老年维持性血液透析患者对动静脉内瘘自我护理体验的质性研究

Qualitative study on self-care experience of arteriovenous fistula in elderly maintenance hemodialysis patients

目的探讨老年维持性血液透析患者对动静脉内瘘自我护理的体验,为干预管理提供参考。方法采用描述性现象学研究方法,通过目的抽样法,选取2022年11月至2023年5月于浙江大学医学院附属第一医院行维持性血液透析并以动静脉内瘘作为血管通路的老年患者为研究对象,对其进行半结构式深度访谈,并运用Colaizzi 7步分析法对资料进行分析。结果共纳入15例访谈对象,男6例,女9例,年龄为(73.53±8.59)岁。共归纳出多重负担叠垒(共病负担、心理负担、经济负担)、自我护理困境(受身体功能衰退影响、自我应对无力、咨询渠道不足)、社会因素的驱使(社会回馈动机的激发、同伴行为的影响、医护延续服务的促进)和人生哲学的领悟(积极应对生命变化、重新规划生活次序、欣赏生命价值)4个主题及12个亚主题。结论老年维持性血液透析患者在动静脉内瘘自我护理过程中存在复杂的负担体验、多维度的问题和需求,自我护理行为受社会因素影响较大。未来的干预应重视加强多学科协作、提供专业便捷的延续性护理服务、完善社会支持路径及给予准确的心理干预,以减轻患者疾病管理负担、满足其自我护理需求、增强自我护理行为内在动力、提高自我护理能力。

ObjectiveTo explore the self-care experience of arteriovenous fistula in elderly maintenance hemodialysis patients,and to provide reference for intervention and management.MethodsThe descriptive phenomenological research method was used to select elderly patients as subjects who underwent hemodialysis and used arteriovenous fistula as vascular access in the blood purification center of The First Affiliated Hospital of Zhejiang University School of Medicine from November 2022 to May 2023 through objective sampling,and semi-structured in-depth interviews were conducted on them,and the data were analyzed by Colaizzi 7-step analysis method.ResultsFinally,15 interviewees were included.There were 6 males and 9 females,aged(73.53±8.59)years old.A total of 4 themes and 12 sub-themes were summarized:multiple burdens(comorbidities management burden,psychological burden,financial burden),self-care dilemmas(affected by physical decline,inadequate self-coping,inadequate counseling channels),driven by social factors(motivated by social feedback,influenced by peer behavior,promoted by extended medical services)and understanding of life philosophy(actively coping with life changes,replanning life order,appreciating life value).ConclusionsElderly maintenance hemodialysis patients have complicated burden experience,multi-dimensional problems and needs in the process of self-care for internal arteriovenous fistula,and self-care behavior is greatly affected by social factors.Future intervention should focus on strengthening multidisciplinary collaboration,providing professional and convenient continuous nursing services,improving social support paths and giving accurate psychological intervention,so as to reduce the burden of disease management of patients,meet their self-care needs,enhance the internal motivation of self-care behavior and improve self-care ability.