聚焦解决模式下居家慢性阻塞性肺疾病患者正念干预方案的构建

Construction of the mindfulness intervention program for patients with chronic obstructive pulmonary disease at home based the solution focused approach

目的以聚焦解决模式为干预框架，Kabat—Zinn的正念减压疗法和Teasdale的正念认知疗法为理论基础，建立全面、标准的居家慢性阻塞性肺疾病患者正念干预方案，为社区和居家护理的开展提供依据。方法采用目的抽样方法选取26名专家作为咨询对象并进行2轮函询，建立最终的居家慢性阻塞性肺疾病患者的正念干预方案。同时运用专家意见的协调程度、积极系数与权威系数等指标对咨询的可靠性和代表性进行检验。结果2轮函询专家的积极系数分别为88．46％（23／26）和100．00％（23／23），专家权威系数分别为0．90、0．91；2轮专家咨询后各项指标的变异系数为0．04～0．14，2轮函询后得出专家的协调系数分别为0．32（P〈0．01）、0．59（P〈0．01），最终构建的居家慢性阻塞性肺疾病患者正念干预方案包含5个步骤、25个条目，各条目均给予合适评价。结论专家函询的代表性和可信度高，基于聚焦解决模式构建的居家慢性阻塞性肺疾病患者正念干预方案具有科学性和实用性。

Objective Based on the Kabat-Zinn＇ s mindfulness decompression therapy and Teasdale＇s mindfulness cognitive therapy, and using the solution-focused approach as the frame structure, we establish comprehensive, standard mindfulness interventions scheme of domiciliary patients with chronic obstructive pulmonary disease, which can provide the basis for the development of the community and residential care. Methods Twenty-six experts were selected as the target of the study and two rounds of correspondence were used to establish the final mindfulness intervention plan of the domiciliary patients with chronic obstructive pulmonary disease. Meanwhile, the reliability and representativeness of the consultation are tested by using the coordination degree, positive coefficient and authoritative coefficient of expert opinions. Results The positive coefficient of the two round correspondence experts were 88.46%（23/26） and 100.00%（23/23）, and the expert authority coefficient was 0.90 and 0.91. The variation coefficient of the indicators after two rounds of expert consultation was 0.04-0.14, the coordination coefficient of experts was 0.32（P〈0.01） and 0.59（P〈0.01） respectively. The final construct of domiciliary patients of chronic obstructive pulmonary disease with the intervention programme consists of 5 steps, 25 entries, which was suitable for the positive reading intervention scheme. Conclusions The results show that experts enquiry for representative and high credibility, and the mindfulness intervention plan of domiciliary patients with chronic obstructive pulmonary disease is scientific and practical.