Application Research of Narrative Care to the Management of Symptom Clusters and Post-traumatic Growth in Patients Undergoing Lung Cancer Surgery

Abstract

叙事护理作为实现高质量护理的一门新兴学科逐渐兴起，临床中可见于改善精神分裂症、抑郁症及慢性病管理等研究，但在肺癌手术患者中的应用鲜少报道。本研究旨在研究叙事护理模式对提升手术患者症状群管理及创伤后成长水平的效果，探讨其对促进肺癌患者身心康复的临床优势。方法 便利抽样选取2024年7月至2024年10月就诊于浙江大学医学院附属第一医院行手术治疗的82例肺癌患者为研究对象，按照随机数字法分为对照组和观察组，各41例。对照组接受常规护理；观察组在此基础上于患者入院当天、术后3天和术后1周融入连续3次的叙事护理。干预前收集患者的一般资料，采用广泛性焦虑量表、匹兹堡睡眠质量指数、中文版肺癌患者生活质量评估量表及中文版创伤后成长评定量表对其进行测评，并在每次叙事干预后对两组患者的情况再次进行测评，比较两组患者三阶段的得分情况。结果 术后3天、术后1周患者焦虑、睡眠、生活质量及创伤后成长水平得分，观察组均优于对照组，差异均具有统计学意义（P<0.05）。组内结果显示，观察组与对照组在术前、术后3天、术后1周焦虑评分均逐渐下降；术前、术后3天、术后1周创伤后成长评分均逐渐增加；但由于手术的应激及术后不适等原因，两组患者术后3天睡眠评分均高于术前和术后1周，术后1周睡眠评分均明显低于术前；术后3天的生存质量评分均低于术前和术后1周，术后1周生存质量评分均高于术前，差异均具有统计学意义（P<0.05）。结论 将叙事护理应用于肺癌手术患者中，有利于减轻围手术期症状群的困扰，帮助患者实现创伤后成长，提升其心理社会适应能力及生存质量。

Background and objective Narrative care is emerging as a new discipline to achieve high-quality nursing. It can be seen in clinical studies on improving the management of schizophrenia, depression and chronic diseases, but its application in surgical patients with lung cancer is rarely reported. The aim of this study was to study the effect on improving symptom cluster management and post-traumatic growth of surgical patients through narrative care model, and to explore its clinical advantages in promoting physical and mental rehabilitation of lung cancer patients. Methods A total of 82 patients with lung cancer who underwent surgical treatment in the First Affiliated Hospital of Zhejiang University from July 2024 to October 2024 were selected as the study objects by convenience sampling, and randomly divided into the control group and observation group according to random number method, with 41 cases in each group. The control group received routine nursing; On this basis, the observation group was integrated into three consecutive narrative nursing sessions on the day of admission, 3 days after surgery and 1 week after surgery. After collecting the general data of the patients before intervention, the Generalized Anxiety Scale, the Pittsburgh Sleep Quality Index, the Chinese Version of the Lung Cancer Patients Quality of Life Assessment Scale and the Chinese Version of the Post-traumatic Growth Assessment Scale were used. After each narrative intervention, the two groups of patients were assessed again, and the scores of the two groups were compared at the three stages. Results The scores of anxiety, sleep, quality of life and post-traumatic growth level of the patients on the 3 days and 1 week postoperatively were better in the observation group than in the control group, and the differences were all statistically significant (P<0.05). In addition, the results within the groups showed that the anxiety scores of the observation group and the control group gradually decreased in the preoperative period, 3 days and 1 week postoperatively; the post-traumatic growth scores gradually increased in the preoperative period, 3 days and 1 week postoperatively; however, due to the stress of the surgery and postoperative discomfort, the sleep scores of the patients of the two groups on 3 days postoperatively were higher than those in the preoperative period and 1 week postoperatively, and the sleep scores of the patients of 1 week postoperatively were significantly lower than those in the preoperative period; and the quality of life of the patients on the 3 days postoperatively scores were lower than preoperative period and 1 week postoperatively, and the quality of survival scores in 1 week postoperatively were higher than the preoperative period, and the differences were statistically significant (P<0.05). Conclusion The application of narrative nursing to lung cancer surgery patients is conducive to alleviating perioperative symptom clusters, helping patients achieve post-traumatic growth, and enhancing their psychosocial adaptability and quality of survival.