基于扎根理论的急性脑卒中患者延迟就诊应对模型的构建

Delayed hospital arrival for acute stroke:development of a coping model using grounded theory

目的探讨急性脑卒中患者延迟就诊的应对过程,构建应对模型。方法运用格拉泽传统扎根理论研究方法,对12例延迟就诊的急性脑卒中患者进行半结构式深度访谈,提取主题。结果析出核心主题"急性脑卒中患者就诊应对方式",基于Lazarus压力应对模式构建急性脑卒中患者延迟就诊应对模型,包括感知阶段、犹豫阶段、决策阶段3个应对阶段,认知因素、经济因素、社会支持、促进因素和阻碍因素5个原因要素。结论急性脑卒中患者延迟就诊受多种因素影响,应对模型的初步构建可为进一步探索急性脑卒中患者院前延迟就诊的干预策略提供依据。

Objective To explore the coping process that influences the time from symptom onset to hospital arrival （delay time） for patients with acute stroke, and to develop a coping model. Methods A qualitative research approach guided by grounded theory was adopted. Data were collected by using semi-structured in-depth interviews on 12 patients who arrived at the hospital greater than 4.5 hours of stroke symptom onset. Results The key theme was how patients dealt with acute stroke. Based on the Lazarus/s stress and coping model, the coping model of delayed hospital arrival for acute stroke was developed, including 3 stages and 5 contributing factors. The 3 stages were symptom perception, hesitation, and decision-making~ and the 5 contributing factors were cognition, financial status, social support, motivation and barrier. Conclusion Delays in hospital arrival after acute stroke were affected by several factors. Development of a coping model can provide reference for formulating intervention measures.