Liu Ying (劉 穎), Zhng Junxi (張俊霞), Sun Jing (孫 晶),Co Zhenying (曹振英), Shen Gungwen (申廣文)

aThe Second Department of Hepatology, Handan Infectious Disease Hospital (Sixth Hospital), Handan 056001, China;

bDepartment of Sever Hepatology, Handan Infectious Disease Hospital (Sixth Hospital), Handan 056001, China;

ABSTRACT

OBJECTIVE: To explore the effects of acupoint massage combined with psychological nursing on depression and hope level and coping style in hospitalized patients with hepatocirrhosis, and to provide scientific basis for clinical treatment.METHODS: A total of 86 patients with hepatocirrhosis hospitalized in The Sixth Hospital of Handan from June 2015 to June 2018 were selected and divided into 2 groups according to the nursing method. The control group, with a total of 42 patients, were given psychological nursing intervention. The observation group, with a total of 44 patients, were given acupoint massage and psychological nursing intervention. Changes in depression levels, hope levels, and coping style scores were compared between the 2 groups. RESULTS: There was no significant difference in depression, hope level and coping style before the intervention between the 2 groups (P > 0.05). In the observation group, the self-rating depression scale (SDS) score of depression before intervention was 55.16 ± 4.17; and the positive attitude score was 8.40 ± 2.02; the positive action score was 8.33 ± 3.05; and the intimate score was 8.13 ± 2.44. The negative response score was 30.14 ± 3.31, and the positive response score was 30.49 ± 3.26. Before the intervention, the SDS score in the control group was 56.81 ± 4.39,and the positive attitude score was 8.29 ± 1.98. The positive action score was 8.04 ± 2.57, and the intimate score was 8.06 ± 2.31. The total level of hope score was 24.07 ± 3.11. The negative coping score was 30.55 ± 3.06, and the positive coping score was 30.93 ± 3.17. After intervention the SDS scores of the observation group were lower than those of the control group (P < 0.05). The SDS score of the observation group was 36.19 ± 4.19, and the SDS score of the control group was 42.95 ± 3.71. The total level of hope in the observation group was higher than that in the control group after intervention (P < 0.05). The positive attitude score of the observation group was 16.10 ± 2.15, and the score of positive action was 14.74 ± 3.11; the score of intimate relationship was 15.08 ± 5.45; and the total score of hope was 45.71 ± 5.63.The positive attitude score of the control group was 10.92 ± 2.07; the score of positive action was 11.38 ± 3.14; the score of intimate relationship was 10.92 ± 2.33; and the total score of hope was 34.09 ± 5.77. The patients in the observation group had lower response scores after intervention than the control group, and the positive response scores were higher than those in the control group (P < 0.05). The negative response score of the observation group was 20.14 ± 2.19; the positive response score was 38.92 ± 4.33; the negative response score of the control group was 26.61 ± 2.34; and the positive response score was 34.08 ± 2.69. CONCLUSION: Acupoint massage combined with psychological nursing can effectively improve depression in hospitalized patients with hepatocirrhosis, improve the patient's hope level, help patients cope with lifestyle changes from negative to positive, which is worthy of clinical promotion.

KEYWORDS: Acupoint massage; Psychological nursing; Hospitalized patients with hepatocirrhosis; Depression;Hope level; Coping style

The causes of hepatocirrhosis are varied. The main cause is viral hepatitis. The early clinical manifestations of patients with hepatocirrhosis are mild fatigue and abdominal distention. Without prompt treatment, it will harm the system of human body, causing upper gastrointestinal bleeding, ascites, hypersplenism,secondary infection and carcinomatous change, which will seriously affect the health of patients[1,2]. At present,there is no specific treatment for hepatocirrhosis.Antiviral drugs are mostly used to delay the progress of liver diseases and reduce the incidence of hepatic carcinoma. Some studies have pointed out that the effects of medication for hepatocirrhosis are limited, but it can effectively prevent complications of hepatocirrhosis and reduce the incidence of carcinogenesis with good mental state and positive treatment[3,4]. Some studies have pointed out that psychological nursing can alleviate patients'negative emotions and improve treatment compliance.Therefore, psychological nursing is an important way to cooperate with treatments clinically[5]. Acupoint massage,one of the important methods of traditional Chinese medicine (TCM) treatment, is widely used clinically. It can improve the psychological state of patients and raise their hope level by promoting and changing the function of qi and blood[6,7]. The purpose of this study is to explore the effect of the combination of acupoint massage and psychological nursing on depression, hope level and coping style of hospitalized patients with hepatocirrhosis.

DATA AND METHODS

General information

A total of 86 patients with hepatocirrhosis hospitalized in The Sixth Hospital of Handan from June 2015 to June 2018 were selected as the study subjects. There were 47 males and 39 females. And they were 38.62 ± 4.17 years old with 7.15 ± 2.31-month duration and 12.09 ± 4.17-year education. According to the nursing method, all patients were divided into 2 groups. There were 42 patients, including 22 males and 20 females, in the control group receiving psychological nursing intervention. They were 37.93 ± 4.41 years old and had the duration of 6.95 ± 2.11 months and the education of 12.34 ± 4.51 years. The other 44 patients,including 25 males and 19 females, in the observation group received acupoint massage combined with psychological nursing intervention. And they were 38.62 ± 4.38 years old with 7.15 ± 2.01-month duration and 12.26 ±4.08-year education. There was no significant difference in age, sex, duration of disease and education years between the 2 groups. Inclusion criteria: (1) The patients were in normal mental state and can communicate normally; (2) the patients did not suffer from dermatosis and can accept acupoint massage; (3) all patients agreed to participate in this study.

Methods

Psychological nursing

The patients in the control group received psychological nursing, including: (1) scientific health education: medical staff explained nursing knowledge to patients every night, asked patients about their physical condition, patiently answered the patients' questions,and established a good relationship with patients, so as to improve the patients' treatment compliance; (2)establishing a comfortable nursing environment: hang the heart-warming tips, encouraging mottos and others in the ward, adjust the temperature of the ward appropriately and the brightness of the ward to warm pale yellow, and ensure the coziness of the environment; (3) enabling family members to help: medical staff should encourage family members to communicate with patients, so that patients would feel the support from families, which improved their confidence in rehabilitation.

Acupoint massage

The patients in the observation group received the intervention of acupoint massage combined with the psychological nursing. Firstly, prepare warm water of 40-50℃ for foot bath, and instruct the patients to adjust their breath in the process of foot bath so as to cooperate with acupoint massage. Secondly, press and knead Baihui(GV 20), Yintang (EX-HN 3), Shangxing (GV 23),Shenmai (BL 62), Taichong (LR 3), Wangu (GB 12) and Sanyinjiao (SP 6), Ganshu (BL 18) and so on. In the process,the thumb should be perpendicular to the point of focus and press and knead hard, but the force should be within the patient's tolerance. The acupoint massage should be done once a day and 5 minutes for each acupoint.

Evaluation Criteria

Compare the changes of depression level, hope level and coping style score of the 2 groups.

SDS was used to measure the level of depression.The scale included 20 questions. Each question was evaluated by a four-level method of 1-4 points. If the total score was lower than 50 points, it showed that there was no depression. And 50-60 points indicated that there was tendency to depression. If the score exceeded 60 points,the problem of depression was serious, which meant that consultation of psychiatrist would be needed.

Herth Hope Scale was used to measure the level of hope. There were 12 items in the scale. This study only selected three items, including positive attitude, positive action and intimate relationship. Each item contained five questions. It adopted the five-level method of 0-4, in which 0-36 was classified as low hope level, 36-48 was classified as medium hope level, and 48-60 was classified as high hope level.

The coping style score adopted the trait coping style questionnaire, which contained 2 dimensions: positive coping style and negative coping style. Each dimension contained 20 items. The value of each dimension ranged from 0 to 50. The lower the negative coping style score was, the lower the degree of negative coping style the patient had. And the higher the positive coping style score was, the degree of positive coping style the patient had.

Statistical Methods

SPSS 19.0 software was used to analyze the data obtained in the study. The results of the 2 groups were compared by t test, and the counting data was compared by χ2test. And if P < 0.05, the differences were significant.

RESULTS

Comparison of SDS scores between 2 groups before and after intervention

There was no significant difference in SDS score between the 2 groups before intervention (P > 0.05), but the SDS score of the observation group was lower than that of the control group after intervention (P < 0.05). See Table 1.

Table 1. Comparison of SDS scores between 2 groups before and after intervention

Comparison of the hope level between 2 groups before and after intervention

There was no significant difference in the total scores of positive attitude, positive action and intimate relationship between the 2 groups before intervention (P < 0.05), but the total scores of positive attitude, positive action and intimate relationship in the observation group were higher than those in the control group after intervention (P < 0.05).See Table 2.

Comparison of coping style scores between 2 groups before and after intervention

There was no significant difference in the scores of negative coping style and positive coping style between the 2 groups before intervention (P > 0.05), but the scores of negative coping style and positive coping style in the observation group were lower and higher after intervention (P < 0.05). See Table 3.

DISCUSSION

Because hepatocirrhosis is at risk of developing into hepatocellular carcinoma and there is no specific treatment for hepatocirrhosis at present, patients are oftenaccompanied by different degrees of fear and anxiety and are more sensitive to the state of illness, thinking that there is no way to be cured. They are less willing to cooperate, and often more irritable, and emotionally vulnerable. Therefore, taking positive measures to improve the mental health of patients with hepatocirrhosis plays an important role in the follow-up treatment[8,9].

Table 2. Comparison of the hope level between 2 groups before and after intervention

Table 3. Comparison of coping style scores between 2 groups before and after intervention

Psychological nursing can promote patients to understand nursing work, make them feel the support from hospitals, families and other aspects, which can increase patients' sense of security, stabilize their heart rate and blood pressure, relieve their mental burden,eliminate the triggering factors of bad emotions, stimulate patients' cooperation in nursing work, and improve the therapeutic effect[10,11]. The data of this study showed that the psychological nursing effect was obvious as the mental health status, hope level and coping style of the 2 groups were improved compared with those before intervention.

The data of this study showed that the SDS score and the total score of positive attitude, positive action and intimate relationship after intervention in the observation group were significantly different from those in the control group (P < 0.05). Acupoint massage is simple but effective. Baihui (GV 20), located on the top of the head, is the reservoir of the yang meridians.And pressing Baihui (GV 20) can stimulate yang qi,harmonize qi and blood, and ascend yang qi. Pressing Shangxing (GV 23) and Shenmai (BL 62) can stimulate yang from yin, relieve pathogenic factors in heart and strengthen qi, as well as regulate yin and yang.The Liver Meridian of Foot-Jueyin is related to Liver Meridian and frontal lobe, and plays an important role in the treatment of depression, which is consistent with the results of previous studies[12-14].

Acupoint massage is one of the most common nondrug treatment methods clinically. It can avoid the toxicity and adverse effects of drugs. And with its high safety and good effect, it can effectively stabilize the emotions of patients who are ineffective in taking sedative drugs[15].The data of this study showed that the negative coping style score was lower while the positive coping style score was higher in the observation group (P < 0.05).Through stimulating acupoints, acupoint massage can promote individual endorphin secretion which, on the one hand, can play an analgesic role, and on the other hand,can promote the Thoroughfare Vessel and Conception Vessel, invigorate the zang-fu organs, nourish qi and blood and promote adrenal functions. Yintang (EX-HN 3) can clear head and eyes, relieve the stuffy nose and resuscitate.Taichong (LR 3) can relive liver qi stagnation to relieve depression. Wangu (GB 12) can alleviate migraine and trigeminal neuralgia. Insomnia acupoint can calm the spirit of hyperactivity, reduce the stress reaction of patients, and help the patients respond positively to the disease, which is consistent with previous studies[16,17].

In conclusion, acupoint massage combined with psychological nursing can effectively improve the depression of hospitalized patients with hepatocirrhosis,improve the level of hope of the patients, help the patients cope with life style positively instead of negatively. Thus,it can be used clinically to improve the treatment effect of hospitalized patients with hepatocirrhosis and reduce the incidence of cancer.