基于社会生态系统理论的脑卒中康复期患者自我倡权体验的质性研究  

Self-advocacy experience of stroke patients during rehabilitation based on social ecological model:a qualitative study

作　　者：侯雅淇 张瑜 王英歌 杨艳 胡兰英[1,2] HOU Yaqi;ZHANG Yu;WANG Yingge;YANG Yan;HU Lanying(Dept.of Neurology,Affiliated Hospital of Yangzhou University,Yangzhou 225001,China;School of Nursing&School of Public Health,Yangzhou University,Yangzhou 225009,China)

机构地区：[1]扬州大学附属医院神经内科,扬州大学,江苏扬州225001 [2]扬州大学护理学院·公共卫生学院,江苏扬州225009

出　　处：《护理学报》2025年第5期7-12,共6页Journal of Nursing(China)

基　　金：扬州大学医学创新转化专项基金“临床转化研究项目”(AHYZUZHXM 202102);中华国际医学交流基金会“脑血管病青年创新基金”(Z-2016-20-2101)。

摘　　要：目的了解脑卒中康复期患者自我倡权体验,为制订针对性干预措施提供参考。方法以社会生态系统理论为理论框架,采用目的抽样法选取18例脑卒中康复期患者为访谈对象,基于现象学研究对其进行面对面半结构式访谈并收集资料,采用Colaizzi现象学研究方法分析资料。结果共归纳出3个主题,10个亚主题。即微观系统-倡权需求和困扰并存(存在自我倡权需求、自我倡权意识薄弱、自觉身体机能下降导致倡权困难、专业知识匮乏影响倡权能力、负性情绪影响倡权积极性);中观系统-社交网络与沟通不畅(家庭与社区支持不足、健康知识获取途径单一、医患沟通存在障碍);宏观系统-康复支持系统薄弱(延续性康复系统不成熟、社区康复医疗人员紧缺)。结论脑卒中康复期患者存在倡权需求,但其倡权水平受病后自身能力及负面情绪的消极影响。完善的社交网络及丰富的沟通渠道是脑卒中康复期患者自我倡权的重点。建立成熟的延续性康复系统、加强基层社区医疗康复支持有利于促进患者更好地进行自我倡权。Objective To understand the self-advocacy experience of stroke patients during rehabilitation,and to provide reference for formulating targeted interventions.Methods Social ecological model was employed as the theoretical framework in the study.Purposive sampling was used to select 18 stroke patients during rehabilitation as the interview objects.Face-to-face semi-structured interviews were conducted and the data were analyzed by Colaizzi seven-step method.Results The following 3 themes and 10 sub-themes were summarized:coexisting of micro system-advocacy needs and problems(self-advocacy needs,weak self-advocacy consciousness,difficulty in advocacy due to body function decline,inadequate professional knowledge affecting advocacy competency,negative emotions affecting advocacy motivation);poor meso system-social network and communication(insufficient family and community support,single access to health knowledge,and barriers to doctor-patient communication);weak macro system-rehabilitation support system(immature continuous rehabilitation system,and shortage of community rehabilitation medical staff).Conclusion Patients in the rehabilitation period of stroke have the need of advocacy,but their advocacy level is affected by their own ability and negative emotions.Perfect social network and rich communication channels are the focus of self-advocacy for stroke patients during rehabilitation.The establishment of a mature continuous rehabilitation system and the strengthening of community-level medical rehabilitation support are conducive to promoting patients’right to better self-advocacy.

关 键 词：社会生态系统理论 脑卒中 自我倡权 质性研究 

分 类 号：R473.74[医药卫生—护理学]