重症脑卒中相关性肺炎患者肺康复护理体验的质性研究

Qualitative Research on Pulmonary Rehabilitation Nursing Experiences in Patients with Severe Stroke-Associated Pneumonia

目的:探讨医务人员对肺康复在重症脑卒中相关性肺炎中的应用体验,为提供高质量肺康复护理提供依据。方法:采用目的抽样法,于2024年1月~3月选取贵州省3家三级甲等医院神经科、呼吸与重症医学科和康复科的18名医务人员进行半结构化访谈。通过Colaizzi 7步分析法对访谈资料进行整理和分析。结果:总结出重症脑卒中SAP患者肺康复护理现状和障碍因素两个类别,共7个亚主题。肺康复护理现状亚主题为:SAP发生率高,肺康复护理意义重大;缺乏专业知识与技能;护理内容不统一且缺乏特异性。障碍因素归纳为:患者健康状况与认知不足;医护人员缺乏专业培训;人力资源不足;缺乏规范管理和效果评价标准。结论:重症脑卒中SAP患者的肺康复护理面临多重障碍,应加强患者及家属的健康教育;强化医护人员的培训,优化护理管理;合理配置人力资源;制定规范的肺康复干预流程,使重症脑卒中SAP患者真正获益于肺康复护理。Objective: To explore the healthcare providers’ experience of pulmonary rehabilitation in severe stroke-associated pneumonia and provide a basis for providing high-quality pulmonary rehabilitation care. Methods: Using purposive sampling, 18 healthcare providers from the departments of neurology, respiratory and critical care medicine, and rehabilitation in three tertiary-level A hospitals in Guizhou Province were selected from January to March 2024 for semi-structured interviews. The interview data were compiled and analyzed by Colaizzi 7-step analysis. Results: Two categories of current status of pulmonary rehabilitation care and barrier factors with seven sub-themes were summarized for SAP patients with severe stroke. The sub-themes of the current status of pulmonary rehabilitation care were: high incidence of SAP and significance of pulmonary rehabilitation care;lack of professional knowledge and skills;and inconsistency and lack of specificity of care. Barrier factors were summarized as: insufficient patient health status and awareness;lack of professional training for healthcare professionals;insufficient human resources;and lack of standardised management and outcome evaluation criteria. Conclusion: Pulmonary rehabilitation care for SAP patients with severe stroke faces multiple barriers. Health education for patients and their families should be strengthened;training for healthcare personnel should be enhanced and care management should be optimized;human resources should be reasonably allocated;and standardized pulmonary rehabilitation intervention processes should be developed, so that SAP patients with severe stroke can truly benefit from pulmonary rehabilitation care.