上海交通大学学报（医学版）

上海交通大学学报（医学版） ›› 2018, Vol. 38 ›› Issue (4): 416-.doi: 10.3969/j.issn.1674-8115.2018.04.011

• 论著·临床研究 • 上一篇    下一篇

照护者疾病管理对慢性心力衰竭患者自我管理行为的影响

杨贝贝 1，郑战战 1，忻笑 2，吴圣佳 3，李贤华 4   

  1. 上海交通大学 1.护理学院，2.医学院附属瑞金医院肿瘤科，3.医学院附属瑞金医院心外科，4.医学院附属瑞金医院门诊办公室，上海200025
  • 出版日期:2018-04-28 发布日期:2018-05-03
  • 通讯作者: 李贤华，电子信箱：elina2005@126.com。
  • 作者简介:杨贝贝（1994—），女，硕士生；电子信箱：yangbeibeilove@sina.cn。
  • 基金资助:
    上海市教委护理学高原项目（Hlgy17002yjs）

Impact of disease management of caregivers on self-management behaviors among patients with chronic heart failure

YANG Bei-bei1, ZHENG Zhan-zhan1, XIN Xiao2, WU Sheng-jia3, LI Xian-hua4   

  1. 1. Shanghai Jiao Tong University School of Nursing, Shanghai 200025, China; 2. Department of Oncology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China; 3. Department of Cardiac Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China; 4. Outpatient Department, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
  • Online:2018-04-28 Published:2018-05-03
  • Supported by:
    Shanghai Municipal Education Commission—Gaoyuan Nursing Support, Hlgy17002yjs

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摘要： 目的·探讨照护者疾病管理对慢性心力衰竭患者自我管理行为的影响及其作用路径。方法·采用照护者对心力衰竭自我管理作用指数量表、心力衰竭自我管理指数量表、亚特兰大心力衰竭知识问卷对方便抽样法选取的231对门诊随访的慢性心力衰竭患者及其照护者进行测评。采用IBM SPSS 22.0软件进行配对t检验和Pearson相关分析。采用LISREL 8.80软件进行路径分析。结果·照护者与患者在自护维持行为（P0.015）、自护管理行为（P0.023）和自我效能（P0.001）3个方面比较，差异均有统计学意义。除照护者自我效能与患者心力衰竭知识技能水平无相关关系外，其余各核心变量间均呈正相关，相关系数r值为0.129～0.575（P<0.05）。照护者疾病管理、患者心力衰竭知识技能以及患者自我效能水平均可直接影响患者的自我管理行为，且照护者疾病管理中的部分维度还可通过患者心力衰竭知识技能和自我效能水平间接影响患者的自我管理行为。结论·照护者疾病管理不仅能直接影响患者的自我管理行为，还可通过患者的心力衰竭知识技能和自我效能水平间接影响其自我管理行为。医务人员应开展以家庭为中心的健康教育，鼓励照护者积极参与对患者心力衰竭的疾病管理；对于照护者疾病管理水平无法改变的患者，医务人员还应通过提高患者的心力衰竭知识技能、自我效能水平来提升患者的自我管理水平。

关键词: 心力衰竭, 照护者, 疾病管理, 自我管理

Abstract:

Objective · To explore the impact and mechanism of disease management of caregivers on self-management behaviors among patients with chronic heart failure. Methods · A total of 231 dyads of outpatient chronic heart failure patients and their caregivers were assessedcaregivers contribution to self-care of heart failure index (CC-SCHFI), self-care of heart failure index (SCHFI) and Atlanta heart failure knowledge test(AHFKT-V2). IBM SPSS 22.0 was used to conduct the paired t test and Pearson correlation analysis. LISREL 8.80 was used to conduct the path analysis. Results · There were significant differences between caregivers and patients in maintenance behavior (P0.015), management behavior (P0.023) and self-efficacy (P0.001). There was no correlation between caregiver self-efficacy and patient heart failure knowledge and skill, but other variables were positively correlated, and r value ranged 0.129 to 0.575 (P<0.05). Patient self-management behaviors were directly influencedcaregiver disease management, patient heart failure knowledge and skill and patient self-efficacy, and indirectly influenced in partcaregiver disease management through patient heart failure knowledge and skill and patient self-efficacy. Conclusion · Caregiver disease management not only can directly influence patient self-management behaviors, but also can indirectly influence patient self-management behaviors through patient heart failure knowledge and skill and self-efficacy. Health care workers should carry out family-centered health education, and help caregivers actively participate in disease management of patients with heart failure; for those patients whose caregivers cant change their disease management behaviors, health care workers should also improve their self-management behaviorsimproving patients′ heart failure knowledge and skill and self-efficacy.

Key words: heart failure, caregiver, disease management, self-management

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