“这是什么意思？”：对英国有尿失禁问题的年轻人的初级和二级临床护理经历的定性探索
'What does that mean?': a qualitative exploration of the primary and secondary clinical care experiences of young people with continence problems in the UK.
作者信息
Whale Katie, Cramer Helen, Wright Anne, Sanders Caroline, Joinson Carol
机构信息
Centre for Child and Adolescent Health, School of Social and Community Medicine, University of Bristol, Bristol, UK.
Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Bristol, UK.
出版信息
BMJ Open. 2017 Oct 16;7(10):e015544. doi: 10.1136/bmjopen-2016-015544.
OBJECTIVES
To explore the clinical care experiences of young people with continence problems.
DESIGN
In-depth semistructured qualitative interviews were conducted by Skype and telephone, with the addition of art-based participatory research techniques. Transcripts were analysed using inductive thematic analysis.
SETTING
Primary and secondary care in the UK.
PARTICIPANTS
We interviewed 20 participants (9 females, 11 males) aged 11-20 years. There were six participants with bedwetting alone, five with daytime wetting alone, five with combined (day and night) wetting and four with soiling.
RESULTS
We identified four themes: appointment experiences, treatment experiences, engagement with treatment and internalisation and externalisation of the continence problem. Patient-focused appointments using age-appropriate language were highly desirable. Continuity of care was highlighted as an important aspect of positive clinical experiences; however, this was found to be rare with many participants seeing a different person on each visit. Participants had tried a wide range of treatments for their continence problems with varying degrees of success. Relapse and treatment failure were common. Experiencing relapse was distressing and diminished participants' belief in the success of future treatments and undermined adherence. Participants would be seen to adopt two opposing coping strategies for dealing with their continence problem- internalisation and externalisation.
CONCLUSION
Incontinence in young people is challenging to manage. Young people may need to try a range of treatments before their symptoms improve. Due to challenges in treatment, there is an increased risk of poor adherence. During patient-focused appointments, clinicians should work to build rapport with patients and use age-appropriate language. Involving young people in their own care decisions is important. The way in which young people understand their continence problem can influence their coping strategies and adherence to treatment regimes.
目的
探讨有尿失禁问题的年轻人的临床护理体验。
设计
通过Skype和电话进行深入的半结构化定性访谈，并辅以基于艺术的参与式研究技术。使用归纳主题分析法对访谈记录进行分析。
背景
英国的初级和二级医疗保健机构。
参与者
我们采访了20名年龄在11至20岁之间的参与者（9名女性，11名男性）。其中6名参与者仅存在尿床问题，5名仅存在日间遗尿问题，5名存在日间和夜间联合遗尿问题，4名存在大便失禁问题。
结果
我们确定了四个主题：就诊体验、治疗体验、对治疗的参与度以及尿失禁问题的内化和外化。使用适合年龄的语言进行以患者为中心的就诊非常必要。护理的连续性被强调为积极临床体验的一个重要方面；然而，许多参与者发现每次就诊见到的是不同的人，连续性护理很少见。参与者针对其尿失禁问题尝试了多种治疗方法，成功程度各不相同。复发和治疗失败很常见。经历复发令人痛苦，削弱了参与者对未来治疗成功的信心，并破坏了依从性。参与者会采取两种相反的应对策略来处理他们的尿失禁问题——内化和外化。
结论
年轻人的尿失禁管理具有挑战性。年轻人可能需要尝试多种治疗方法，症状才会改善。由于治疗存在挑战，依从性差的风险增加。在以患者为中心的就诊过程中，临床医生应努力与患者建立融洽关系，并使用适合年龄的语言。让年轻人参与自己的护理决策很重要。年轻人理解其尿失禁问题的方式会影响他们的应对策略和对治疗方案的依从性。
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