慢性心力衰竭患者疾病感知对失志的影响:疾病进展恐惧和正性情绪的链式中介作用  

Research on the relationship between disease perception and demoralization of patients with chronic heart failure: the chain mediating effect of disease progression′s fear and positive affect

作　　者：高兴 底瑞青[1] 李星丹[2] 叶琳[3] 杜文婷[4] 白井双 金子琛 王钊锐 Gao Xing;Di Ruiqing;Li Xingdan;Ye Lin;Du Wenting;Bai Jingshuang;Jin Zichen;Wang Zhaorui(Department of Nursing,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450000,China;Department of Pediatric,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450000,China;Department of Rhinology,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450000,China;Department of Cardiology,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450000,China)

机构地区：[1]郑州大学第一附属医院护理部,郑州450000 [2]郑州大学第一附属医院儿科,郑州450000 [3]郑州大学第一附属医院鼻科,郑州450000 [4]郑州大学第一附属医院心血管内科,郑州450000

出　　处：《中国实用护理杂志》2024年第5期372-379,共8页Chinese Journal of Practical Nursing

基　　金：河南省高等学校重点科研项目(23A320055);中华护理学会2023年度立项科研课题项目(ZHKY202316)。

摘　　要：目的探讨疾病进展恐惧和正性情绪在慢性心力衰竭患者疾病感知与失志关系中的中介作用, 为医护工作者采取针对性的干预措施提供理论依据。方法采用便利抽样法选取2022年10月至2023年3月在郑州大学第一附属医院住院的320例慢性心力衰竭患者为研究对象。使用一般资料调查表、修订版中文失志量表、简易疾病感知问卷、简易恐惧疾病进展量表、正负性情绪量表(正性情绪分量表)进行横断面调查, 通过构建结构方程模型, 探索疾病进展恐惧与正性情绪在疾病感知与失志间的中介效应。结果回收有效问卷268份。268例患者中男168例, 女100例, ≤40岁占3.36%(9/268), 41~65岁占55.22%(148/268), >65岁占41.42%(111/268)。相关分析显示, 慢性心力衰竭患者疾病感知与疾病进展恐惧、失志各维度均呈正相关(r值为0.300~0.586, 均P<0.01), 与正性情绪呈负相关(r=-0.374, P<0.01);疾病进展恐惧与正性情绪呈负相关(r=-0.318, P<0.01), 与失志各维度呈正相关(r值为0.339~0.464, 均P<0.01);正性情绪与失志各维度呈负相关(r值为-0.430~-0.334, 均P<0.01)。结构方程模型分析表明, 慢性心力衰竭患者疾病感知对失志的直接效应显著(β=0.407, P<0.01), 疾病进展恐惧及正性情绪在疾病感知与失志间的中介效应均显著(β=0.074、0.079, 均P<0.01), 疾病进展恐惧-正性情绪的链式中介效应亦显著(β=0.019, P<0.01)。结论疾病感知可直接预测慢性心力衰竭患者的失志水平, 亦可分别通过疾病进展恐惧、正性情绪的中介作用或疾病进展恐惧-正性情绪的链式中介作用间接预测慢性心力衰竭患者的失志水平。Objective To explore the mediating role of disease progression′s fear and positive affect in the relationship between disease perception and demoralization in patients with chronic heart failure.It provided a theoretical basis for targeted interventions for healthcare workers.Methods From October 2022 to March 2023,320 patients with chronic heart failure in the First Affiliated Hospital of Zhengzhou University were selected as the research objects by convenience sampling.The General Information Questionnaire,Demoralization Scale Redacted Mandarin Version,Brief Illness Perception Questionnaire,Fear of Progression Questionnaire-Short Form,Positive and Negative Affect Schedule(Positive Affect Schedule)were used to conduct the questionnaire survey exploring the mediating effects of fear of disease progression and positive emotions between disease perception and disorientation by construction structural equation model.Results There were 268 valid questionnaires.Of the 268 patients,168 were male and 100 were female,3.36%(9/268)were≤40 years old,55.22%(148/268)were 41-65 years old,and 41.42%(111/268)were>65 years old.Correlation analysis showed that disease perception was positively correlated with disease progression′s fear,and every dimension of demoralization(r values were 0.300-0.586,all P<0.01),and negatively correlated with positive affect(r=-0.374,P<0.01);disease progression′s fear was negatively correlated with positive affect(r=-0.318,P<0.01),and positively correlated with every dimension of demoralization(r values were 0.339-0.464,all P<0.01);positive affect was negatively correlated with every dimension of demoralization(r values were-0.430--0.334,all P<0.01).Structural equation model analysis showed that the direct effect of disease perception on demoralization was significant(β=0.407,P<0.01),and both mediating effects of disease progression′s fear and positive affect between disease perception and demoralization in patients with chronic heart failure were significant(β=0.074,0.079,both P<0.01).T

关 键 词：慢性心力衰竭 疾病感知 失志 疾病进展恐惧 正性情绪 中介效应 

分 类 号：R473.5[医药卫生—护理学]