老年膀胱癌根治术后患者居家自我管理体验的质性研究  

Qualitative study on home self-management experience of elderly patients after radical bladder cancer surgery

作　　者：郑燕君 屠耀芬[1] 林根芳[1] 周云仙[2] ZHENG Yanjun;TU Yaofen;LIN Genfang;ZHOU Yunxian(Zhejiang Provincial People's Hospital,Hangzhou 310014;Zhejiang University of Traditional Chinese Medicine,Hangzhou 310053,China)

机构地区：[1]浙江省人民医院,310014 [2]浙江中医药大学,310053

出　　处：《中国老年保健医学》2025年第1期80-85,共6页Chinese Journal of Geriatric Care

摘　　要：目的了解老年膀胱癌根治术后患者居家自我管理体验与需求,为制定针对性的出院计划及构建居家自我管理护理方案提供现实和理论依据。方法采用描述性质性研究方法,对13名根治性膀胱切除泌尿造口术后出院患者进行半结构式访谈,采用内容分析法分析资料。结果本研究共提炼出5个主题和16个亚主题,即自我管理存在挑战(疾病管理知识缺乏、造口护理技能不足、改变固化习惯困难、身体机能减退)、自我管理支持不足(社会偏见与排挤、地方医疗资源落后、缺乏延续性医疗支持)、自我管理存在顾虑(担心安全隐患、担心资源浪费、担心身体吃不消)、负性情绪困扰(焦虑与担心、自卑与难过、自责与忏悔)、自我效能增强(采取健康的生活方式、总结吸取经验教训、积极探索解决问题)。结论老年膀胱癌根治术后患者居家自我管理存在诸多困难与挑战,老年患者自我管理能力不足,居家自我管理支持缺乏,患者对疾病管理缺乏信心,居家管理过程中负性情绪普遍存在。部分患者在自我管理过程中能发挥主观能动性去应对处理疾病管理过程中遇到的问题,在自我管理过程中其自我效能逐渐增强,居家自我管理较好。因此,医务人员应考虑老年患者实际困难与需求,多途径提高老年患者居家自我管理能力,加强居家护理支持,减轻患者负性情绪,增加患者自我管理信心,提高患者主观能动性,增强患者自我管理效能,促进老年患者更好地开展居家自我管理,尽早回归家庭和社会。Objective To understand the home self-management experience and needs of elderly patients after radical surgery,to provide the practical and theoretical basis for the formulation of targeted discharge plan and the construction of home self-management care plan.Methods The semi-structured interviews with 13 patients discharged after radical cystectomy urostomy,and the data were analyzed by content analysis.Results Extract five themes and 16 subthemes,namely self management challenges(lack of disease management knowledge,stoma care skills,change curing habits difficult,body function),self management support(social prejudice and exclusion,local medical resources backward,lack of continuity medical support),self management concerns(worry about safety,worry about waste of resources,worry about the body),negative emotional distress(anxiety and worry,inferiority and sad,remorse and confession),self efficacy(adopt a healthy lifestyle,learn lessons,actively explore to solve the problem).Conclusion There are many difficulties and challenges in home self-management of elderly bladder cancer patients after radical surgery,lack of self-management ability,lack of home self-management support,lack of confidence in disease management,and negative emotions in the process of home management.In the process of self-management,some patients can play their subjective initiative to deal with the problems encountered in the process of disease management.In the process of self-management,their self-efficacy is gradually enhanced,and home self-management is better.Therefore,medical staff should consider the actual difficulties and needs,elderly patients with multiple ways to improve elderly patients self management ability at home,strengthen home care support,reduce negative emotions,increase patients with self management confidence,improve patients'subjective initiative,enhance patient self management efficiency,promote elderly patients to better self management at home,return to family and society as soon as possible.

关 键 词：根治性膀胱切除术 居家 自我管理 体验 质性研究 

分 类 号：R473.73[医药卫生—护理学]