首次接受化學治療乳癌婦女介入護理指導後不確定感、焦慮及自我照顧之成效探討

Effectiveness of Nursing Instruction in Reducing Uncertainty, Anxiety and Self-Care in Breast Cancer Women Undergoing Initial Chemotherapy

10.6224/JN.57.6.51

連金延(Chin-Yen Lien)；陳淑慧(Shu-Hui Chen)；蔡佩嬪(Pei-Pin Tsai)；陳康敏(Kang-Min Chen)；謝雅宜(Ya-I Hsieh)；梁穎(Ying Liang)

焦慮 ； 化學治療 ； 護理指導 ； 自我照顧 ； 不確定感 ； anxiety ； chemotherapy ； nursing instruction ； self-care ； uncertainty

護理雜誌

57卷6期（2010 / 12 / 01）

51 - 60

繁體中文

Background: Level of uncertainty and anxiety may increase when breast cancer women experience unexpected side effects during chemotherapy. Purpose: This longitudinal study explored the effectiveness of nursing instruction in reducing uncertainty, anxiety and self-care in breast cancer women undergoing initial chemotherapy. Methods: This study used a quasi-experimental design. Convenience sampling was used to recruit 75 women with breast cancer at a medical centre in northern Taiwan between January 2008 and September 2008. Participants were divided into either the control (n=37) or experimental (n=38) group. Control group patients received usual care. Experimental group patients were provided with nursing instructions that followed the evidence-based guidelines prescribed in the ”Chemotherapy Self-Care for Breast Cancer” handbook and individualized education. Both groups received repeated questionnaires in the first, third and sixth chemotherapy cycles. Demographic data, Mishel's Uncertainty Illness Scale, Hospital Anxiety and Depression Scale and the Self-Care Scale were used for data collection and analysis. Results: There were no significant differences in demographic data between the two groups. There were moderate to high levels of uncertainty and low levels of anxiety in both groups prior to the first chemotherapy cycle. There was a significant decrease in uncertainty and an elevation in self-care level (p＜.05(superscript *)) in both groups at the sixth chemotherapy cycle. However, the experimental group showed less uncertainty and higher levels of self-care in comparison with the control group. There was a significant decrease in complexity uncertainty in the experimental group (p=.02(superscript *)) and no significant decrease in the control group. Conclusions: Study results indicate that nursing instruction can decrease uncertainty and elevate self-care levels. We suggest that nurses provide structured nursing instructions based on evidence-based guidelines to breast cancer women undergoing initial chemotherapy in order to promote self-care level and patient degree of control over their disease and treatment. This intervention may ameliorate patient and family uncertainties with regard to disease and chemotherapy complexity.

Background: Level of uncertainty and anxiety may increase when breast cancer women experience unexpected side effects during chemotherapy. Purpose: This longitudinal study explored the effectiveness of nursing instruction in reducing uncertainty, anxiety and self-care in breast cancer women undergoing initial chemotherapy. Methods: This study used a quasi-experimental design. Convenience sampling was used to recruit 75 women with breast cancer at a medical centre in northern Taiwan between January 2008 and September 2008. Participants were divided into either the control (n=37) or experimental (n=38) group. Control group patients received usual care. Experimental group patients were provided with nursing instructions that followed the evidence-based guidelines prescribed in the ”Chemotherapy Self-Care for Breast Cancer” handbook and individualized education. Both groups received repeated questionnaires in the first, third and sixth chemotherapy cycles. Demographic data, Mishel's Uncertainty Illness Scale, Hospital Anxiety and Depression Scale and the Self-Care Scale were used for data collection and analysis. Results: There were no significant differences in demographic data between the two groups. There were moderate to high levels of uncertainty and low levels of anxiety in both groups prior to the first chemotherapy cycle. There was a significant decrease in uncertainty and an elevation in self-care level (p＜.05(superscript *)) in both groups at the sixth chemotherapy cycle. However, the experimental group showed less uncertainty and higher levels of self-care in comparison with the control group. There was a significant decrease in complexity uncertainty in the experimental group (p=.02(superscript *)) and no significant decrease in the control group. Conclusions: Study results indicate that nursing instruction can decrease uncertainty and elevate self-care levels. We suggest that nurses provide structured nursing instructions based on evidence-based guidelines to breast cancer women undergoing initial chemotherapy in order to promote self-care level and patient degree of control over their disease and treatment. This intervention may ameliorate patient and family uncertainties with regard to disease and chemotherapy complexity.

1. 黃代泱(2013)。影響加護病房老年重症病人面臨疾病末期時期成年子女簽署DNR同意書意願因素。長榮大學護理學系(所)學位論文。2013。1-71。 
2. 沈心薇(Hsin-Wei Shen);洪婉綺(Wan-Chi Hung);張素容(Su-Jung Chang);高綺吟(Chi-Yin Kao)(2019)。運用團隊資源管理提升大腸直腸癌首次化學治療病人出院服務滿意度。高雄護理雜誌。36(3)。28-41。 
3. 朱怡瑾(Chu, Yi-Chin);劉曼盈(Liu, Man-Ying);胡嘉桂(Hu, Chia-Kuei);蘇家慧(Su, Chia-Huei);陳姿蓉(Chen, Tzu-Jung);陳俏潓(Chen, Chiao-Hui);吳麗敏(Wu, Li-Min)(2018)。不確定感之概念分析。高雄護理雜誌。35(2)。53-60。 
4. 林詩涵(2015)。大腸直腸癌個案管理介入成效之研究。義守大學醫務管理學系學位論文。2015。1-82。 
5. 蕭淑嫺(2015)。參與臨床試驗的肺癌病人不確定感與希望狀態之探討。臺灣大學護理學研究所學位論文。2015。1-113。 
6. 李雅惠(Ya-Hui Lee);汪慧鈴(Huey-Ling Wang);李中一(Chung-Yi Li);蕭安穗(An-Suey Shiao);杜宗陽(Tzong-Yang Tu)(2014)。探討護理指導方案經由改變不確定感刺激結構對不確定感之成效－初次罹患突發性聽力喪失病人。護理雜誌。61(3)。36-44。 
7. 徐瑞貞(Jui-Chen Hsu)(2016)。中年未婚乳癌病患面對全乳房切除手術之護理經驗。榮總護理。33(1)。100-107。 
8. 尤文鈺(2015)。白血病患者化學治療期間整體舒適變化及其相關因子探討。中國醫藥大學護理學系碩士班學位論文。2015。1-130。
9. 陳淑女(2017)。乳癌婦女的睡眠障礙與焦慮、憂鬱症狀及生活品質相關因素之探討。義守大學醫務管理學系學位論文。2017。1-69。
10. 劉瑞靈(2018)。結直腸癌病人在化療期間症狀困擾、焦慮與憂鬱預測因子之探討。義守大學護理學系學位論文。2018。1-72。