造血干细胞移植患者在移植仓内生活护理缺乏依从性的行为成因的质性研究  

Behavioral causes of lack of compliance with life care in the transplant warehouse in hematopoietic stem cell transplantation patients:a qualitative study

作　　者：田园[1] 林晓非[1] 林圆圆 翁娇娇 吕信恩 周淑娟[1] Tian Yuan;Lin Xiaofei;Lin Yuanyuan;Weng Jiaojiao;Lyu Xin'en;Zhou Shujuan(Department of Hematology,the First Affiliated Hospital of Wenzhou Medical University,Wenzhou 325000,China;Department of Higher Education,Wenzhou City Education Bureau,Wenzhou 325000,China)

机构地区：[1]温州医科大学附属第一医院血液内科,温州325000 [2]温州市教育局高等教育处,温州325000

出　　处：《中华现代护理杂志》2025年第10期1364-1370,共7页Chinese Journal of Modern Nursing

基　　金：温州市基础性科研项目(Y20220680)。

摘　　要：目的探索造血干细胞移植患者在移植仓内独自生活期间生活护理缺乏依从性的原因,为制订针对性的促进措施提供依据。方法采用目的抽样法,于2023年6—12月实地观察温州医科大学附属第一医院血液移植中心入住的造血干细胞移植患者在移植仓内(以30 d为观察周期)自觉完成生活护理的情况并进行登记,观察期满后计算依从率。找出依从率<80%的患者,经知情同意后对其中的17例患者进行半结构式访谈,再应用Colaizzi现象学资料7步分析程序对访谈资料进行整理和分析。结果提炼出3个与缺乏依从性相关的核心主题,分别为妨碍依从的生理因素(躯体的特异性症状导致注意力转移、躯体的非特异性症状导致活动无耐力)、妨碍依从的心理因素(负性情绪、舒适区困境、退行现象、个性心理特征的制约)、妨碍依从的认知因素(主观认知未觉获益、不良示范造成的认知偏差、感知注意力有限)。结论造血干细胞移植患者在移植仓内独自生活期间生活护理缺乏依从性行为的成因是身心意多方面因素导致,其中心理中介机制是依从的关键。医护人员应同时关注患者的生理需求和心理需求,积极地缓解躯体症状,恰如其分地给予心理护理以排除心理障碍,帮助其积极寻求家庭和社会支持,并促进认知改善,进而提高使依从性。Objective To explore the causes of lack of compliance with life care in hematopoietic stem cell transplantation recipients while living alone in the transplant warehouse,and to provide a basis for developing targeted promotion measures.Methods Using purposive sampling method,from June to December 2023,on-site observations were conducted on the voluntary completion of life care by hematopoietic stem cell transplant patients(with a 30 day observation period)admitted to the Blood Transplantation Center of the First Affiliated Hospital of Wenzhou Medical University.The compliance was calculated after the observation period.Patients with a compliance of less than 80%were selected,and semi-structured interviews were conducted with 17 of them after informed consent.The Colaizzi 7-step analysis method was applied to organize and analyze the interview data.Results Three core themes on lack of compliance were distilled,namely physical factors impeding compliance(somatic specific symptoms leading to distraction,somatic non-specific symptoms leading to activity intolerance),psychological factors impeding compliance(negative emotions,comfort zone dilemmas,regression phenomena,constraints of personality psychological traits),and cognitive factors impeding compliance(subjective cognitive unperceived benefit,poor modeling resulting in cognitive biases,limited perceived attention).Conclusions The behavioral causes of lack of compliance with life care of hematopoietic stem cell transplant patients while living alone in the transplant warehouse are due to multiple factors of the body and mind,among which psychologically mediated mechanisms are key to compliance.Healthcare professionals should pay attention to both the physiological and psychological needs of patients,actively alleviate physical symptoms,appropriately provide psychological care to remove psychological barriers,help them actively seek family and social support,and promote cognitive improvement,thereby improving compliance.

关 键 词：造血干细胞移植 生活护理 依从性 质性研究 

分 类 号：R47[医药卫生—护理学]