Combined with self-efficacy theory, how to effectively help patients to expectorate after thoracotomy.

During Zhu Zhen's thoracotomy in the Department of Thoracic Surgery, Cancer Hospital of China Academy of Medical Sciences, airway secretions will increase due to large trauma, long anesthesia time, tracheal irritation and the influence of anesthetic drugs. Effective expectoration after operation is very important for patients undergoing thoracotomy. When coughing up phlegm, the wound is often shaken and pulled, causing pain. Some patients refuse to cough and expectorate effectively for fear of pain, which will lead to decreased lung ventilation, bronchiolitis spasm and prone to complications such as lung infection, atelectasis, ARDS and respiratory failure? Self-efficacy, as an individual's subjective self-judgment on the interaction between himself and the environment, is not produced out of thin air, but based on certain experience or information. Self-efficacy is formed through the cognitive processing of this information: ① Direct experience refers to the direct experience of an individual's own ability through his own personal behavior operation, and it is the individual's explanation of the effect of his own actions. If interpreted as success, it can enhance self-efficacy, otherwise it will reduce self-efficacy. (2) Substitution experience refers to observing other people's behavior effect information. To some extent, a person's judgment of his own ability is realized by comparing people who are similar to him. Demonstration is another effective means to promote personal efficacy. The similarity between individual and role model is one of the factors to improve the correlation between the displayed behavior information and the observer's self-efficacy belief. If you see the success of people similar to yourself, you can promote the improvement of self-efficacy; Seeing people similar to themselves fail, especially after making great efforts, will reduce their sense of self-efficacy. (3) Language persuasion refers to the verbal judgment provided by others and the change of self-efficacy through suggestions, advice, hints and encouragement. As far as the same level of behavior is concerned, demeaning criticism will reduce people's self-efficacy, while constructive criticism will support people's ambitions and maintain or even improve personal self-efficacy. (4) Physiological and emotional states, when people judge their abilities, they depend on the physical information conveyed by physiological and emotional states to some extent. People often interpret their physiological activities when they are nervous and tired, such as panting, palpitations and various physical discomforts, as signs of dysfunction, and judge that their bodies are invalid accordingly. At the same time, emotional state makes attention deviate, and affects people's interpretation of events, cognitive organization and memory retrieval. Triggered positive emotions can enhance self-efficacy, while depression is the opposite. Combined with the above theory, nurses in thoracic surgery should start from four aspects of self-efficacy, help patients after thoracotomy to enhance their self-efficacy, actively and effectively expectorate and prevent postoperative pulmonary complications. ① In terms of direct experience, patients with decreased blood oxygen saturation or complaining of holding their breath, and those with obvious improvement after expectoration are direct experiences. These facts directly tell patients the necessity of expectoration and can promote patients to expectorate actively. Li and others [7] believe that mastering skills is the most effective way to improve self-efficacy, and individuals will become more confident only if they successfully complete what they try. Educators should know the feedback information of the educated in time and correct and guide it. Therefore, in the preoperative education, the nurse should ask the patient to expectorate according to his understanding after telling the patient the effective expectoration method, and then the nurse will evaluate his expectoration method and correct the mistakes until the patient masters the correct method. Mastering the correct method of expectoration before operation is also to enhance patients' direct experience in this respect, and then improve their self-efficacy. ② In the aspect of substitution experience, the most outstanding substitution experience is that patients in the same ward were suctioned by doctors at the bedside or even intubated for rescue because of unfavorable expectoration. At this time, the patient's pain in sputum aspiration and nervousness in rescue can directly stimulate the patient to expectorate actively. In addition, patients who can't expectorate will see patients with similar age and disease, which will also enhance their sense of self-efficacy and improve their confidence in mastering correct expectoration. He will imitate the posture and methods of his patients to expectorate, which can play a positive role. Patients with proper expectoration methods during ward rounds can be fully affirmed, which not only enhances the confidence of patients, but also increases the substitute experience before or after surgery for other patients with poor expectoration methods. The communication between patients and friends, to some extent, will play a role that health guidance of medical staff can not achieve. ③ In the aspect of language persuasion, it mainly lies in the professional authority of medical staff. From the beginning of health education, we should give corresponding guidance before operation, so that patients can understand the purpose and necessity of expectoration, increase their initiative in thought, and then teach abdominal breathing, lip contraction breathing and effective cough methods to improve expectoration skills. By learning effective expectoration methods and psychological recognition, patients' sense of self-efficacy can be increased; After the operation, after the patient expectorates correctly, the medical staff should give affirmation and encouragement in time to enhance the confidence of the patient. In addition, the patient's appearance statement is also an effective means for patients to enhance their sense of self-efficacy through oral persuasion. Nurses can choose people who are similar to patients in age, sex, operation mode and personality, which is the most convincing and has a great influence on individuals. In addition, the role of educational media can not be ignored. Nurses can use pictures, practical demonstrations and other forms in teaching, so that patients can intuitively understand the correct method of expectoration, which is conducive to rapid mastery. There are special nurses in the thoracic surgery department of our hospital, who give special lectures on expectoration, exercise and diet for perioperative patients in the health consultation garden every week. The head nurse gave consolidation guidance after operation, and the effect was good. Generally speaking, patients and their families can master the main points of expectoration, and most patients can effectively expectorate after operation. (4) Physiological and emotional state, mainly pain caused by expectoration, increased heart rate and other discomfort. Without the guidance of medical staff, patients often can't understand correctly, so they often refuse to expectorate, which affects postoperative lung recruitment and easily causes lung infection. Li et al. [7] also pointed out that people's attitude and behavior towards their health depends on personal beliefs, not necessarily for rational consideration. Therefore, when patients refuse to expectorate for the above reasons, nurses should provide them with relevant knowledge, actively guide patients to correctly understand physiological symptoms, and channel negative emotions that may affect self-efficacy. Nurses should observe the problems in the process of expectoration in time, handle and explain them in time, eliminate misconceptions, trigger positive emotions and enhance patients' sense of self-efficacy. In the process of explanation, we must avoid words that fail to convey the meaning, use as few technical terms as possible, and use simple and clear language, so as to get the best effect. To sum up, self-efficacy can be used as an intermediary between individual self-perception and specific behavior, which well explains the mechanism of individual's transformation from knowledge mastery to behavior. People can improve their sense of self-efficacy through their own practice, or other people's practical experience, and accept other people's suggestions [7]. Nurses in thoracic surgery should attach importance to the application of self-efficacy theory in helping patients to effectively expectorate, make use of various favorable factors, improve the effect of health education, promote patients' early recovery and try to avoid pulmonary complications. References: ellipsis