| Objective:To evaluate the pregnancy stress level and its influencing factors in patients with gestational diabetes mellitus(GDM),and evaluate intervention effect of the transtheoretical model’s(TTM)psychological nursing in the pregnancy stress of patients with GDM,coping style,blood glucose levels and pregnancy outcomes,search for the intervention model suitable for the change of stress management behavior in patients with GDM,to provide practical basis for improve and perfect health promotion behavior of patients with GDM。Methods:This study is divided into two parts and the one studies the status of pregnancy stress and its influences of patients with GDM(referred to as “the study one”),the purposeful sampling method was used to collect fifteen patients with GDM of a three-grade hospital in Chengde from February to July in 2016,the pregnancy stress of the patients with GDM were studied in semi-structured and in-depth inteviews,then data using Colaizzi’s analysis to analyze and refine the themes.Another part is the Transtheoretical Model’s psychological nursing apply in the pregnancy stress of patients with GDM(referred to as “the study two”).The convenience sampling method was used to this study,the patients with GDM in a three-grade hospital of Chengde were selected as the study objects on the basis of informed consent from February to July in 2016,eighty six patients were divided into the experimental group(forty three cases)and the control group(forty three cases)according to the random number table method;There were given routine nursing in the control group,and the experimental group were implemented based on the TTM’spsychological nursing included the routine nursing,the intervention time of the two groups lasted 3 months;Two groups were measured by the Pregnancy Stress Scale,the behavior change stage questionnaire,Simplified Coping Style Questionnaire(SCSQ),the newborn and the maternal evaluation index before intervention,after the intervention for one month,after the intervention for three months.Statistical analysis using SPSS22.0 statistical software package to analysis the data.Results:The study one on Colaizzi’s analysis method to refine eight themes:experiencesof negative emotions,fetal health,pregnancy outcomes,knowledge acquisition,future life,control blood sugar,working、social aspects and family aspects.The results of the study two were showed that:1.Baseline data showed that(1)There were no significant statistically differences(overall P>0.05)between the two groups in age,occupation,residence,education level,family income,payment of medical expenses,the number of pregnancy,family history of diabetes and abnormal pregnancy;(2)The Pregnancy Stress Scale score of patients with GDM were(47.05±5.11)and score index were 52.51%.(3)There were no significant statistically differences(overall P>0.05)in Pregnancy Stress Scale score between the experimental group and the control group[(0.52±0.05)VS(0.53±0.06),t=-0.842],behavior change stage(=3.248)and SCSQ score[positive coping style score were(16.83±2.97)VS(15.51±2.68),t=-1.696;negative coping style score were(9.88±1.69)VS(10.02±1.37),t=1.634],the two groups were comparable.2.The results after intervention showed that:(1)Before intervention,after one months of intervention and after three months of intervention,the Pregnancy Stress Scale score of repeated measures analysis of variance showed that there were significant statistically differences(overall P<0.01)in times effect、interventions effect and its interaction effect(Ftime effects=930.459,Fintervention effects=20.831,Finteraction effects=90.086);There were significant statistically differences(overall P<0.01)in the Pregnancy Stress Scale score of the patients between the experimental group and the control group [(0.43±0.47)VS(0.48±0.06),t=-4.323] after one month of intervention,the score of the patients between the experimental group and the control group[(0.35±0.04)VS(0.44±0.06),t=-8.403]after three months of intervention;There were significant statistically differences(overall P<0.01)in Pregnancy Stress Scale score in both the experience group(Fexperimental group=607.241)and the control group(Fcontrol group=323.332)at different time points;There were significant statistically differences(overall P<0.05)in Post Hoc Multiple Comparisons in the Pregnancy Stress Scale score both two groups at different time points.(2)Before intervention,after the intervention for one month and after the intervention for three months,the SCSQ score of repeated measures analysis of variance showed that there were significant statistically differences(overall P<0.01)of the positive coping style scores in times effect、interventions effect and its interactions effect(Ftime effects=232.522,Fintervention effects=12.280,Finteraction effects=4.246);There were significant statistically differences(overall P<0.05)in the positive coping style score between the experimental group and the control group[(18.02±2.69)VS(16.42±2.60),tone month=2.814;(22.12±2.54)VS(19.53±2.81),t three months=-3.232];There were significant statistically differences(overall P<0.01)in the positive coping style score in both the experimental group(Fexperimental group=107.013)and the control group(Fcontrol group=144.906)at different time points;There were significant statistically differences(overall P<0.05)in Post Hoc Multiple Comparisons in the positive coping style score both two groups at different time points.There were no significant statistically differences(overall P>0.05)of the negative coping style scores in times effect、interventions effect and its interactions effect(Ftime effects=0.584,Fintervention effects=2.126,Finteraction effects=4.246);There was significant statistically differences(P<0.05)in the negative coping style score between the experimental group and the control group[(9.44±1.59)VS(10.26±1.36),t=-2.545] after theintervention for one month;There were significant statistically differences(overall P<0.05)in the negative coping style score in both the experimental group(Fexperimental group=5.064)and the control group(Fcontrol group=4.226)at different time points;There were significant statistically differences(P<0.05)in Post Hoc Multiple Comparisons in the negative coping style score both two groups before intervention and after the intervention for one month,there were no significant differences(overall P>0.05)between the two groups in the rest of the time points.(3)The results which compared the behavior change stages in pregnancy stress between two groups and in groups at different time points showed there were significant statistically differences(overall P<0.01)between the experimental group and the control group(χ2one month=22.928,χ2three months=24.952);There were significant statistically differences(overall P<0.01)in behavior change stages with pregnancy stress in the experimental group(χ2experimental group=84.488)and in the control group(χ2control group=37.360)at different time points.(4)There were statistically significant differences(overall P<0.05)after the intervention for three months of the 2h blood glucose in the experimental group was lower than those in the control group[(5.41±0.55)VS(6.00±0.77),tbreakfast=-3.132;(6.31±0.29)VS(6.96±0.89),t Lunch=-2.248;(6.23±0.26)VS(7.21±0.67),tdinner=-2.030];There were statistically significant differences(overall P<0.05)in the experimental group of the incidence rates of cesarean section,neonatal complications and maternal complications were lower than those in the control group[χ2cesarean section=5.296,χ2neonatal complications=5.780,χ2maternal complications=7.026].Conclusions:1.The pregnancy stress level of patients with GDM at the moderate level and need for timely assessment and give targeted psychological nursing intervention;2.The TTM apply in pregnancy stress intervention in patients with GDM can effectively reduce the stress level of patients,to promote patients adopt thepositive coping style,to promote the development of behavioral changes stage significantly;3.The TTM apply in patients with GDM can promote self-management of patients,make patients aware of the benefits of behavioral change to control blood sugar and finally improve pregnancy outcome;... |
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