自我护理、症状体验、需求以及心力衰竭个体的过去医疗保健利用情况：一项横断面研究的结果。
Self-care, symptom experience, needs, and past health-care utilization in individuals with heart failure: results of a cross-sectional study.
机构信息
School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland Fribourg, Haute Ecole de Santé Fribourg, Route des Arsenaux 16a, Fribourg, CH-1700, Switzerland.
Institute of Higher Education and Research in Healthcare IUFRS, Faculty of Biology and Medicine, University of Lausanne and Lausanne University Hospital, Route de la Corniche 10, Lausanne, CH-1010, Switzerland.
出版信息
Eur J Cardiovasc Nurs. 2021 Jun 29;20(5):464-474. doi: 10.1093/eurjcn/zvaa026.
AIMS
Self-care in heart failure (HF) is generally sub-optimal and impacts morbidity and mortality. To describe self-care prevalence and explore its relationships with symptom experience, patient needs, and health-care utilization in a Swiss hospital providing regional secondary care.
METHODS AND RESULTS
Cross-sectional study, convenience sample of individuals with HF from four campuses of one regional Swiss hospital. Self-care was assessed via the Self-Care of Heart Failure Index (SCHFI) and the European Heart Failure Self-care Behaviour Scale (EHFScBS), symptom experience via the M.D. Anderson Symptom Inventory-HF (MDASI-HF) and needs via the Heart Failure Needs Assessment Questionnaire (HFNAQ). Healthcare utilization reflected the preceding year's hospitalization incidence. A cut-off level of ≥70% indicated adequate self-care. We analysed SCHFI, EHFScBS, MDASI-HF and HFNAQ scores' relationships with hospitalizations using Spearman's rho correlation; no prior hypotheses were stated. Sample of 310 individuals with HF (37.4% female; mean age 76.8; 55% NYHA III). Adequate self-care maintenance, management, and confidence were reported by 24%, 10%, and 61%. respectively. The sample's mean number of experienced symptoms was 12.8 (SD 4.0) and 14.0 (SD 5.8) for needs. Over the previous year, 269 hospitalizations had occurred (median: 0, IQR 1). Hospitalizations positively correlated with self-care; symptom experience with needs. Neither symptom experience nor needs correlated with hospitalizations.
CONCLUSION
The findings indicated low self-care levels and suggest a need for increased support to maintain physiological stability, manage symptoms and prevent hospitalizations. This study is the first of its kind in Switzerland and among few studies worldwide to report on self-care, symptom experience, needs, and health-care utilization. Interventional studies are warranted considering baseline self-care capabilities, symptoms, and needs of individuals with HF.
目的
心力衰竭（HF）患者的自我护理通常不理想，这会影响发病率和死亡率。本研究旨在描述瑞士一家提供区域二级护理的医院中 HF 患者的自我护理现状，并探讨其与症状体验、患者需求和医疗保健利用之间的关系。
方法和结果
本研究为横断面研究，采用便利抽样法选取了瑞士一家区域性医院的四个院区的 HF 患者。采用心力衰竭自我护理量表（SCHFI）和欧洲心力衰竭自我护理行为量表（EHFScBS）评估自我护理，采用安德森症状评估量表-心力衰竭（MDASI-HF）评估症状体验，采用心力衰竭需求评估问卷（HFNAQ）评估需求。医疗保健利用反映了前一年的住院发生率。SCHFI、EHFScBS、MDASI-HF 和 HFNAQ 评分与住院的关系采用 Spearman 相关系数进行分析；未提出任何假设。共纳入 310 名 HF 患者（女性占 37.4%，平均年龄 76.8 岁，55% NYHA 分级为 III 级）。分别有 24%、10%和 61%的患者报告自我护理维持、管理和信心充足。患者报告的平均症状数为 12.8（SD 4.0），需求数为 14.0（SD 5.8）。在过去一年中，共发生 269 例住院治疗（中位数：0，IQR 1）。住院与自我护理呈正相关，与需求呈负相关。症状体验和需求均与住院无相关性。
结论
研究结果表明 HF 患者的自我护理水平较低，需要增加支持以维持生理稳定性、管理症状和预防住院。本研究在瑞士和全球范围内属于为数不多的报告自我护理、症状体验、需求和医疗保健利用的研究之一。考虑到 HF 患者的自我护理能力、症状和需求，有必要开展干预性研究。
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