基于个人和家庭自我管理理论的慢性心力衰竭患者出院时照顾者准备度的影响因素分析

Analysis of influencing factors of caregiver preparedness at discharge of patients with chronic heart failure based on the individual and family self-management theory

目的基于个人和家庭自我管理理论构建慢性心力衰竭患者出院时照顾者准备度影响因素的结构方程模型,探索影响照顾者准备度的主要路径。方法本研究为横断面调查性研究,采用便利抽样法选取2020年10月至2021年8月于中国医科大学附属第四医院住院的345名慢性心力衰竭患者照顾者作为研究对象,采用一般人口学资料调查表、照顾者准备度量表、家庭关怀度指数问卷、Herth希望量表、社会支持评定量表、简易应对方式问卷对其进行调查,分析慢性心力衰竭患者出院时照顾者准备度的影响因素。结果慢性心力衰竭患者出院时照顾者准备度量表得分为(20.79±4.92)分,家庭关怀度指数问卷得分为(8.05±1.43)分,Herth希望量表得分为(35.34±4.47)分,社会支持评定量表得分为(43.89±6.56)分,简易应对方式问卷中积极应对与消极应对分量表得分分别为(24.38±5.21)、(11.21±4.26)分。慢性心力衰竭患者照顾者准备度与家庭功能、希望、积极应对、社会支持呈正相关(r值为0.213~0.383,均P<0.01),与消极应对呈负相关(r=-0.546,P<0.01)。家庭功能、社会支持可直接或间接影响慢性心力衰竭患者照顾者准备度(总效应值为0.380、0.212),希望、消极应对直接作用于慢性心力衰竭患者照顾者准备度(总效应值为0.200、-0.433),总共可解释慢性心力衰竭患者照顾者准备度总变异的39%。结论慢性心力衰竭患者照顾者准备度仍需进一步提高,重视照顾者家庭功能,提高希望水平,增加社会支持,减少消极应对是改善其照顾者准备度的有效途径。

Objective A structural equation model of the influencing factors on caregiver preparedness at discharge of patients with chronic heart failure was constructed based on the individual and family self-management theory,and the main paths influencing caregiver preparedness were explored.Methods This study was a cross-sectional survey.A total of 345 caregivers of patients with chronic heart failure who were hospitalized in the Fourth Affiliated Hospital of China Medical University from October 2020 to August 2021 were selected as research objects by convenience sampling method,and they were investigated by Caregiver Preparedness Scale,Family APGAR Index,Herth Hope Index,Social Support-Rating Scale,Simplified Coping Style Questionnaire.The influencing factors on caregiver preparedness at discharge of patients with chronic heart failure were analyzed.Results The total score of Caregiver Preparedness Scale,Family APGAR Index,Herth Hope Index,Social Support-Rating Scale,and Positive and Negative Coping Subscale of Simplified Coping Style Questionnaire in patients with chronic heart failure was(20.79±4.92),(8.05±1.43),(35.34±4.47),(43.89±6.56),(24.38±5.21),(11.21±4.26)points.Caregiver preparedness in patients with chronic heart failure was positively correlated with family function,hope,positive coping and social support(r values were 0.213-0.383,all P<0.01),and negatively correlated with negative coping(r=-0.546,P<0.01).Family function and social support in patients with chronic heart failure could directly or indirectly affect caregiver preparedness(total effect value:0.380,0.212),hope and negative coping directly affected caregiver preparedness(total effect value:0.200,-0.433),and could account for 39%of the total variation in caregiver preparedness.Conclusions Caregiver preparedness of patients with chronic heart failure needs further improvement.The effective ways to improve caregiver preparedness are to pay attention to family function,improve hope level,increase social support and reduce negative coping.