基于理论域框架的老年慢性心力衰竭患者认知衰弱管理障碍因素的质性研究  

arriers to cognitive frailty management in elderly patients with chronic heart failure based on the Theoretical Domains Framework:a qualitative study

作　　者：李思倩 张伟英[3] 张孔雁 张锐 张利利 Li Siqian;Zhang Weiying;Zhang Kongyan;Zhang Rui;Zhang Lili(Department of Geriatric Medicine,Fuyang Hospital of Anhui Medical University,Fuyang 236000,China;School of Nursing,Medical College of Soochow University,Suzhou 215006,China;Department of Nursing,Shanghai East Hospital of Tongji University,Shanghai 200120,China)

机构地区：[1]安徽医科大学附属阜阳医院老年医学科,阜阳236000 [2]苏州大学苏州医学院护理学院,苏州215006 [3]上海同济大学附属东方医院护理部,上海200120

出　　处：《中华现代护理杂志》2025年第10期1351-1356,共6页Chinese Journal of Modern Nursing

基　　金：安徽省高校科学研究项目-重点项目(2023AH050606)。

摘　　要：目的探讨护士对老年慢性心力衰竭患者进行认知衰弱管理中的障碍因素。方法采用目的抽样法,2024年1—4月,选取安徽医科大学附属阜阳医院心血管内科及老年医学科工作的15名护士为研究对象进行半结构式访谈。基于理论域框架(TDF)制订访谈提纲,采用主题分析法对资料进行分析。结果本研究总结出与TDF中5个领域有关的障碍因素,分别为知识/技能、对结果的信念、动力和目标、环境与资源、行为调节。经过再次提炼,发现缺乏系统的老年慢性心力衰竭患者认知衰弱知识和技能、激励机制不完善、政府和医疗机构政策支持力度一般、缺乏认知衰弱的管理规范等是护士在老年慢性心力衰竭患者认知衰弱管理中存在的障碍因素。结论护士在老年慢性心力衰竭患者认知衰弱管理中存在不同层面的障碍因素,需要加强认知衰弱知识及技能培训、完善激励机制、提高政府及医疗机构的政策支持力度、建立规范化的认知衰弱质量管理体系,以提升护士对老年慢性心力衰竭患者认知衰弱的管理能力。Objective To explore the barriers encountered by nurses in managing cognitive frailty in elderly patients with chronic heart failure(CHF).Methods Using purposive sampling,15 nurses working in the Cardiovascular and Geriatric Departments of Fuyang Hospital of Anhui Medical University were recruited for semi-structured interviews from January to April 2024.The interview guide was developed based on the Theoretical Domains Framework(TDF),and data were analyzed using thematic analysis.Results The study identified barriers related to five TDF domains:knowledge/skills,beliefs about consequences,motivation and goals,environmental context and resources,and behavioral regulation.Further refinement revealed specific challenges,including a lack of systematic knowledge and skills in cognitive frailty management for elderly CHF patients,inadequate incentive mechanisms,limited policy support from government and healthcare institutions,and the absence of standardized management protocols for cognitive frailty.Conclusions Nurses face multiple barriers in managing cognitive frailty in elderly CHF patients.Addressing these challenges requires strengthening training on cognitive frailty knowledge and skills,improving incentive mechanisms,enhancing policy support from governments and healthcare institutions,and establishing standardized quality management systems to enhance nurses'ability to manage cognitive frailty in elderly CHF patients.

关 键 词：老年人 慢性心力衰竭 认知衰弱 障碍因素 质性研究 

分 类 号：R47[医药卫生—护理学]