【摘要】：目的:以信息—?jiǎng)訖C(jī)—行為技能模型為理論框架,探討家庭照護(hù)者對(duì)慢性心衰患者自我護(hù)理貢獻(xiàn)的影響因素,為提高患者自護(hù)能力和家庭生活質(zhì)量提供依據(jù)。方法:2015年12月至2016年6月,抽取某三甲教學(xué)醫(yī)院243名慢性心衰患者的家庭照護(hù)者進(jìn)行問卷調(diào)查。資料收集工具包括患者及其家庭照護(hù)者的一般資料問卷、心衰自護(hù)貢獻(xiàn)量表、心衰知識(shí)測(cè)試量表、社會(huì)支持評(píng)定量表和照護(hù)能力測(cè)量表。數(shù)據(jù)經(jīng)整理后應(yīng)用SPSS 20.0進(jìn)行統(tǒng)計(jì)分析。結(jié)果:1.家庭照護(hù)者對(duì)心衰自護(hù)維持和心衰自護(hù)管理的貢獻(xiàn)平均得分分別為52.40±9.96 和 55.61 ± 16.29。2.患者及其家庭照護(hù)者一般資料特征與家庭照護(hù)者對(duì)心衰自護(hù)貢獻(xiàn)的關(guān)系(1)文化水平為初中及以下、務(wù)農(nóng)、病程為6個(gè)月及以下患者的家庭照護(hù)者對(duì)心衰自護(hù)維持的貢獻(xiàn)得分低于文化水平為高中或?qū)？�、從事腦力勞動(dòng)或退休、病程為36個(gè)月及以上患者的家庭照護(hù)者(均P0.05);有配偶、文化水平為初中及以下、務(wù)農(nóng)、病程為12個(gè)月及以下患者的家庭照護(hù)者對(duì)心衰自護(hù)管理的貢獻(xiàn)得分低于無配偶、文化水平為高中或?qū)？啤⑼诵�、病程�?6個(gè)月及以上患者的家庭照護(hù)者(均P0.05)。(2)在職(務(wù)農(nóng)、其它體力勞動(dòng)、腦力勞動(dòng))、居住地為農(nóng)村、家庭人均月收入1000元以下的家庭照護(hù)者對(duì)心衰自護(hù)維持的貢獻(xiàn)得分低于退休、居住地為城鎮(zhèn)、家庭人均月收入1000元以上的家庭照護(hù)者(均P0.05);文化水平為初中及以下、務(wù)農(nóng)、居住地為農(nóng)村、家庭人均月收入1000元以下的家庭照護(hù)者對(duì)心衰自護(hù)管理的貢獻(xiàn)得分低于文化水平為本科及以上、退休或從事腦力勞動(dòng)或其他體力勞動(dòng)、居住地為城鎮(zhèn)、家庭人均月收入5000元以上的家庭照護(hù)者(均P0.05)。3.家庭照護(hù)者的心衰知識(shí)、心衰自護(hù)貢獻(xiàn)信心、社會(huì)支持和照護(hù)能力與心衰自護(hù)貢獻(xiàn)的相關(guān)性(1)家庭照護(hù)者的心衰知識(shí)得分(4.70±2.11)與心衰自護(hù)維持貢獻(xiàn)和心衰自護(hù)管理貢獻(xiàn)均呈正相關(guān)(r = 0.221,P0.01;r = 0.410,P0.01)。(2)家庭照護(hù)者對(duì)心衰自護(hù)貢獻(xiàn)的信心得分(55.26± 16.32)與心衰自護(hù)維持貢獻(xiàn)和心衰自護(hù)管理貢獻(xiàn)均呈正相關(guān)(r = 0.263,P0.01;r = 0.469,P0.01)。(3)家庭照護(hù)者的社會(huì)支持總分(41.84 ±6.70)與心衰自護(hù)維持貢獻(xiàn)和心衰自護(hù)管理貢獻(xiàn)得分均呈正相關(guān)(r = 0.140,P0.05;r = 0.281,P0.01)。其中客觀支持得分(11.05 ± 1.96)與心衰自護(hù)管理貢獻(xiàn)呈正相關(guān)(r = 0.236,P0.01);主觀支持得分(24.00±4.42)與心衰自護(hù)管理貢獻(xiàn)呈正相關(guān)(r = 0.188,P0.01);社會(huì)支持利用度得分(6.79±2.31)與心衰自護(hù)維持貢獻(xiàn)和心衰自護(hù)管理貢獻(xiàn)均呈正相關(guān)(r = 0.190,P0.01;r = 0.264,P0.01)。(4)家庭照護(hù)者的照護(hù)能力總分(5.03±4.65)與心衰自護(hù)維持貢獻(xiàn)和心衰自護(hù)管理貢獻(xiàn)均呈負(fù)相關(guān)(r =-0.202,P0.01;r =-0.311,P0.01)。其中適應(yīng)照護(hù)角色能力得分(1.03 ±1.15)與心衰自護(hù)維持貢獻(xiàn)和心衰自護(hù)管理貢獻(xiàn)均呈負(fù)相關(guān)(r =-0.260,P0.01;r =-0.346,P0.01);應(yīng)變需要及提供協(xié)助能力得分(0.59±4.42)與心衰自護(hù)管理貢獻(xiàn)均呈負(fù)相關(guān)(r =-0.188,P0.01);處理個(gè)人情緒能力得分(0.68 ± 1.38)與心衰自護(hù)管理貢獻(xiàn)均呈負(fù)相關(guān)(r =-0.246,P0.01);評(píng)估家人及社區(qū)資源能力得分(0.95±1.25)與心衰自護(hù)維持貢獻(xiàn)和心衰自護(hù)管理貢獻(xiàn)均呈負(fù)相關(guān)(r =-0.135,P0.05;r =-0.235,P0.01);調(diào)整生活以滿足照護(hù)需求能力得分(1.79± 1.93)與心衰自護(hù)維持貢獻(xiàn)和心衰自護(hù)管理貢獻(xiàn)均呈負(fù)相關(guān)(r =-0.156,P0.05;r =-0.188,P0.01)。4.家庭照護(hù)者對(duì)心衰自護(hù)貢獻(xiàn)的相關(guān)因素(1)經(jīng)多元回歸分析后,家庭照護(hù)者對(duì)心衰自護(hù)維持貢獻(xiàn)的相關(guān)變量為:患者的文化水平為高中或?qū)？?初中及以下為對(duì)照)、家庭照護(hù)者居住在城鎮(zhèn)(農(nóng)村為對(duì)照)、心衰自護(hù)貢獻(xiàn)信心和社會(huì)支持利用度。4個(gè)變量共解釋家庭照護(hù)者對(duì)心衰自護(hù)維持貢獻(xiàn)18.6%的變異量(調(diào)整R2= 0.186)。(2)經(jīng)多元回歸分析后,家庭照護(hù)者對(duì)心衰自護(hù)管理貢獻(xiàn)的相關(guān)變量為:家庭照護(hù)者的心衰知識(shí)、心衰自護(hù)貢獻(xiàn)信心、客觀社會(huì)支持、適應(yīng)照護(hù)角色能力和調(diào)整生活以滿足照護(hù)需求能力。5個(gè)變量共解釋家庭照護(hù)者對(duì)心衰自護(hù)管理貢獻(xiàn)38.8%的變異量(調(diào)整R2= 0.388)。5.適應(yīng)照護(hù)角色能力和評(píng)估家人及社區(qū)資源能力的中介效應(yīng)Baron和Kenny逐步檢驗(yàn)回歸系數(shù)法分析結(jié)果顯示,家庭照護(hù)者的心衰知識(shí)、心衰自護(hù)貢獻(xiàn)信心與心衰自護(hù)管理貢獻(xiàn)的關(guān)系均被適應(yīng)照護(hù)角色能力部分中介(均P0.05);家庭照護(hù)者的客觀社會(huì)支持與心衰自護(hù)管理貢獻(xiàn)的關(guān)系被適應(yīng)照護(hù)角色能力和評(píng)估家人及社區(qū)資源能力部分中介(均P0.05)。結(jié)論:1.患者和家庭照護(hù)者一般狀況不同使家庭照護(hù)者對(duì)心衰自護(hù)的貢獻(xiàn)存在差異。臨床護(hù)理人員應(yīng)該注重提高文化水平低、農(nóng)村、家庭經(jīng)濟(jì)水平較差、病程較短的心衰患者家庭對(duì)心衰自護(hù)的貢獻(xiàn)水平。2.家庭照護(hù)者對(duì)心衰自護(hù)維持貢獻(xiàn)的影響因素為心衰自護(hù)貢獻(xiàn)信心、社會(huì)支持利用度、患者的文化水平和家庭照護(hù)者的居住地。3.家庭照護(hù)者對(duì)心衰自護(hù)管理貢獻(xiàn)的影響因素為心衰知識(shí)、心衰自護(hù)貢獻(xiàn)信心、客觀社會(huì)支持、適應(yīng)照護(hù)角色能力和調(diào)整生活以滿足照護(hù)需求能力。4.家庭照護(hù)者的心衰知識(shí)、心衰自護(hù)貢獻(xiàn)信心可以直接和間接(通過適應(yīng)照護(hù)角色能力)對(duì)心衰自護(hù)管理貢獻(xiàn)產(chǎn)生影響;家庭照護(hù)者的客觀社會(huì)支持可以直接和間接(通過適應(yīng)照護(hù)角色能力和評(píng)估家人及社區(qū)資源能力)對(duì)心衰自護(hù)管理貢獻(xiàn)產(chǎn)生影響。5.臨床護(hù)理人員可以通過增強(qiáng)家庭照護(hù)者的心衰知識(shí)、心衰自護(hù)貢獻(xiàn)信心、客觀社會(huì)支持和社會(huì)支持利用度,幫助他們盡快適應(yīng)照護(hù)角色并提高照護(hù)能力,從而提升家庭照護(hù)者對(duì)心衰自護(hù)的貢獻(xiàn)水平。
[Abstract]:Objective: To explore the factors influencing the contribution of family caregivers to the self care of chronic heart failure patients with the information motivation behavioral skills model, and to provide the basis for improving the self-care ability and the quality of family life. Methods: from December 2015 to June 2016, the family care of 243 patients with chronic heart failure in a three a teaching hospital was taken. The data collection tools included the general data questionnaire for patients and their family caregivers, the self-care contribution scale of heart failure, the heart failure knowledge test scale, the social support assessment scale and the care ability measurement table. The data were collected and analyzed with SPSS 20. Fruit: 1. family caregivers for self-care maintenance and heart failure of heart failure The average score of the contribution of self-care management was 52.40 + 9.96 and 55.61 + 16.29.2. and the family caregivers' general data characteristics and family caregivers' contribution to the self-care contribution of heart failure (1) the cultural level was junior middle school and below, farming, the contribution of the family caregivers to the self-care maintenance of heart failure for the patients with the course of illness for 6 months and less. Lower than the cultural level for high school or specialist, engaged in mental labor or retirement, family caregivers of 36 months and more patients (all P0.05); with spouses, cultural level for junior middle school and below, farming, the family caregivers of 12 months or less, the contribution of the family caregivers to the self-care management of heart failure is lower than that of the non spouses, and the cultural level is high school Or specialist, retired, family caregivers of 36 months and more patients (all P0.05). (2) on the job (farming, other physical labor, mental labor), living in rural areas, family caregivers whose per capita monthly income is less than 1000 yuan are lower than retirement, residence is town, and the per capita monthly income of the family is 1000 yuan. Family caregivers (both P0.05); cultural level for junior high school and below, farming, residence for rural areas, family caregivers whose per capita monthly income is less than 1000 yuan per month are below the cultural level for undergraduate and above, retired or engaged in mental labor or other physical labor, residence is town, family per month. Family caregivers (all P0.05) and more family caregivers (all P0.05).3. family caregivers' heart failure knowledge, self-care contribution confidence of heart failure, social support and care ability and self-care contribution of heart failure (1) family caregivers' heart failure knowledge score (4.70 + 2.11) was positively correlated with the contribution of heart failure self-care maintenance and heart failure self-care management (r = 0.221, P0 .01; r = 0.410, P0.01). (2) the confidence score of family caregivers' self-care contribution to heart failure (55.26 + 16.32) was positively correlated with the contribution of heart failure self-care maintenance and the self-care management of heart failure (r = 0.263, P0.01; r = 0.469, P0.01). (3) family caregivers' social support total score (41.84 + 6.70) and self-care contribution to heart failure and self-care management of heart failure The scores were positively correlated (r = 0.140, P0.05; r = 0.281, P0.01). The objective support score (11.05 + 1.96) was positively correlated with the contribution of self-care management of heart failure (r = 0.236, P0.01); the subjective support score (24 + 4.42) was positively correlated with the contribution of self-care management of heart failure (r = 0.188, P0.01); social support utilization score (6.79 + 2.31) and self protection dimension of heart failure The contribution and the contribution of self-care management of heart failure were positively correlated (r = 0.190, P0.01; r = 0.264, P0.01). (4) the total score of care ability of family caregivers (5.03 + 4.65) was negatively correlated with the contribution of self-care maintenance and self-care management of heart failure (R =-0.202, P0.01; R =-0.311, P0.01). Among them, the ability to adapt to the role of care (1.03 + 1.15) and heart failure The contribution of self-care maintenance and self-care management of heart failure were negatively correlated (R =-0.260, P0.01; R =-0.346, P0.01); the score of strain needs and providing assistance ability (0.59 + 4.42) had negative correlation with the contribution of self-care management of heart failure (R =-0.188, P0.01), and the score of individual emotional ability (0.68 + 1.38) had a negative correlation with the contribution of self-care management of heart failure (R =-0.2. 46, P0.01); the score of assessment of family and community resources (0.95 + 1.25) had a negative correlation with the contribution of self-care maintenance and self-care management of heart failure (R =-0.135, P0.05; R =-0.235, P0.01), and the score (1.79 + 1.93) of adjusting life to satisfy the care demand (1.79 + 1.93) had a negative correlation with the contribution of heart failure maintenance and the self-care management of heart failure (R =-0.1) 56, P0.05, R =-0.188, P0.01).4. family caregivers' contribution to heart failure self care contribution (1) after multiple regression analysis, family caregivers' contribution to self-care maintenance of heart failure is: the cultural level of the patient is high school or specialist (junior high school and below), family caregivers live in the town (rural control), heart failure self-protection Tribute Confidence and social support use.4 variables to explain the variation of family caregivers' contribution to self-care maintenance of heart failure (adjusted R2= 0.186). (2) after multiple regression analysis, family caregivers contributed to the self-care management of heart failure: family caregivers' heart failure knowledge, self support confidence in heart failure, objective social support, and appropriate social support. .5 variables (adjusted R2= 0.388) 38.8% variation in family caregivers' contribution to self-care management of heart failure should be taken into account by roles of caring for role and adjusting life to meet the needs of care demand. The intermediate effect of.5. adaptation to the ability of care role and the ability to assess family and community resources, Baron and Kenny stepwise test regression coefficient method analysis results show that The relationship between the heart failure knowledge, the self-care contribution confidence of the heart failure and the self care management contribution of the heart failure was adapted to the part of the role competence (all P0.05); the relationship between the objective social support of the family caregivers and the self-care management contribution of the heart failure was adapted to the role of the role and the assessment of the ability of the family and community resources (all P0.05). Conclusion: the general situation of 1. patients and family caregivers is different. The contribution of family caregivers to heart failure self care is different. Clinical nurses should pay more attention to the contribution level of low level of culture, poor rural, family economy and short course of heart failure for heart failure self-care..2. family caregivers contribute to the self-care maintenance of heart failure. The factors affecting the self-care contribution of heart failure, social support utilization, the cultural level of the patients and the family caregivers'.3. family caregivers' contribution to the self-care management of heart failure are the knowledge of heart failure, the self support of the heart failure, the objective social support, the adaptation to the ability to protect the role and the adjustment of life to meet the needs of care. .4. family caregivers' heart failure knowledge, self-care contribution confidence of heart failure can be directly and indirectly (through adaptation to role ability) to contribute to the contribution of self-care management of heart failure; the objective social support of family caregivers can be directly and indirectly (by adapting to the ability to care for the role and assessing the ability of family and community resources) to care for heart failure self-care management. .5. clinical nursing staff can improve family caregivers' contribution to the self-care of heart failure by enhancing the knowledge of heart failure of family caregivers, self support of heart failure, objective social support and social support utilization, helping them to adapt to the role of care as soon as possible and to improve their care ability.
【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R473.5

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