基于ICF对慢性心力衰竭患者全方面功能损伤真实感受的质性研究

True feelings of comprehensive function impairment based on ICF among chronic heart failure patients: a qualitative research

目的深入挖掘慢性心力衰竭(chronic heart failure,CHF)患者全方面功能损伤状况及其影响因素。方法采用目的抽样法,于2018年11月-2019年1月选择江苏省某三甲医院心脏内科医务工作者(包括心脏科医生和护士)、CHF患者或家属作为研究对象。以现象学方法为指导,对研究对象进行半结构式访谈,根据Colaizzi法分析提取概念,由2名研究员根据Cieza链接规则将概念与国际功能、残疾和健康分类(international classification of functioning,disability,and health,ICF)进行匹配,以2次连续采访后新出现的ICF类目不超过前者的5%作为样本量饱和标准。结果最终共纳入28名受访者,链接到80个唯一的ICF类目,其中身体功能部分类目数为31个(38.8%),身体结构5个(6.2%),活动与参与28个(35.0%)和环境因素16个(20.0%);另有482个概念不可被链接到ICF类目,健康状况占比最多(30.7%),其次是个人因素(27.4%)。结论ICF可以用于CHF患者全方面功能损伤状态及其影响因素的描述,链接到众多ICF类目说明其功能损伤状况复杂、影响因素众多。本研究为有利于今后开展基于综合评估的CHF患者个体化、详尽化、动态化的治疗与护理。

Objective To deeply explore the comprehensive function impairment of chronic heart failure(CHF)patients and analyze its influencing factors.Methods From November 2018 to January 2019,this study selected medical workers(doctors and nurses),CHF patients or their family members in Department of Cardiovascular at a ClassⅢGrade A hospital in Jiangsu Province as subjects by purposive sampling.Semi-structured interview was carried out for the subjects with the phenomenological method.Colaizzi analysis was used to extract concepts.Two researchers matched the concept with the international classification of functioning,disability and health(ICF)based on Cieza link rules.This study took ICF category no more than 5%of the former after two interviews as the sample size saturated standard.Results Finally,a total of 28 interviewees were included.A total of 80 ICF categories were linked,31(38.8%)of them in body function,5(6.2%)in body structure,28(35.0%)in activity participation and 16(20.0%)in environmental factors.Other 482 concepts could not be linked with ICF categories with health status(30.7%)for the most followed by personal factors(27.4%).Conclusions ICF could be used to describe the comprehensive function impairment of CHF patients and its influencing factors.Being linked with multitudinous ICF categories indicates the complex function impairment and the numerous influencing factors.This study will be beneficial to carry out the individualized,detailed and dynamic treatment and nursing based on comprehensive evaluation for CHF patients.