护理干预促进慢性呼吸困难患者自我管理的研究进展:整合性综述

Nursing interventions to promote dyspnea self-management of complex chronic patients:An integrated review

目的旨在通过系统综述,确定针对复杂慢性病患者增强自我管理的干预措施,以改善慢性呼吸困难,为护理人员促进该类人群的自我管理提供依据。方法2023年12月,系统检索Medline、Scopus、Web of Science、CINAHL、Cochrane图书馆和乔安娜布里格斯研究所(Joanna Briggs Institute,JBI)循证实践数据库。对纳入研究进行数据提取和综合,研究人员采用Rayyan文献管理软件筛选标题及摘要,并依据JBI研究质量评估工具进行方法学质量评估。结果共纳入18项研究。这些研究探讨了针对慢性呼吸困难的各种干预措施,包括药物干预(氧气疗法和吸入疗法)和非药物方法(教育计划、呼吸练习、液体摄入管理、身体感知技术、同伴支持、情商培训和网络应用程序的使用)。这些干预措施减轻了患者情绪困扰,可以使患者在自我管理方面变得独立自主。结论促进复杂慢性病患者对慢性呼吸困难的自我管理需要采取综合方法,但目前研究中没有充分考虑到针对患者行为改变的干预措施,需要进一步开展相关研究完善干预措施。

Objectives:Chronic dyspnea,a distressing symptom in patients with complex chronic conditions,is linked to higher risks of mortality.This study aimed to identify nursing interventions that could improve self-management for complex chronic patients,thereby enhancing control over chronic dyspnea.The findings intend to guide nursing care strategies that promote self-management among this population.Methods:We searched the databases Medline,Scopus,Web of Science,CINAHL,Cochrane Database of Systematic Reviews(CDSR),and Joanna Briggs Institute(JBI)databases were searched in December 2023.We included adult patients with complex chronic conditions with chronic dyspnoea.The team screened articles collaboratively,using Rayyan software.A qualitative appraisal was performed according to JBI Critical Appraisal Checklist tools.The review protocol is registered under the number CRD42023456021.Results:Our review included 18 studies that explored a variety of interventions for chronic dyspnea.We identified pharmacological interventions(such as oxygen therapy and inhalation treatments)and nonpharmacological approaches(including educational programs,breathing exercises,fluid intake management,body awareness techniques,peer support,emotional intelligence training,and the use of web applications).Those interventions empower patients,improve their ability to fulfill life roles,mitigate emotional distress,and improve overall quality of life.Nursing care can be crucial in enabling individuals to achieve independence and autonomy in self-care.Conclusions:Promoting self-management for chronic dyspnea in complex chronic patients requires a holistic approach,encompassing multidisciplinary interventions,individualized self-care education,peer engagement,and technological support.Current research on self-management inadequately addresses interventions targeting patient behaviour change.It highlights the need to delve deeper into the selfmanagement process.Further research is needed to expand the evidence base and refine these interventions.