急性缺血性脑卒中患者早期活动影响因素的质性研究

doi:10.3761/j.issn.0254-1769.2023.17.009

摘要/Abstract

摘要：

目的探究急性缺血性脑卒中患者早期活动行为的影响因素，为制订个体化活动干预策略提供依据。方法 2021年3月—4月采用行为事件访谈法对南京市某三级甲等医院神经内科的15例急性缺血性脑卒中患者进行访谈，基于能力-机会-动机-行为系统及Colaizzi 7步分析法进行分析、归纳后提炼主题。结果提炼出3个主题及下属12个亚主题：能力因素（身体功能障碍、感知性“失能”、早期活动知识缺乏）、动机因素（康复结果预期、早期活动价值感知、康复应对方式、运动康复偏好、早期活动体验、康复自我效能）、机会因素（早期活动处方与指导、环境助推、多元外部支持）。结论急性缺血性脑卒中患者早期活动行为的影响因素复杂多样，医护人员应重视患者康复运动偏好，制订个性化活动处方，建立多维度早期活动助推策略及多元外部支持系统，以提高早期活动行为的依从性，实现运动康复效益最大化，改善疾病转归。

关键词: 脑卒中, 早期活动, 行为转变, COM-B系统, 影响因素分析, 质性研究, 护理

Abstract:

Objective To explore the influencing factors of early activities in patients with acute ischemic stroke，and to provide bases for conducting individualized interventions. Methods 15 patients with acute ischemic stroke were interviewed by behavioral event interviews，and then the data were analyzed，and themes were extracted based on the Capacity，Opportunity，Motivation-Behavior（COM-B） system and Colaizzi 7-step analysis method. Results 3 themes of capability，motivation and opportunity were identified containing 12 subthemes：capability（physical dysfunction，perception of "incapacitation"，lack of early activity knowledge）；motivation（expectation of rehabilitation outcome，value perception of early activity，rehabilitation coping style，preference for exercise rehabilitation，early activity experience，rehabilitation self-efficacy）；opportunity（prescription and guidance of early activity，environment nudging，multiple external support）. Conclusion The influencing factors of early activity in patients with acute ischemic stroke are complex and diverse. Medical staff should pay attention to patients’ rehabilitation preference，formulate personalized activity prescription，establish multi-dimensional early activity nudging strategies and multiple external support systems，so as to improve the compliance of early activity，maximize the benefit of exercise rehabilitation，and improve the disease outcome.

Key words: Stroke, Early Activity, Behavior Change, COM-B System, Root Cause Analysis, Qualitative Study, Nursing Care

张敏, 王清, 史慧玲, 盛少婷. 急性缺血性脑卒中患者早期活动影响因素的质性研究[J]. 中华护理杂志, 2023, 58(17): 2112-2118.

ZHANG Min, WANG Qing, SHI Huiling, SHENG Shaoting. Influencing factors of early activities in patients with acute ischemic stroke：a qualitative study[J]. Chinese Journal of Nursing, 2023, 58(17): 2112-2118.

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