家庭照护者对慢性心衰患者自我护理的贡献及影响因素分析
发布时间：2018-07-21 11:34
【摘要】：目的:以信息—动机—行为技能模型为理论框架,探讨家庭照护者对慢性心衰患者自我护理贡献的影响因素,为提高患者自护能力和家庭生活质量提供依据。方法:2015年12月至2016年6月,抽取某三甲教学医院243名慢性心衰患者的家庭照护者进行问卷调查。资料收集工具包括患者及其家庭照护者的一般资料问卷、心衰自护贡献量表、心衰知识测试量表、社会支持评定量表和照护能力测量表。数据经整理后应用SPSS 20.0进行统计分析。结果:1.家庭照护者对心衰自护维持和心衰自护管理的贡献平均得分分别为52.40±9.96 和 55.61 ± 16.29。2.患者及其家庭照护者一般资料特征与家庭照护者对心衰自护贡献的关系(1)文化水平为初中及以下、务农、病程为6个月及以下患者的家庭照护者对心衰自护维持的贡献得分低于文化水平为高中或专科、从事脑力劳动或退休、病程为36个月及以上患者的家庭照护者(均P0.05);有配偶、文化水平为初中及以下、务农、病程为12个月及以下患者的家庭照护者对心衰自护管理的贡献得分低于无配偶、文化水平为高中或专科、退休、病程为36个月及以上患者的家庭照护者(均P0.05)。(2)在职(务农、其它体力劳动、脑力劳动)、居住地为农村、家庭人均月收入1000元以下的家庭照护者对心衰自护维持的贡献得分低于退休、居住地为城镇、家庭人均月收入1000元以上的家庭照护者(均P0.05);文化水平为初中及以下、务农、居住地为农村、家庭人均月收入1000元以下的家庭照护者对心衰自护管理的贡献得分低于文化水平为本科及以上、退休或从事脑力劳动或其他体力劳动、居住地为城镇、家庭人均月收入5000元以上的家庭照护者(均P0.05)。3.家庭照护者的心衰知识、心衰自护贡献信心、社会支持和照护能力与心衰自护贡献的相关性(1)家庭照护者的心衰知识得分(4.70±2.11)与心衰自护维持贡献和心衰自护管理贡献均呈正相关(r = 0.221,P0.01;r = 0.410,P0.01)。(2)家庭照护者对心衰自护贡献的信心得分(55.26± 16.32)与心衰自护维持贡献和心衰自护管理贡献均呈正相关(r = 0.263,P0.01;r = 0.469,P0.01)。(3)家庭照护者的社会支持总分(41.84 ±6.70)与心衰自护维持贡献和心衰自护管理贡献得分均呈正相关(r = 0.140,P0.05;r = 0.281,P0.01)。其中客观支持得分(11.05 ± 1.96)与心衰自护管理贡献呈正相关(r = 0.236,P0.01);主观支持得分(24.00±4.42)与心衰自护管理贡献呈正相关(r = 0.188,P0.01);社会支持利用度得分(6.79±2.31)与心衰自护维持贡献和心衰自护管理贡献均呈正相关(r = 0.190,P0.01;r = 0.264,P0.01)。(4)家庭照护者的照护能力总分(5.03±4.65)与心衰自护维持贡献和心衰自护管理贡献均呈负相关(r =-0.202,P0.01;r =-0.311,P0.01)。其中适应照护角色能力得分(1.03 ±1.15)与心衰自护维持贡献和心衰自护管理贡献均呈负相关(r =-0.260,P0.01;r =-0.346,P0.01);应变需要及提供协助能力得分(0.59±4.42)与心衰自护管理贡献均呈负相关(r =-0.188,P0.01);处理个人情绪能力得分(0.68 ± 1.38)与心衰自护管理贡献均呈负相关(r =-0.246,P0.01);评估家人及社区资源能力得分(0.95±1.25)与心衰自护维持贡献和心衰自护管理贡献均呈负相关(r =-0.135,P0.05;r =-0.235,P0.01);调整生活以满足照护需求能力得分(1.79± 1.93)与心衰自护维持贡献和心衰自护管理贡献均呈负相关(r =-0.156,P0.05;r =-0.188,P0.01)。4.家庭照护者对心衰自护贡献的相关因素(1)经多元回归分析后,家庭照护者对心衰自护维持贡献的相关变量为:患者的文化水平为高中或专科(初中及以下为对照)、家庭照护者居住在城镇(农村为对照)、心衰自护贡献信心和社会支持利用度。4个变量共解释家庭照护者对心衰自护维持贡献18.6%的变异量(调整R2= 0.186)。(2)经多元回归分析后,家庭照护者对心衰自护管理贡献的相关变量为:家庭照护者的心衰知识、心衰自护贡献信心、客观社会支持、适应照护角色能力和调整生活以满足照护需求能力。5个变量共解释家庭照护者对心衰自护管理贡献38.8%的变异量(调整R2= 0.388)。5.适应照护角色能力和评估家人及社区资源能力的中介效应Baron和Kenny逐步检验回归系数法分析结果显示,家庭照护者的心衰知识、心衰自护贡献信心与心衰自护管理贡献的关系均被适应照护角色能力部分中介(均P0.05);家庭照护者的客观社会支持与心衰自护管理贡献的关系被适应照护角色能力和评估家人及社区资源能力部分中介(均P0.05)。结论:1.患者和家庭照护者一般状况不同使家庭照护者对心衰自护的贡献存在差异。临床护理人员应该注重提高文化水平低、农村、家庭经济水平较差、病程较短的心衰患者家庭对心衰自护的贡献水平。2.家庭照护者对心衰自护维持贡献的影响因素为心衰自护贡献信心、社会支持利用度、患者的文化水平和家庭照护者的居住地。3.家庭照护者对心衰自护管理贡献的影响因素为心衰知识、心衰自护贡献信心、客观社会支持、适应照护角色能力和调整生活以满足照护需求能力。4.家庭照护者的心衰知识、心衰自护贡献信心可以直接和间接(通过适应照护角色能力)对心衰自护管理贡献产生影响;家庭照护者的客观社会支持可以直接和间接(通过适应照护角色能力和评估家人及社区资源能力)对心衰自护管理贡献产生影响。5.临床护理人员可以通过增强家庭照护者的心衰知识、心衰自护贡献信心、客观社会支持和社会支持利用度,帮助他们尽快适应照护角色并提高照护能力,从而提升家庭照护者对心衰自护的贡献水平。
[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.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R473.5
[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.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R473.5
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