基于COM-B理论的老年慢性心力衰竭病人容量超负荷居家管理行为体验的质性研究  

Behavioral experience of home management of volume overload in elderly patients with chronic heart failure based on COM-B theory:a qualitative study

作　　者：于文汇 朱欢欢[2] 陈秋菊[3] 朱迪 陈雁 YU Wenhui;ZHU Huanhuan;CHEN Qiuju;ZHU Di;CHEN Yan(School of Nursing,Nanjing University of Chinese Medicine,Nanjing 210029,China;Department of Geriatrics,Nanjing Drum Tower Hospital,Nanjing 210008,China;Department of Jiangbei Nursing,Nanjing Drum Tower Hospital,Nanjing 210031,China;Department of Nursing,Nanjing Drum Tower Hospital Clinical College of Nanjing University of Chinese Medicine,Nanjing 210008,China)

机构地区：[1]南京中医药大学护理学院,江苏省南京市210029 [2]南京大学医学院附属鼓楼医院老年医学科,江苏省南京市210008 [3]南京大学医学院附属鼓楼医院江北护理部,江苏省南京市210031 [4]南京中医药大学附属鼓楼临床医学院护理部,江苏省南京市210008

出　　处：《实用老年医学》2024年第6期625-628,633,共5页Practical Geriatrics

基　　金：江苏省干部保健科研课题(BJ21004);南京鼓楼医院护理科研项目(2023-B216)。

摘　　要：目的探索基于能力-机会-动机-行为(COM-B)理论的老年CHF病人居家容量管理行为的真实体验,为制定个性化的老年CHF病人容量超负荷居家管理方案提供参考。方法采用目的抽样法,对15例老年CHF病人进行半结构式访谈,运用内容分析法对资料进行分析。结果老年CHF病人容量超负荷居家管理行为共提炼出3个主题及9个亚主题,分别是能力方面:症状感知能力欠佳、管理知识欠缺或偏差、居家管理应对无效;动机方面:容量管理信心缺乏、容量管理体验不佳、运动自我效能低下;机会方面:医院支持、社区支持、家庭支持。结论老年CHF病人容量超负荷居家管理行为受多种因素的影响,需拓展容量管理教育方式及途径,切实提高老年CHF病人的自我决策及应对能力;重视不良体验,树立积极信念,激发容量管理行为动机;优化居家容量管理策略,加强医院-社区-家庭容量管理的连续性。Objective To explore the real-world experience of home volume management behaviors in the elderly patients with chronic heart failure(CHF)using the capacity-opportunity-motivation-behavior(COM-B)theoretical model as a framework,and to inform the development of a personalized home management plan for volume overload in the elderly patients.Methods Purposive sampling was used to conduct semi-structured interviews with 15 elderly CHF patients,and content analysis was applied to analyze the data.Results A total of three themes and nine sub-themes were distilled for volume overload home management behaviors in the elderly patients with CHF.The three themes were capacity,opportunity and motivation.Capacity included three sub-themes as poor symptom perception,lack of or deviated management knowledge and ineffective home management coping;Motivation included three sub-themes as lack of confidence in volume management,poor experience of volume management and low exercise self-efficacy;Opportunity included three sub-themes as hospital support,community support and family support.Conclusions The home management behavior of volume overload in the elderly patients with CHF is affected by multiple factors.It is necessary to expand the educational methods and approaches of volume management to effectively improve the self-decision-making and coping ability of the patients,to pay attention to the adverse experience,to establish positive beliefs,to stimulate the motivation for the behavior of volume management,to optimize the strategy of home volume management,and to strengthen the continuity of hospital-community-family volume management.

关 键 词：慢性心力衰竭 居家容量管理 容量超负荷管理 质性研究 

分 类 号：R473.54[医药卫生—护理学]