messages for difficult inquiries in time, and relevant personnel answered online within 24 hours. For patients discharged from hospital with deep vein pipes, nursing staff patiently guided them to the correct method, and asked patients to pay attention to the changes of puncture mouth, and timely feedback for reconsultation. Both intervention groups lasted for 3 months.

1.3 Observation indicators and evaluation criteria

① Quality of life [5-6] : Before and after care, the changes in quality of life of the two groups were assessed by using the Quality of Life Scale (SF-36), which included eight dimensions, including physiological function, physiological function, physical pain, physical health, vitality, social function, emotional function and mental health, with a total score of 37 to 155 points, and the higher the score, the better the quality of life. ② Self-management ability: After nursing, self-management behavior scale [7] was used to evaluate patients' self-management behavior from six aspects: psychological factors, life factors, social help, changes in symptoms, understanding of the disease and communication with doctors. The higher the score, the higher the level of self-management behavior. In addition, the patients' self-efficacy was evaluated by using the Emotion Regulation Self-efficacy Scale (SRESE) [8], which included 12 items in three aspects: expressing positive emotions (POS), regulating anger or anger emotions (ANG), and regulating frustration or painful emotions (DES). All of them were scored at 5 levels, with the total score ranging from 0 to 60 points. The higher the score, the better the self-efficacy. ③ Self-perceived burden [9] : The Chinese version of Self-perceived Burden Scale (SPBS) was used to measure the degree of SPB in patients with a total of 10 items, and scored according to 1-5 points. Scores <20 points were classified as no obvious self-burden, scores 20-29 as mild SPB, scores 30-39 as moderate SPB, scores ≥40 as severe SPB. Mild rate = (no obvious + mild) cases/total cases ×100%. Outcome measures: The SF-36 score and SPBS score of the two groups were compared before and after 3 months of care, and the self-management effect of dry prognosis (self-management ability scale, SRESE) was recorded.

1.4 Statistical Methods

Statistical software SPSS 18.0 was used to analyze the data. The statistical data were represented by percentage %, χ2 test was used, rank sum test was used for rank data, and mean ± standard deviation (±s) was used for measurement data. Independent sample t test was used for comparison between groups, and paired sample t test was used for comparison at different time points within groups. P<0.05 was considered to be statistically significant.

2 Results

2.1 Comparison of SF-36 scores before and after care between the two groups

There was no significant difference in SF-36 scores between the two groups before nursing (P > 0.05). The SF-36 score of the two groups after care was higher than before care (P<0.05), and the SF-36 score of the observation group after care was higher than that of the control group, with statistical significance (P<0.05) (Table 2).

Table 2 Comparison of SF-36 scores before and after care between the two groups (score, ±s)

Compared with this group before nursing, * P<0.05; Compared with the control group after nursing, #P<0.05

2.2 Comparison of SPB after care between the two groups

After nursing, SPB of observation group was better than control group (P<0.05). The mild SPB rate in the observation group was 84.3%, higher than that in the control group (64.7%), and the difference was statistically significant (P<0.05).

Table 3 Comparison of SPB between the two groups [n (%)]

2.3 Comparison of self-management behavior level between the two groups after nursing

After 3 months of nursing, the self-management behavior index level and SRESE total score of the observation group were higher than those of the control group, and the difference was statistically significant (P<0.05).

Table 4 Comparison of self-management behavior levels between the two groups after intervention (score, ±s)

3 Discussion

As a kind of malignant tumor, leukemia has a complicated condition with poor prognosis and is difficult to cure. Chemotherapy is the main treatment method for the disease at present. However, due to its long course of treatment, many toxic and side effects, and high treatment cost, patients generally suffer from economic, psychological, physiological and other aspects of pressure, and often suffer from anxiety, depression and other negative emotions. The sudden onset of the disease not only adversely affects the quality of life of patients, but also may lead to changes in their family status and relationship, and ultimately affect the treatment compliance of patients.

Routine nursing intervention only involves the basic guidance of the patient's disease knowledge, psychology, drug safety and other aspects, and the nursing purpose is poor, the patient is in a completely passive state for a long time, and the dependence is strong, which is not conducive to the continuous nursing after discharge. IFSMT was first proposed by Pyan in the United States in 2009, and is now widely used in prognostic care of various tumors in foreign countries, achieving ideal intervention effects, while there are few clinical nursing reports on this theory in China. IFSMT classifies patients' self-management behavior from the psychological level into three dimensions: context, process and outcome. Context refers to patients' individual information, including gender, education level, family situation and other information, all of which constitute patients' personal rehabilitation background. By establishing self-management teams, patients' personal information is analyzed and communicated. To find out the deep reasons for the weak nursing ability, and start the process from disease-related knowledge education, role transformation and psychological interview, which not only includes group cooperation, but also takes into account the contact between patients and their families. Under the encouragement and guidance of family members and nursing staff, gradually change the coping style and remove the psychological burden, which not only contributes to the closer doctor-patient relationship and kinship relationship. It can also effectively reduce patients' perceived burden. It is more conducive to the construction of hospital - community - family - individual pathway, so that patients can receive health education in an all-round way, improve their treatment initiative, and improve their self-management ability, which is conducive to early discharge.

The results of this study showed that after 3 months of nursing intervention, the self-management ability, emotional mediation ability, self-perceived burden and quality of life in the observation group were more significantly improved than those in the control group (P<0.05), suggesting that the implementation of IFSMQT nursing intervention on the basis of routine nursing was more conducive to the improvement of patients' understanding ability, acceptance ability and thinking ability. To improve health outcomes. Peng Min et al. [15] found that IFSMT targeted care for foot management of patients with type 2 diabetes could improve their self-care ability and prevent the occurrence of diabetic foot.

In summary, IFSMT can not only significantly improve the self-care ability and self-burden feeling of leukemia patients, but also improve the management effect and quality of life.