慢性心力衰竭患者照护者居家照护体验质性研究的Meta整合

doi:10.3761/j.issn.0254-1769.2022.04.006

摘要/Abstract

摘要：

目的系统评价和整合慢性心力衰竭患者照护者的居家照护体验,为提升照护者居家照护能力、改善慢性心力衰竭患者生活质量提供依据。方法计算机检索Web of Science、PubMed、Embase、The Cochrane Library、EBSCO、PsyclNFO、中国生物医学文献数据库、中国知网和万方数据知识服务平台,收集从建库至2021年5月关于慢性心力衰竭患者照护者居家照护体验的相关质性研究。采用澳大利亚乔安娜布里格斯研究所（Joanna Briggs Institute,JBI）循证卫生保健中心的质性研究质量评价标准（2016版）对纳入文献进行质量评价,采用汇集性整合法整合文献结果。结果共纳入15篇文献,提炼出38个明确的研究结果,归纳为10个新的类别,汇总成以下3个整合结果。改变生活常态：挑战、压力、冲突;缺乏外界支持：知识、资源、期望;获得积极感受：认同、获益、成长。结论护理工作者应当重视并关注心力衰竭患者照护者的负担、压力以及需求,给予照护者专业支持和情感支持,提升其照护胜任力,进而提高照护者的居家照护质量,最终改善心力衰竭患者的生活质量。

关键词: 心力衰竭, 照护者, 照护体验, 家庭护理, 质性研究, Meta整合

Abstract:

Objective To systematically review and synthesize the experience of informal caregivers caring for patients with chronic heart failure at home. Methods 9 databases,including Web of science,PubMed,Embase,The Cochrane Library,EBSCO,PsyclNFO,Sinomed,CNKI and Wanfang Data,were searched from their inception to May 2021 for the qualitative studies on experience of informal caregivers caring for patients with chronic heart failure at home. The study quality was evaluated using the qualitative research quality evaluation criteria of the Joanna Briggs Institute Evidence-based Health Care Center in Australia. The research results were summarized and integrated using the pooled integration method. Results A total of 15 articles were included and 38 complete findings were grouped into 10 categories according to their similarities. These 10 categories resulted in 3 synthesized findings：the change of the normal life（challenge,stress,and conflict）,the lack of external support（knowledge,resources,and expectations）,the gain of positive feelings（identification,benefits,growth）. Conclusion Nurses should pay more attention to the burden,stress,as well as needs of heart failure caregivers,improve their caregiving competency,and give professional support and emotional support to them. By these ways,quality of life of patients with heart failure can be ultimately improved.

Key words: Heart Failure, Caregivers, Caring Experience, Home Nursing, Qualitative Research, Meta-Synthesis

范文海, 刘悦, 李春霞, 于明明. 慢性心力衰竭患者照护者居家照护体验质性研究的Meta整合[J]. 中华护理杂志, 2022, 57(4): 424-430.

FAN Wenhai, LIU Yue, LI Chunxia, YU Mingming. The experience of informal caregivers caring for patients with chronic heart failure at home：a meta-syn-thesis of qualitative studies[J]. Chinese Journal of Nursing, 2022, 57(4): 424-430.

图/表 1

参考文献 29

[1]	中国心血管健康与疾病报告编写组. 中国心血管健康与疾病报告2020概要[J]. 中国循环杂志, 2021, 36(6):521-545.
	The Writing Committee of the Report on Cardiovascular Health and Diseases in China. Report on cardiovascular health and diseases burden in China:an updated summary of 2020[J]. Chin Circ J, 2021, 36(6):521-545.
[2]	杨盼盼, 范燕燕, 马梦真, 等. 慢性心力衰竭病人家庭照护者照护体验及需求研究现状[J]. 护理研究, 2021, 35(19):3469-3473.
	Yang PP, Fan YY, MA MZ, et al. Research status quo of nursing experience and needs of family caregivers in patients with chronic heart failure[J]. Chin Nurs Res, 2021, 35(19):3469-3473.
[3]	Bidwell JT, Lyons KS, Lee CS. Caregiver well-being and patient outcomes in heart failure:a meta-analysis[J]. J Cardiovasc Nurs, 2017, 32(4):372-382. DOI PMID
[4]	Pressler SJ, Gradus-Pizlo I, Chubinski SD, et al. Family caregivers of patients with heart failure:a longitudinal study[J]. J Cardiovasc Nurs, 2013, 28(5):417-428. DOI PMID
[5]	张贤贤, 张利霞, 贾智慧, 等. 夫妻自我表露在青年乳腺癌患者癌症复发恐惧干预中的应用研究[J]. 中华护理杂志, 2019, 54(11):1610-1614.
	Zhang XX, Zhang LX, Jia ZH, et al. Application and effect evaluation of marital self-disclosure intervention on the fear of cancer recurrence in young breast cancer patients[J]. Chin J Nurs, 2019, 54(11):1610-1614.
[6]	Grant JS, Graven LJ. Problems experienced by informal caregivers of individuals with heart failure:an integrative review[J]. Int J Nurs Stud, 2018, 80:41-66. DOI PMID
[7]	Joanna Briggs Institute. JBI Critical Appraisal Checklist for Qualitative Research[EB/OL]. (2016-08-03)[2021-08-20]. http://joannabriggs.org/assets/docs/critical-appraisal-tools.html.
[8]	Barnes S, Whittingham K. Informal carers’ experiences of caring for a person with heart failure in a community setting[J]. Health Soc Care Community, 2020, 28(3):883-890. DOI URL
[9]	Fitzsimons D, Doherty LC, Murphy M, et al. Inadequate communication exacerbates the support needs of current and bereaved caregivers in advanced heart failure and impedes shared decision-making[J]. J Cardiovasc Nurs, 2019, 34(1):11-19. DOI PMID
[10]	Chi NC, Demiris G, Pike KC, et al. Exploring the challenges that family caregivers faced when caring for hospice patients with heart failure[J]. J Soc Work End Life Palliat Care, 2018, 14(2/3):162-176. DOI URL
[11]	Bangerter LR, Griffin JM, Dunlay SM. Qualitative study of challenges of caring for a person with heart failure[J]. Geriatr Nurs, 2018, 39(4):443-449. DOI PMID
[12]	Wingham J, Frost J, Britten N. Behind the smile:qualitative study of caregivers’ anguish and management responses while caring for someone living with heart failure[J]. BMJ Open, 2017, 7(7):e014126. DOI URL
[13]	Näsström L, Luttik ML, Idvall E, et al. Exploring partners’ pers-pectives on participation in heart failure home care:a mixed-method design[J]. J Adv Nurs, 2017, 73(5):1208-1219. DOI PMID
[14]	Gusdal AK, Josefsson K, Adolfsson ET, et al. Informal caregivers’ experiences and needs when caring for a relative with heart failure:an interview study[J]. J Cardiovasc Nurs, 2016, 31(4):E1-E8.
[15]	Sullivan BJ, Marcuccilli L, Sloan R, et al. Competence,compassion,and care of the self:family caregiving needs and concerns in heart failure[J]. J Cardiovasc Nurs, 2016, 31(3):209-214. DOI URL
[16]	Strøm A, Andersen KL, Korneliussen K, et al. Being “on the alert” and “a forced volunteer”:a qualitative study of the invisible care provided by the next of kin of patients with chronic heart failure[J]. J Multidiscip Healthc, 2015, 8:271-277.
[17]	Burke RE, Jones J, Ho PM, et al. Caregivers’ perceived roles in caring for patients with heart failure:what do clinicians need to know?[J]. J Card Fail, 2014, 20(10):731-738. DOI URL
[18]	Bahrami M, Etemadifar S, Shahriari M, et al. Caregiver burden among Iranian heart failure family caregivers:a descriptive,exploratory,qualitative study[J]. Iran J Nurs Midwifery Res, 2014, 19(1):56-63. PMID
[19]	Luttik ML, Blaauwbroek A, Dijker A, et al. Living with heart failure:partner perspectives[J]. J Cardiovasc Nurs, 2007, 22(2):131-137. DOI URL
[20]	贺捷, 蒋维连. 居家慢性心力衰竭患者家庭照顾者负担体验的质性研究[J]. 解放军护理杂志, 2016, 33(1):26-28,43.
	He J, Jiang WL. Qualitative study of the burden of caregivers in family of stay-home patients with chronic heart failure[J]. Nurs J Chin PLA, 2016, 33(1):26-28,43.
[21]	李莉莉. 慢性心力衰竭病人照顾者疾病获益感的质性研究[J]. 全科护理, 2019, 17(22):2808-2810.
	Li LL. A qualitative study on the sense of disease benefit of caregivers of patients with chronic heart failure[J]. Chin Gen Pract Nurs, 2019, 17(22):2808-2810.
[22]	黄卫新, 姜谧, 温澄非, 等. 心力衰竭患者主要陪护者真实体验的质性研究[J]. 中国老年学杂志, 2011, 31(20):4035-4036.
	Huang WX, Jiang M, Wen CF, et al. Qualitative study on the real experience of main caregivers in patients with heart failure[J]. Chin J Gerontol, 2011, 31(20):4035-4036.
[23]	Harkness KI, Tranmer JE. Measurement of the caregiving experience in caregivers of persons living with heart failure:a review of current instruments[J]. J Card Fail, 2007, 13(7):577-587. PMID
[24]	祝红娟, 王淑君, 史巍, 等. 特重度烧伤患者康复期家庭照护者生活质量现状及其影响因素研究[J]. 中华护理杂志, 2018, 53(8):907-912.
	Zhu HJ, Wang SJ, Shi W, et al. Study on the correlation of quality of life for family caregivers of patients with extremely severe burns during rehabilitation period[J]. Chin J Nurs, 2018, 53(8):907-912.
[25]	Nicholas Dionne-Odom J, Hooker SA, Bekelman D, et al. Family caregiving for persons with heart failure at the intersection of heart failure and palliative care:a state-of-the-science review[J]. Heart Fail Rev, 2017, 22(5):543-557. DOI PMID
[26]	Bekelman DB, Nowels CT, Retrum JH, et al. Giving voice to patients’ and family caregivers’ needs in chronic heart failure:implications for palliative care programs[J]. J Palliat Med, 2011, 14(12):1317-1324. DOI PMID
[27]	Lyons KS, Lee CS. The theory of dyadic illness management[J]. J Fam Nurs, 2018, 24(1):8-28. DOI URL
[28]	丁春戈, 梅永霞, 林蓓蕾, 等. 二元应对在慢性病患者及其配偶中的应用进展[J]. 中华护理杂志, 2018, 53(5):626-630.
	Ding CG, Mei YX, Lin BL, et al. The application of dyadic coping in patients with chronic diseases and their spouses[J]. Chin J Nurs, 2018, 53(5):626-630.
[29]	史根芽, 史铁英, 刘宇, 等. 慢性病患者与配偶亲密关系的研究进展[J]. 中华护理杂志, 2021, 56(5):786-790.
	Shi GY, Shi TY, Liu Y, et al. Research progress on the intimate relationship between chronic disease patients and their spouses[J]. Chin J Nurs, 2021, 56(5):786-790.