肾移植患者自我管理行为改变特征的纵向质性研究  

A longitudinal qualitative study of the characteristics of self-management behavior change in kidney transplant patients

作　　者：马铮铮[1] 钮美娥[2] 王静 李慧君 钱春娅[1] Ma Zhengzheng;Niu Mei'e;Wang Jing;Li Huijun;Qian Chunya(Department of Urology,The First Affiliated Hospital of Soochow University,Suzhou 215006,China)

机构地区：[1]苏州大学附属第一医院泌尿外科,江苏苏州215006 [2]苏州大学附属第一医院护理部,江苏苏州215006

出　　处：《护理学杂志》2024年第22期52-56,共5页Journal of Nursing Science

基　　金：苏州市护理学会姑苏护理人才“青苗”计划项目(SHQM202302);苏州市科技发展计划(医疗卫生科技创新)项目(SKJY2021065)。

摘　　要：目的探索肾移植患者自我管理行为改变的特征,为改善患者的自我管理行为提供参考。方法运用质性研究中的扎根理论方法,以研究者本人为研究工具,采用目的抽样法和理论抽样法,选取2020年4月至2021年3月在苏州市某三级甲等医院泌尿外科接受过肾移植手术的17例患者作为研究对象,分别于患者出院后2周、2个月、3个月、6个月、1年、2年进行6次面对面半结构式访谈,采用三级编码的方法对访谈资料进行整理和分析。结果肾移植患者自我管理行为改变呈现两个明显特征,即肾移植患者自我管理行为轨迹(尝试、摸索、重塑、超越)和行为改变类型(遵医坚持型、随心所欲型和遵医-随心徘徊型)。结论肾移植患者自我管理行为轨迹是多阶段变化的过程,其自我管理行为改变类型复杂多样。建议医护人员可根据患者自我管理行为改变的特征,制订多阶段、个性化的干预策略。Objective To explore the characteristics of self-management behavior changes in kidney transplant patients,and to provide a reference for improving patients'self-management behavior.Methods Using the grounded theory method in qualitative research,with the researcher himself as the research tool,17 patients who had received kidney transplantation in the department of urology of a Grade A hospital in Suzhou from April 2020 to March 2021 were selected as the research objects by means of objective sampling method and theoretical sampling method.Six face-to-face semi-structured interviews were conducted at 2 weeks,2 months,3 months,6 months,1 year,and 2 years after the patients'discharge from the hospital,respectively,and the interview data was sorted out and analyzed using the method of three-level coding.Results Self-management behavior change in kidney transplant patients presented two distinctive features,namely,the trajectory of self-management behavior in kidney transplant patients(trying,groping,reshaping,and transcending)and the type of behavior change(compliant adherence type,freewheeling type,and wandering between compliant and free wheeling type).Conclusion The self-management behavioral trajectory of kidney transplant patients is a multi-stage change process,and their self-management behavioral change types are complex and diverse.It is suggested that healthcare professionals can develop multi-stage and individualized intervention strategies according to the characte-ristics of patients'self-management behavior change.

关 键 词：终末期肾病 肾移植 自我管理 行为特征 用药管理 并发症预防 行为改变 质性研究 

分 类 号：R473.6[医药卫生—护理学]