1 Strengthen communication and establish a good nurse-patient relationship.
The nurse-patient relationship is the interpersonal relationship formed and established between nurses and patients in the nursing process, which directly affects the psychological changes of patients and is closely related to their rehabilitation. Our ward is one of the earliest wards in the hospital to carry out holistic nursing, and patients' satisfaction with nursing work is over 95%. A good nurse-patient relationship is not only conducive to the cooperation of patients, but also can increase patients' trust in medical staff, alleviate patients' fear in the special environment of hospital, and relieve patients' psychological pressure.
2 do a good job of preoperative education
We combine general psychological care with individual psychological care, use nursing procedures to evaluate patients, apply psychological counseling skills to individual nursing, and adopt different nursing methods according to different psychological problems of patients. At the same time, communicate with patients' families to understand their psychology and give appropriate support and encouragement. We not only make patients and their families know the basic knowledge of enterostomy through preoperative education, but also cooperate with surgical treatment; Family members are also required to understand the psychological and behavioral changes of enterostomy patients in the process of recovery and rehabilitation, so as to treat patients patiently, warm, support and encourage patients and promote their psychological rehabilitation. Doctors do not conceal the patient's condition before operation, fully communicate, patiently and meticulously explain the condition and explain the necessity of enterostomy. Before operation, we invited patients and their families to watch slides and videos to introduce the general situation and nursing methods of enterostomy, so that they could understand that enterostomy only moved the stool outlet from anus to abdomen and had no effect on digestive function. Enterostomy is generally painless; Enterostomy itself has no effect on sexual function, except for surgical reasons; The unfamiliarity caused by enterostomy will gradually improve with the passage of time. By learning and mastering the appropriate nursing methods of enterostomy, the inconvenience caused by enterostomy will be minimized.
3 Nursing care in recovery period
(1) Psychological nursing: When patients see the intestinal mucosa on their abdominal wall for the first time after operation, they will have psychological changes of fear, loss, helplessness and even disgust; Emotions are often unstable. In order to help patients through this difficult period and overcome psychological obstacles, on the one hand, we should be careful and patient, deeply understand the psychological state of patients, comfort, support and encourage patients; On the other hand, we should do a good job in psychological care of patients with family members; At the same time, patients are encouraged to learn the nursing methods of enterostomy as soon as possible, so as to promote their psychological recovery and improve their confidence in returning to society.
(2) Nursing of enterostomy: Proper enterostomy nursing is not only beneficial to patients' physical recovery, but also can promote their psychological recovery. We use the following methods:
Natural defecation by enterostomy (artificial anal bag method): This method is the most commonly used, simple and easy to master. Try not to smell or leak feces when breastfeeding. We repeatedly and patiently demonstrate, explain and teach the nursing knowledge and skills of enterostomy to patients and their families, encourage them to operate as soon as possible under the supervision of nurses, improve their ability to adapt to environmental changes and take care of themselves, and thus promote their psychological rehabilitation.
Colon lavage: Since 1998, we have been caring for 22 patients with enterostomy, starting from 1 time every day, and changing to 1 time every two days after 7 ~ 10, and after lavage 1 ~ 3 months, most patients have received lavage. This method takes a lot of time, and it takes 10 ~ 20min for each irrigation, and then wait 1h to discharge all the feces. This method can reduce or even eliminate odor, reduce skin irritation around stoma, reduce patients' psychological burden, help stoma users to better participate in social activities, improve self-confidence and promote psychological rehabilitation. After 3 months of irrigation, 2 patients did not need to wear artificial anal bag, but only covered the stoma with cotton ball and fixed it with adhesive tape, which was very convenient and the patients felt good about themselves.
Patients with enterostomy should learn the selected nursing methods before leaving the hospital, and personally operate the nursing care of enterostomy. At least one member of his family has mastered the nursing method of enterostomy.
4. Rehabilitation nursing
(1) Undertaking ostomy association: In view of the inferiority complex of ostomy patients, Guangzhou started to hold ostomy association from 1994 for three months 1 time. We mobilize and encourage enterostomists to join the fraternity, so that they can communicate and entertain with many enterostomists and alleviate their loneliness. At the fraternity, patients saw many enterostomists like themselves returning to their preoperative life, which inspired their confidence in returning to their preoperative life and social activities. Enterostomists' Association is a good way to improve the self-confidence of enterostomists, which has a positive effect on their psychological rehabilitation. It links the consultation service provided by medical staff, the care and support of family members, the concern of friends and the social activities conducted in groups.
(2) Outpatient consultation and regular follow-up: The First Affiliated Hospital of Sun Yat-sen University of Medical Sciences set up a health education service center in June, 1998, and held an ostomy consultation day once a week 1 time to provide psychological consultation for ostomy patients and provide help and guidance as needed. The enterostomy patients discharged within 6 months were followed up 65438 0 times a month. Through face-to-face communication, consultation, help and guidance were given on the corresponding psychological and behavioral changes caused by diet, enterostomy care, feces and some side effects in chemotherapy or radiotherapy.
A large number of foreign documents show that if enterostomy patients can't return to their preoperative social life, including their work and social activities within 6 months after operation, the chances of recovery will be greatly reduced. The rehabilitation of enterostomy patients includes psychological, physiological and social rehabilitation. Psychological rehabilitation can accelerate their physical rehabilitation, which is more conducive to the rehabilitation of their social life, thus improving the quality of life of enterostomy patients. According to our experience in nursing 245 patients with enterostomy, it is considered that establishing a good nurse-patient relationship, doing a good job of psychological nursing before and after operation, doing a good job of enterostomy nursing and carrying out various forms of consultation activities are effective measures to promote the rehabilitation of enterostomy patients. Through the joint efforts of medical staff, patients' families and friends, psychological care before and after enterostomy, during recovery period and rehabilitation period can reduce or eliminate patients' psychological pressure, improve their confidence in resuming their preoperative life and social activities, and improve their physical and social life quality.