心力衰竭患者和非专业照护者二元参与背景下的自我护理：一项混合方法研究。
Heart Failure Self-care Within the Context of Patient and Informal Caregiver Dyadic Engagement: A Mixed Methods Study.
机构信息
Harleah G. Buck, PhD, RN, FPCN, FAAN Associate Professor and Coordinator of Chronic Illness Initiatives, College of Nursing, University of South Florida, Tampa. Judith Hupcey, EdD, CRNP, FAAN Associate Dean for Graduate Education and Research Professor of Nursing, College of Nursing, and Professor of Medicine, College of Medicine, Penn State University, State College, Pennsylvania. Hsiao-Lan Wang, PhD, RN, CMSRN, HFS Associate Professor, College of Nursing, University of South Florida, Tampa. Michael Fradley, MD Assistant Professor, College of Medicine, University of South Florida, Tampa. Kristine A. Donovan, PhD, MBA Clinical Psychologist, Moffitt Cancer Center, Tampa, Florida. Alexa Watach, MS, RN, PhD Postdoctoral Fellow, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania.
出版信息
J Cardiovasc Nurs. 2018 Jul/Aug;33(4):384-391. doi: 10.1097/JCN.0000000000000465.
BACKGROUND
Recent heart failure (HF) patient and informal caregiver (eg, dyadic) studies have either examined self-care from a qualitative or quantitative perspective. To date, the 2 types of data have not been integrated.
OBJECTIVE
The aim of this study was to understand HF self-care within the context of dyadic engagement.
METHODS
This was a cross-sectional, mixed methods (quantitative/qualitative) study. Heart failure self-care was measured with the Self-care of Heart Failure Index (v.6) dichotomized to adequate (≥70) or inadequate (<69). Dyadic symptom management type was assessed with the Dyadic Symptom Management Type scale. Interviews regarding self-care were conducted with both dyad members present. Content analytic techniques were used. Data were integrated using an information matrix and triangulated using Creswell and Plano Clark's methods.
RESULTS
Of the 27 dyads, HF participants were 56% men, with a mean age of 77 years. Caregivers were 74% women, with a mean age of 66 years, representing spouses (n = 14) and adult children (n = 7). Quantitatively, few dyads scored as adequate (≥70) in self-care; the qualitative data described the impact of adequacy on the dyads' behavior. Dyads who scored higher, individually or both, on self-care self-efficacy and self-care management were less likely to change from their life course pattern. Either the patient or dyad continued to handle all self-care as they always had, rather than trying new strategies or reaching out for help as the patient's condition deteriorated.
CONCLUSIONS
Our data suggest links that should be explored between dyadic adequacy and response to patients' symptoms. Future studies should assess dyadic adequacy longitudinally and examine its relationship to event-free survival and health services cost.
背景
最近的心力衰竭（HF）患者和非专业护理人员（例如，对偶体）研究要么从定性角度，要么从定量角度研究自我护理。迄今为止，这两种类型的数据尚未整合。
目的
本研究旨在了解对偶体参与背景下的 HF 自我护理。
方法
这是一项横断面、混合方法（定量/定性）研究。使用心力衰竭自我护理指数（第 6 版）对 HF 自我护理进行衡量，分为充足（≥70）或不足（<69）。对偶症状管理类型使用对偶症状管理类型量表进行评估。与对偶体成员同时进行关于自我护理的访谈。使用内容分析技术。使用信息矩阵整合数据，并使用 Creswell 和 Plano Clark 的方法进行三角剖分。
结果
在 27 对对偶体中，HF 参与者 56%为男性，平均年龄为 77 岁。护理人员 74%为女性，平均年龄为 66 岁，代表配偶（n=14）和成年子女（n=7）。从定量上看，很少有对偶体在自我护理方面得分较高（≥70）；定性数据描述了充足性对对偶体行为的影响。在自我护理自我效能感和自我护理管理方面得分较高的对偶体，无论是个体还是双方，都不太可能改变他们的生活轨迹模式。要么是患者，要么是对偶体，继续按照他们一直以来的方式处理所有的自我护理，而不是在患者病情恶化时尝试新的策略或寻求帮助。
结论
我们的数据表明，应该在对偶体的充足性和对患者症状的反应之间探索联系。未来的研究应该纵向评估对偶体的充足性，并研究其与无事件生存和医疗服务成本的关系。
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