医护人员对慢性阻塞性肺疾病患者开展居家肺康复阻滞因素及应对策略的质性研究  

Physicians and Nurses’Perspective of Barriers and Solutions to the Delivery of Home-based Pulmonary Rehabilitation for Patients with Chronic Obstructive Pulmonary Disease:a Qualitative Study

作　　者：方慧 施雁[2] 刘贤亮[3] 管嘉贝 FANG Hui;SHI Yan;LIU Xianliang;GUAN Jiabei(Medical School,Fuyang Normal University,Fuyang 236000,China;Shanghai Tenth People's Hospital,Shanghai 200072,China;School of Nursing,Jinggangshan University,Ji'an 343600,China)

机构地区：[1]阜阳师范大学医学院,安徽省阜阳市236000 [2]上海市第十人民医院,200072 [3]井冈山大学护理学院,江西省吉安市343600

出　　处：《中国全科医学》2021年第10期1284-1288,共5页Chinese General Practice

基　　金：国家自然科学基金地区项目(7186401);阜阳市妇女儿童医院横向合作项目(HX2020039)。

摘　　要：背景流行病学调查显示目前我国约有1亿慢性阻塞性肺疾病(COPD)患者,每年约有100万人死于呼吸系统疾病,并有超过500万人因呼吸系统疾病致残。居家肺康复在提高COPD患者生活质量、改善患者肺功能等方面与医院、社区肺康复同等有效。而目前较少有研究从医护人员的角度了解阻碍COPD患者实施居家肺康复的相关因素。目的了解医护人员对COPD患者开展居家肺康复的真实想法和体验,明晰阻碍COPD居家肺康复开展的相关因素。方法采用目的抽样法,于2019年7—11月选取上海市某三级甲等医院从事呼吸科和康复科工作的14名医务人员作为研究对象,采用半结构访谈提纲进行深度访谈,采用内容分析法对访谈资料进行整理和分析。结果提炼出阻碍COPD居家肺康复开展的3个主题、9个次主题:患者健康状态、肺康复认知、心理状况限制居家肺康复的开展(COPD患者合并症多,居家肺康复动力不足;患者对居家肺康复认知不足、信心不够;患者对居家肺康复不信任且锻炼依从性低);医护人员肺康复知识、培训及重视度不足限制居家肺康复的开展(医护人员自身知识储备不足、实施居家肺康复力不从心;居家肺康复服务开展规范化培训不足;医院、科室对居家肺康复重视度不够);医疗组织层面提供居家肺康复服务的有限性(医院和社区家庭联动不足,后续追踪监测体系不完善;提供居家肺康复服务的专业人员不足;缺乏系统的康复训练模式及简便实用的效果评价指标)。结论 COPD患者开展居家肺康复存在诸多阻滞因素,应加强专业化培训,提高医护人员居家肺康复知识,重视COPD居家肺康复功能锻炼指导,调动社会支持,使COPD患者真正受益于居家肺康复。Background The latest epidemiological survey shows that there are about 100 million patients with chronic obstructive pulmonary disease(COPD)in China,about 1 million people die of respiratory diseases each year,and more than 5 million people become disabled due to respiratory diseases.The effectiveness of home-based pulmonary rehabilitation is as good as hospital and community pulmonary rehabilitation in improving the quality of life and lung function of COPD patients.However,there are few studies showing the barriers to the delivery of home-based pulmonary rehabilitation from the perspective of physicians and nurses.Objective To investigate the barriers to the delivery of home-based pulmonary rehabilitation based on a survey of physicians and nurses blocking the quality of life and lung function of COPD.Methods From July to November 2019,in-depth semi-structural interviews regarding the barriers to the delivery of home-based pulmonary rehabilitation based on a self-developed framework were carried out in a purposive sample of 14 medical workers from respiratory and rehabilitation departments of a grade A tertiary hospital in Shanghai.Content analysis was performed to sort out and analyze the recorded interview results.Results Three themes with nine sub-themes(each including three sub-themes)were extracted:patients’negative health,cognitive,and psychological conditions(prevalence of multiple comorbidities and low motivation of receiving home-based pulmonary rehabilitation;insufficient knowledge of home-based pulmonary rehabilitation;distrust of the efficacy of home-based pulmonary rehabilitation and low exercise compliance).Physicians and nurses’insufficient knowledge and trainings and attentions regarding home-based pulmonary rehabilitation(insufficient related knowledge and feeling incompetent to carry out home-based pulmonary rehabilitation;insufficient related standard trainings;insufficient attentions paid to home-based pulmonary rehabilitation by hospitals and related departments).Limited capacities at

关 键 词：肺疾病 慢性阻塞性 肺康复 阻滞因素 质性研究 

分 类 号：R563[医药卫生—呼吸系统] R197[医药卫生—内科学]