心力衰竭的社会支持和自我护理。
Social support and self-care in heart failure.
机构信息
Faculty of Nursing, Midwifery and Health, University of Technology, Sydney, Australia.
出版信息
J Cardiovasc Nurs. 2011 Nov-Dec;26(6):439-45. doi: 10.1097/JCN.0b013e31820984e1.
BACKGROUND AND OBJECTIVE
Self-care by heart failure (HF) patients is essential for optimal disease management of their condition. However, as the nature of HF is unrelenting and burdensome, self-care is usually achieved with the support of partners. It is not clear what role the level of social support by partners plays in HF self-care; therefore, this study sets out to determine the types of social support provided to HF patients and the impact of differing levels of social support on HF patients' self-care.
SUBJECTS AND METHOD
This is secondary analysis of a subgroup of patients experiencing their second hospital admission for HF at baseline in the COACH study, a multisite trial conducted in the Netherlands. Measures included the European Heart Failure Self-care Behaviour Scale and a multiple component assessment of social support, which categorized patients into low, moderate, and high levels of social support according to the presence of a partner and their perception of support they received from their partner.
RESULTS AND CONCLUSIONS
Patients (n = 333) had an average age of 72 (SD, 11) years, and 92% belonged to New York Heart Association class III or greater. Of the patients with partners (56%), only 49% had a high level of support from their partner. No demographic or clinical characteristic was associated with self-care behavior. Patients with a high level of support reported significantly better self-care (P = .002) than patients with low or moderate levels of social support. Patients with a high level of social support reported being significantly more likely to consult with a health professional for weight gain (P = .011), to limit the amount of fluids they have (P = .02), take their medication (P = .017), to get a flu shot (P = .001), and to exercise on a regular basis (P < .001) than those with medium or low levels of social support. The presence of social support by a partner is not sufficient to influence HF patients' self-care. Social support provided by partners needs to be of a quality and content that matches HF patients' perception of need to influence self-care. Caregivers, especially partners, should be considered as integral in the treatment and care of HF patients.
背景与目的
心力衰竭（HF）患者的自我护理对于优化其疾病管理至关重要。然而，由于 HF 的性质是无情且负担沉重的，因此自我护理通常需要伴侣的支持。目前尚不清楚伴侣提供的社会支持水平在 HF 自我护理中扮演什么角色；因此，本研究旨在确定为 HF 患者提供的社会支持类型以及不同水平的社会支持对 HF 患者自我护理的影响。
研究对象与方法
这是 COACH 研究中基线时第二次因 HF 住院的患者亚组的二次分析，该研究是在荷兰进行的多地点试验。测量包括欧洲心力衰竭自我护理行为量表和社会支持的多成分评估，该评估根据患者是否有伴侣以及他们对伴侣支持的感知，将患者分为低、中、高三个社会支持水平。
结果与结论
患者（n = 333）的平均年龄为 72（SD，11）岁，92%属于纽约心脏协会（NYHA）III 级或更高级别。在有伴侣的患者中（56%），只有 49%的患者得到了伴侣的高支持。没有任何人口统计学或临床特征与自我护理行为相关。具有高水平支持的患者报告的自我护理明显更好（P =.002），而低或中水平社会支持的患者则不然。具有高水平社会支持的患者报告更有可能因体重增加而咨询医疗保健专业人员（P =.011），限制液体摄入量（P =.02），服用药物（P =.017），接种流感疫苗（P =.001），以及定期锻炼（P <.001），而中或低水平社会支持的患者则不然。伴侣提供的社会支持的存在不足以影响 HF 患者的自我护理。伴侣提供的社会支持需要具有质量和内容，以满足 HF 患者对自我护理的需求。护理人员，尤其是伴侣，应被视为 HF 患者治疗和护理的重要组成部分。
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