心力衰竭患者心理资源损耗与恢复过程的质性研究

doi:10.3761/j.issn.0254-1769.2024.06.009

摘要/Abstract

摘要：

目的探索心力衰竭患者心理资源损耗与恢复过程的特征。方法基于自我损耗理论，采用描述性现象学研究方法，于2022年9月—11月，对南京市某三级甲等综合医院心血管内科16例心力衰竭患者进行半结构式深度访谈，采用Colaizzi七步法对资料进行分析、提炼。结果共提炼出急性心理损耗源（角色转换导致心理应激、生理痛苦引发心理资源危机），慢性心理损耗源（躯体症状导致原有行为习惯改变、持续的不适症状令患者备受煎熬、不确定性使患者深陷反刍思维、治疗费用加重经济负担），自我损耗表现（消极思维模式与浅层认知加工、复杂交织的负性情绪、行为执行力弱化），心理资源恢复（激发个人成长，实现自我疗愈；多方资源支持，营造复愈性环境）4个主题，11个亚主题。结论心力衰竭患者病程中存在急、慢性损耗源，可导致多种自我损耗表现，损耗与恢复并存且动态变化。医护人员应密切关注心理损耗源对患者的影响，判断自我损耗的表现及严重程度，及时采取恢复措施，维持患者心理资源平衡，提高自我调节能力。

关键词: 自我损耗, 自我调节, 心理资源, 心力衰竭, 质性研究, 心理护理

Abstract:

Objective To explore the process of mental resource depletion and recovery in patients with heart failure. Methods Based on the ego-depletion theory，using descriptive phenomenology research method，a semi-structured in-depth interview was conducted on 16 patients with heart failure in the cardiovascular ward of a tertiary A general hospital in Nanjing from September to November 2022，and the data were analyzed and refined by the Colaizzi seven-step method. Results 4 themes were extracted：acute ego-depletion sources（including psychological stress caused by role transition，and mental resource crisis caused by physical pain），chronic ego-depletion sources （including physical symptoms leading to changes in old habits，patients suffering from persistent discomfort symptoms，patients mired in rumination due to uncertainty，and the cost of treatment increasing the economic burden），ego-depletion（including negative thinking patterns and shallow cognitive processing，complex mixed adverse emotions，and weak performance of behavior），mental resource recovery（including seeking self-healing and providing a healing environment）. Conclusion There are acute and chronic ego-depletion sources in the course of heart failure patients，which can lead to a variety of ego-depletion manifestations，depletion and recovery coexist，and change dynamically. Medical staff should pay attention to the impact of ego-depletion sources on patients，evaluate the performance and severity of ego-depletion，and take timely recovery measures to maintain the balance of patients’ mental resource and improve the ability of self-regulation.

Key words: Ego-Depletion, Self-Regulation, Mental Resource, Heart Failure, Qualitative Study, Psychological Nursing

孙姝怡, 孙国珍, 高敏, 王洁, 于甜栖, 刘沈馨雨, 汤志杰, 温高芹. 心力衰竭患者心理资源损耗与恢复过程的质性研究[J]. 中华护理杂志, 2024, 59(6): 706-712.

SUN Shuyi, SUN Guozhen, GAO Min, WANG Jie, YU Tianxi, LIU Shenxinyu, TANG Zhijie, WEN Gaoqin. The process of mental resource depletion and recovery in patients with heart failure：a qualitative research[J]. Chinese Journal of Nursing, 2024, 59(6): 706-712.

图/表 1

参考文献 23

[1]	中华医学会心血管病学分会心力衰竭学组, 中国医师协会心力衰竭专业委员会, 中华心血管病杂志编辑委员会. 中国心力衰竭诊断和治疗指南2018[J]. 中华心血管病杂志, 2018, 46(10):760-789.
	Heart Failure Group of Chinese Cardiovascular Disease Branch, the Heart Failure Professional Committee of the Chinese Medical Doctor Association, Editorial Committee of the Chinese Journal of Cardiovascular Disease. China guidelines for the diagnosis and treatment of heart failure 2018[J]. Chin J Cardiol, 2018, 46(10):760-789.
[2]	Hao G, Wang X, Chen Z, et al. Prevalence of heart failure and left ventricular dysfunction in China:the China Hypertension Survey,2012-2015[J]. Eur J Heart Fail, 2019, 21(11):1329-1337. DOI URL
[3]	Baumeister RF, Bratslavsky E, Muraven M, et al. Ego depletion:is the active self a limited resource?[J]. J Pers Soc Psychol, 1998, 74(5):1252-1265. DOI PMID
[4]	Nes LS, Carlson CR, Crofford LJ, et al. Self-regulatory deficits in fibromyalgia and temporomandibular disorders[J]. Pain, 2010, 151(1):37-44. DOI PMID
[5]	于斌, 乐国安, 刘惠军. 自我控制的力量模型[J]. 心理科学进展, 2013, 21(7):1272-1282. DOI
	Yu B, Yue GA, Liu HJ. The strength model of self-control[J]. Adv Psychol Sci, 2013, 21(7):1272-1282. DOI
[6]	高倩, 李晓敏, 孙王乐贤, 等. 自我调节疲劳对冠心病患者自我管理行为的影响[J]. 中国慢性病预防与控制, 2019, 27(1):38-42.
	Gao Q, Li XM, Sun WLX, et al. Effect of self-regulated fatigue on self-management behavior of patients with coronary heart disease[J]. Chin J Prev Control Chronic Dis, 2019, 27(1):38-42.
[7]	单亚维, 陈维佳, 金丽娟, 等. 全膝关节置换术后患者康复行为演变的质性研究[J]. 中华护理杂志, 2020, 55(10):1470-1475. DOI
	Shan YW, Chen WJ, Jin LJ, et al. The development of rehabilitation behaviors of patients with total knee arthroplasty:a qualitative study[J]. Chin J Nurs, 2020, 55(10):1470-1475.
[8]	潘习, 王稚, 徐岚. 基于自我损耗理论的脑卒中患者健康行为退化成因的质性研究[J]. 护理学杂志, 2022, 37(17):18-22.
	Pan X, Wang Z, Xu L. A qualitative study on causes of degeneration of health behavior in stroke patients based on the ego-depletion theory[J]. J Nurs Sci, 2022, 37(17):18-22.
[9]	陆璐, 赵少勇, 戴春林. 睡眠质量对自我控制的影响:基于自我损耗理论的解释[J]. 中国健康心理学杂志, 2020, 28(7):1100-1105.
	Lu L, Zhao SY, Dai CL. Effects of sleep quality on self-control:an explanation based on the ego-depletion theory[J]. China J Health Psychol, 2020, 28(7):1100-1105.
[10]	Alquist JL, Baumeister RF, Tice DM. Uncertainty depletes self-regulatory resources[M]. Florida: Florida State University, 2016.
[11]	Fischer P, Greitemeyer T, Frey D. Ego depletion and positive illusions:does the construction of positivity require regulatory resources?[J]. Pers Soc Psychol Bull, 2007, 33(9):1306-1321. DOI URL
[12]	Hofmann W, Rauch W, Gawronski B. And deplete us not into temptation:automatic attitudes,dietary restraint,and self-regulatory resources as determinants of eating behavior[J]. J Exp Soc Psychol, 2007, 43(3):497-504. DOI URL
[13]	Vohs KD, Baumeister RF, Ciarocco NJ. Self-regulation and self-presentation:regulatory resource depletion impairs impression management and effortful self-presentation depletes regulatory resources[J]. J Pers Soc Psychol, 2005, 88(4):632-657. DOI URL
[14]	Hagger MS, Wood C, Stiff C, et al. The strength model of self-regulation failure and health-related behaviour[J]. Health Psychol Rev, 2009, 3(2):208-238. DOI URL
[15]	王星星, 钟瑶, 张媛. 自我损耗对攻击行为的影响:复愈性环境的作用[J]. 心理与行为研究, 2021, 19(1):137-144.
	Wang XX, Zhong Y, Zhang Y. The effect of self-depletion on aggressive behavior:the role of restorative environments[J]. Stud Psychol Behav, 2021, 19(1):137-144.
[16]	郑改改, 杨巧芳, 殷月, 等. 急性心力衰竭患者入院时及易损期核心症状群的纵向研究[J]. 中华护理杂志, 2022, 57(17):2109-2115. DOI
	Zheng GG, Yang QF, Yin Y, et al. The changes of core symptom clusters in patients with acute heart failure during admission and vulnerable phase:a longitudinal study[J]. Chin J Nurs, 2022, 57(17):2109-2115.
[17]	郑改改, 张艳杰, 杨巧芳, 等. 慢性心力衰竭病人非药物症状管理方案的构建[J]. 护理研究, 2021, 35(15):2637-2643.
	Zheng GG, Zhang YJ, Yang QF, et al. Construction of non-drug symptom management plan for patients with chronic heart failure[J]. Chin Nurs Res, 2021, 35(15):2637-2643.
[18]	马钰, 肖晨洁, 车敬上, 等. 自我损耗降低决策理性:心理机制与边界条件[J]. 心理科学进展, 2020, 28(11):1911-1925. DOI
	Ma Y, Xiao CJ, Che JS, et al. Ego depletion impedes rational decision making:mechanisms and boundary conditions[J]. Adv Psychol Sci, 2020, 28(11):1911-1925. DOI URL
[19]	Li XM, Gao Q, Sun LX, et al. Effect of self-control on health promotion behavior in patients with coronary heart disease:mediating effect of ego-depletion[J]. Psychol Health Med, 2022, 27(6):1268-1276. DOI URL
[20]	马丽云, 莫文. 自我损耗下积极情绪对亲社会行为的影响[J]. 心理与行为研究, 2022, 20(5):684-691. DOI
	Ma LY, Mo W. The influence of positive emotion on prosocial behavior under ego-depletion[J]. Stud Psychol Behav, 2022, 20(5):684-691. DOI
[21]	张梦倩, 李晓敏, 梁明明, 等. 小组赋权干预对冠心病介入治疗术后患者自我损耗的影响[J]. 中华护理教育, 2020, 17(11):970-974.
	Zhang MQ, Li XM, Liang MM, et al. The influence of group empowerment intervention on self-depletion of patients with coronary heart disease after percutaneous coronary intervention[J]. Chin J Nurs Educ, 2020, 17(11):970-974.
[22]	Muraven MB, Slessareva E. Mechanisms of self-control failure:motivation and limited resources[J]. Pers Soc Psychol Bull, 2003, 29(7):894-906. DOI URL
[23]	王雨晴, 张慧超, 孙绪晗, 等. 家庭系统理论视角下慢性心力衰竭患者家庭照护的研究进展[J]. 中华护理杂志, 2023, 58(13):1659-1664. DOI
	Wang YQ, Zhang HC, Sun XH, et al. Research progress on family care in patients with chronic heart failure from the perspective of family system theory[J]. Chin J Nurs, 2023, 58(13):1659-1664. DOI