慢性心力衰竭心脏再同步化治疗患者自我管理行为的质性研究

Qualitative research on self-management behaviors in patients with chronic heart failure undergoing cardiac resynchronization therapy

目的了解影响心脏再同步化治疗(CRT)患者自我管理行为的因素,为制定患者自我管理行为护理措施和个性化护理方案提供参考。方法采用便利抽样法,选取2019年6-12月在大连市某三级甲等综合医院心内科接受CRT的15例慢性心力衰竭患者为研究对象。应用质性研究中的现象学研究法对患者进行半结构访谈,采用Colaizzi 7步分析法进行资料分析。结果归纳出首次行CRT术后患者自我管理行为的阻碍因素和促进因素2个方面的主题。阻碍因素包括对CRT术后健康结局的理解偏差;忽视术后症状的识别能力;术后习得性无助感;术后社会联结感水平降低。促进因素包括术后获益感;情绪的积极自我调整;重建对未来生活的信心。结论CRT术后患者的自我管理行为受多重因素的影响,应从症状、生理、心理、社会等方面综合评估,以提高首次行CRT术后患者的自我管理能力。

Objective To understand the factors that affect the self-management behavior of patients with cardiac resynchronization therapy(CRT)and to provide reference for the development of patients'self-management behavior nursing measures and personalized nursing programs.Methods The convenient sampling method was used to select 15 chronic heart failure patients who underwent CRT in the cardiology department in a ClassⅢGrade A general hospital in Dalian from June to December 2019 as the research objects.The phenomenological research method in qualitative research was used to conduct semi-structured interviews with patients,and the data was analyzed by the Colaizzi 7-step analysis method.Results The two themes of hindering factors and promoting factors of self-management behavior of patients after the first operation of CRT were summarized.Hindering factors included the misunderstanding of health outcomes after CRT,the ignorance of the ability to recognize postoperative symptoms,postoperative learned helplessness and decreased postoperative social connectedness.Promoting factors included perceived postoperative benefit,positive self-adjustment of emotions and rebuilding confidence in future life.Conclusions The self-management behavior of patients after CRT is affected by multiple factors,and comprehensive evaluation should be made from the aspects of symptoms,physiology,psychology and society to improve the self-management ability of patients after CRT for the first time.