脑卒中恢复期患者社会疏离现状及影响因素研究

Study on social isolation status and influencing factors of stroke patients during rehabilitation

目的探讨脑卒中恢复期患者社会疏离现状及影响因素,为社会疏离的针对性心理干预提供参考。方法采用一般资料调查问卷、一般疏离感量表、脑卒中症状体验量表、心理弹性量表、脑卒中患者病耻感量表、社会支持评定量表对225例脑卒中恢复期患者进行调查。结果脑卒中恢复期患者社会疏离总分为(45.33±4.13)分,症状负担总分为(43.76±3.95)分,心理弹性总分为(51.28±4.57)分,病耻感总分为(45.27±4.81)分,社会支持总分为(38.95±3.81)分。社会疏离与症状负担呈正相关(r=0.243,P<0.01),与心理弹性呈负相关(r=-0.486,P<0.01),与病耻感呈正相关(r=0.658,P<0.01),与社会支持呈负相关(r=-0.733,P<0.01)。多元线性回归分析显示,年龄、文化程度、症状负担、心理弹性、病耻感和社会支持是脑卒中恢复期患者社会疏离的主要影响因素(P<0.01)。结论脑卒中恢复期患者社会疏离处于中等偏上水平,针对高龄、文化程度低、症状负担重、心理弹性差、病耻感强、社会支持水平低的脑卒中恢复期患者,建议护理人员分别采用支持性表达小组治疗、加强疾病健康教育、制订个性化护理方案、叙事疗法干预、正念训练干预、渐进式聚焦访谈、同伴支持干预等方式,降低脑卒中恢复期患者社会疏离水平。

Objective To explore the status and influencing factors of social isolation in patients with stroke convalescence,and to provide reference for targeted psychological intervention of social isolation.Methods General information questionnaire,general social isolation scale,stroke symptom experience scale,mental resilience scale,stroke patients'stigma scale and social support scale were used to investigate 225 stroke patients in the convalescent period.Results The total scores of social isolation,symptom burden,mental resilience,stigma and social support were(45.33±4.13)points,(43.76±3.95)points,(51.28±4.57)points,(45.27±4.81)points,and(38.95±3.81)points respectively.The general sense of social isolation was positively correlated with stroke symptom experience(r=0.243,P<0.01),negatively correlated with mental resilience(r=-0.486,P<0.01),positively correlated with stroke patients'stigma(r=0.658,P<0.01),and negatively correlated with social support(r=-0.733,P<0.01).Multiple linear regression analysis showed that age,educational level,symptom burden,mental resilience,stigma and social support were the main influencing factors of social isolation in stroke patients in the convalesce period(P<0.01).Conclusion The social isolation of stroke patients in the convalescent period is at the upper middle level.Aiming at the old age,low educational level,heavy symptom burden,poor mental resilience,strong stigma and low social support level,it is suggested that nursing staff can use supportive expression group therapy,strengthen disease education,develop personalized nursing plan,narrative therapy intervention,mindfulness training intervention,progressive focus interview,peer support intervention and other methods to reduce the level of social isolation of patients in the convalescence of stroke.