病耻感对创伤性截瘫患者孤独感的影响:自我效能和希望的链式中介效应分析

Effects of stigma on loneliness in patients with traumatic paraplegia:an analysis of the chain mediating effect of self-efficacy and hope

目的探讨自我效能与希望在创伤性截瘫患者病耻感和孤独感的链式中介效应,以期为临床针对创伤性截瘫患者实施有效的护理干预提供科学的理论指导。方法采用便利抽样法,选取2017年6月—2021年5月泰州市人民医院骨科收治的307例创伤性截瘫患者为研究对象,采用一般资料调查表、一般自我效能感量表、Herth希望量表、社会影响量表和美国加州大学洛杉矶分校(UCLA)孤独量表对患者进行调查。采用Pearson相关分析自我效能、希望、病耻感和孤独感之间的关系。采用Amos 21.0软件建立结构方程模型并进行中介效应检验。本研究共发放问卷307份,回收292份,问卷回收率为95.11%,剔除规律作答和漏项超过10%的问卷,有效问卷289份,问卷有效回收率为94.14%(289/307)。结果不同性别、年龄、婚姻状况、家庭关系和卧床的患者UCLA孤独量表总分比较差异有统计学意义(P<0.05)。289例创伤性截瘫患者自我效能总分为(25.54±3.37)分;希望总分为(27.73±3.66)分;病耻感总分为(65.97±8.35)分;孤独感总分为(53.82±6.78)分。Pearson相关分析结果显示,孤独感与病耻感呈正相关(P<0.05),与自我效能、希望呈负相关(P<0.05)。创伤性截瘫患者病耻感对孤独感的中介效应成立,总间接效应占总效应的46.39%,其中自我效能的特定中介效应占19.91%,希望的特定中介效应占19.12%,自我效能与希望在病耻感和孤独感间的链式中介效应占7.37%。结论创伤性截瘫患者自我效能、希望、病耻感和孤独感评分均处于中等水平,且孤独感与病耻感呈正相关,与自我效能、希望呈负相关。自我效能与希望在病耻感和孤独感间的链式中介成立,提示病耻感可以通过自我效能进而调节希望水平,最终影响孤独感水平。临床医护人员在关注患者病耻感的同时,应注重评估自我效能和希望水平,针对性地采取措施以降低病耻感对孤独感的影响。

Objective To explore the chain mediating effect of self-efficacy and hope in stigma and loneliness among patients with traumatic paraplegia and provide scientific theoretical guidance for effective nursing intervention for these patients in clinical practice.Methods Totally 307 patients with traumatic paraplegia who were admitted to the Department of Orthopedics of Jiangsu Taizhou People's Hospital from June 2017 to May 2021 were selected by convenience sampling and investigated with the general information questionnaire,General Self-efficacy Scale(GSES),Herth Hope Index(HHI),Social Impact Scale(SIS),and UCLA Loneliness Scale.Pearson correlation was used to analyze the relationship between self-efficacy,hope,stigma,and loneliness.Amos 21.0 was used to construct a structural equation model(SEM)and test the mediating effect.A total of 307 questionnaires were distributed in this study,and 292 were recovered,accounting for a recovery rate of 95.11%.After excluding the questionnaires with more than 10%regular answers and missing items,289 valid questionnaires were obtained,and the effective recovery rate was 94.14%(289/307).Results There were significant differences in the total score of UCLA Loneliness Scale among patients with different gender,age,marital status,family relationship,and bedridden conditions(P<0.05).The total score of self-efficacy among the 289 patients with traumatic paraplegia was(25.54±3.37);the total score of hope was(27.73±3.66);the total score of stigma was(65.97±8.35);the total score of loneliness was(53.82±6.78).Pearson correlation analysis showed that loneliness was positively correlated with stigma(P<0.05),and negatively correlated with self-efficacy and hope(P<0.05).The mediating effect of stigma on loneliness in patients with traumatic paraplegia was established,and the total indirect effect accounted for 46.39%of the total effect,of which the specific mediating effects of self-efficacy and hope accounted for 19.91%and 19.12%,respectively.The chain mediating effect of self-efficacy and hope between stigma and loneliness accounted for 7.37%.Conclusions The scores of self-efficacy,hope,stigma,and loneliness in patients with traumatic paraplegia are all at moderate levels.Loneliness is positively correlated with stigma,and negatively correlated with self-efficacy and hope.The chain mediating effect of self-effect between self-efficacy and hope between stigma and loneliness is established,suggesting that stigma can adjust hope through self-efficacy,and ultimately affect loneliness.While paying attention to patient'stigma,clinical medical and nursing staff should pay attention to evaluating self-efficacy and hope levels and take targeted measures to reduce the impact of stigma on loneliness.