糖尿病视网膜病变患者就诊延迟原因的描述性质性研究  

Causes of delayed medical visits in patients with diabetic retinopathy:a descriptive study

作　　者：范春梅 高伟[2] 赵庆霞[3] 陈红梅[4] 怀宝莎 盛源 吴廷兰 Fan Chunmei;Gao Wei;Zhao Qingxia;Chen Hongmei;Huai Baosha;Sheng Yuan;Wu Tinglan(School of Nursing and Rehabilitation,Shandong University,Jinan,250012,China;Department of PICC Clinic,Qilu Hospital,Shandong University,Jinan,250012,China;Department of Endocrinology,Qilu Hospital,Shandong University,Jinan,250012,China;Department of Ophthalmology,Qilu Hospital,Shandong University,Jinan,250012,China)

机构地区：[1]山东大学护理与康复学院,山东济南250012 [2]山东大学齐鲁医院PICC门诊,山东济南250012 [3]山东大学齐鲁医院内分泌科,山东济南250012 [4]山东大学齐鲁医院眼科,山东济南250012

出　　处：《现代临床护理》2023年第2期33-39,共7页Modern Clinical Nursing

基　　金：山东省老年医学学会科技攻关计划项目,项目编号LKJGG2021Z003。

摘　　要：目的探讨糖尿病视网膜病变患者就诊延迟的原因,为促进糖尿病视网膜病变患者及时就诊相关策略的制定提供参考依据。方法采用目的抽样法,利用最大变异取样策略法,于2021年4月至10月选取山东省某三级甲等综合医院的16例糖尿病视网膜病变患者、8名护士和4名医生进行访谈,以描述性质性研究方法为指导,运用Braun和Clarke主题分析法对数据进行分析。结果共提炼出3个主题,10个子主题,分别为主题一:患者无法识别疾病相关的症状风险(缺乏疾病知识,症状的“合理化”,低估疾病的严重后果,视力的“代偿”作用,侥幸心理);主题二:患者感知就诊障碍(就医能力不足,直接和间接成本);主题三:护士忽视糖尿病视网膜病变知识防治教育(护士缺乏相关知识与宣教意识,护士自身宣教能力不足,亟需规范、统一的教育方案)。结论应提高患者与护理人员对糖尿病视网膜病变的认识,提供标准化的护士培训及健康教育内容,尝试创新型的健康教育模式,提高患者的就医决策水平和早期筛查就诊的健康意识,从而降低患者视力障碍的发生。Objective To investigate the causes of delayed medical visits for patients with diabetic retinopathy so as to provide references for promoting timely medical treatment for patients with diabetic retinopathy.Methods Between April and October 2021,16 patients with diabetic retinopathy,8 nurses and 4 doctors in a Tier-one tertiary hospital in Shandong Province were interviewed by the purpose sampling method and maximum variation sampling.Braun and Clarke thematic analysis was carried out to analyse the data with a descriptive nature research method.Results A total of 3 themes covering 10 dimensions were abstracted.For Theme 1:patients unable to recognise the risk of symptoms related to the disease in following 5 dimensions:lack of knowledge to the disease,"rationalisation"of symptoms,underestimation of serious consequences of the disease,compensatory effect of vision and fluke mentality.For Theme 2:patients perception of the barriers to see a doctor including economic difficulty in seeking medical care and direct and indirect costs.For Theme 3:ignorance of education by medical staff on diabetic retinopathy prevention and treatment in three dimensions including lack of attention to the knowledge of diabetic retinopathy with medical staff,poor ability in performing health education and lack of standardised education program with nurses.Conclusions Awareness of diabetic retinopathy among the patients and nurses should be improved.Standardised nurse training and health education should be provided.Innovative health education for the purpose of improving the ability in decision-making should be attempted in order to improve patients'awareness of early medical consultation and screening,therefore to reduce the occurrence of visual impairment caused by diabetic retinopathy.

关 键 词：糖尿病视网膜病变 延迟就诊 主题分析 描述性质性研究 

分 类 号：R473.5[医药卫生—护理学]