老年全膝关节置换患者及其主要照顾者跌倒恐惧心理体验的质性研究

A qualitative study of the psychological experience of fall fear in total knee replacement patients and their primary caregivers

目的结合全膝关节置换术后患者及其主要照顾者的不同视角,更为全面了解患者跌倒恐惧及其照顾者害怕患者跌倒的心理体验,为患者制定个性化护理干预方案提供参考。方法于2021年12月至2022年9月,采用目的抽样法选取安徽省某三级甲等医院骨科住院的14例全膝关节置换术后跌倒恐惧患者及其主要照顾者为研究对象,采用半结构式访谈,访谈资料根据Colaizzi 7步分析法进行分析。结果全膝关节置换患者及其主要照顾者跌倒恐惧可归纳为3个主题和8个亚主题,跌倒恐惧的正负性情绪体验(多重负性情绪体验、正性情绪的调节);跌倒恐惧的应对体验(谨慎的态度和行为、心理和行为的退缩、自我效能的提升);居家康复护理的需求(跌倒和预防骨折的知识需求、家庭成员支持需求、居家医疗护理服务的需求)。结论老年全膝关节置换术后患者及其主要照顾者普遍存在着负性心理体验,护理人员应重视其内心感受和居家医疗护理服务的需求。

Objective Combined with the different perspectives of patients and their main caregivers after total knee replacement,to more comprehensively understand the patients′fear of falling and their caregivers′psychological experience of fear of falling,so as to provide reference for patients to develop personalized nursing intervention programs.Methods From December 2021 to September 2022,14 patients with fear of falling after total knee arthroplasty and their main caregivers in the orthopaedic department of a tertiary A-level hospital in Anhui Province were selected as the research objects by means of purposive sampling.Semi structured interviews were conducted.The interview data were analyzed according to Colaizzi′s 7-step analysis method.Results The fall fear of patients with total knee replacement and their main caregivers can be summarized into 3 themes and 8 sub themes.The positive and negative emotional experience of fall fear(multi burden emotional experience,regulation and guidance of positive emotions);Coping experience of falling fear(cautious attitude and behavior,withdrawal of psychology and behavior,improvement of self-efficacy);Needs of home rehabilitation care(knowledge needs of falls and fracture prevention,support needs of family members Home based medical care services).Conclusion The elderly patients and their main caregivers after total knee arthroplasty generally have negative psychological experience.Nurses should pay attention to their inner feelings and the needs of home medical care services.