家庭参与老年慢性病共病患者用药安全促进与障碍因素的质性研究

doi:10.3761/j.issn.0254-1769.2025.10.014

摘要/Abstract

摘要：

目的探讨家庭参与老年慢性病共病患者用药安全的影响因素，为临床实践提供参考。方法基于能力、机会、动机-行为模型，采用目的抽样法，于2024年9月—11月选取河南省郑州市8个社区卫生服务中心的17名老年慢性病共病患者的家庭照顾者进行半结构式访谈，使用定向内容分析法进行资料分析。结果家庭参与老年慢性病共病患者用药安全促进因素主要包括能力因素（较强的自我反思与情绪调节能力）、机会因素（家庭及朋辈支持、医护人员的专业支持）、动机因素（参与用药安全的重要性感知、高水平的参与自我效能、强烈的责任感）；障碍因素包括能力因素（家庭照顾者自身的衰老及疾病限制、家庭照顾者用药安全管理能力不足）、机会因素（患者过高的身心独立性、家庭照顾者所承担的多重角色冲突）。结论家庭参与老年慢性病共病患者用药安全过程中存在一定的阻碍因素，也有明显的促进性因素，医护人员应当重视家庭参与体验，采取针对性策略促进家庭参与老年慢性病共病患者的用药安全，促进患者疾病康复。

关键词: 老年人, 慢性病共病, 家庭参与, 用药安全, 能力、机会、动机-行为模型, 质性研究, 护理

Abstract:

Objective To explore the influencing factors of family participation in medication safety of aged patients with multi-morbidity，and to provide references for clinical practice. Methods Based on capability，opportunity and motivation-behavior model，17 family caregivers of aged patients with multi-morbidity at 8 communities of Zhengzhou，Henan Province from September to November 2024 were selected for semi-structured interviews using purposive sampling method. The data were analyzed using directed content analysis. Results Facilitators of family participation behavior included ability factors（strong self-reflection and emotional regulation ability），opportunity factors（family and peer support，professional support from medical staff），motivational factors （par-ticipation in medication safety importance perception，high level of participation self-efficacy，strong sense of responsibility）. Barriers of family participation behavior included ability factors（the family caregivers’ own aging and disease limitations，and the family caregivers’ medication safety management ability is insufficient），opportunity factors（the excessive physical and mental independence of the patients，the multiple role conflict of the family caregivers）. Conclusion There are some facilitators and barriers in the process of family participation in medication safety of elderly patients with multi-morbidity. Medical staff should attach importance to family participation experience，adopt targeted strategies to promote family participation in medication safety of elderly patients with multi-morbidity，so as to promote disease recovery.

Key words: Aged, Multi-Morbidity, Family Participation, Medication Safety, Capability, Opportunity, and Motivation-Behavior Model, Qualitative Study, Nursing Care

郭永攀, 苏琳琳, 吕晓辰, 渠利霞, 张春慧. 家庭参与老年慢性病共病患者用药安全促进与障碍因素的质性研究[J]. 中华护理杂志, 2025, 60(10): 1244-1250.

GUO Yongpan, SU Linlin, LÜ Xiaochen, QU Lixia, ZHANG Chunhui. Facilitators and barriers of family participation in medication safety in elderly patients with multi-morbidity：a qualitative study[J]. Chinese Journal of Nursing, 2025, 60(10): 1244-1250.

图/表 1

参考文献 24

[1]	黄倩, 徐慧萍, 张艳, 等. 社区慢性病共病老年患者肌少症筛查工具的比较研究[J]. 中华护理杂志, 2022, 57(24):3017-3021. DOI
	Huang Q, Xu HP, Zhang Y, et al. Comparative study of sarco-penia screening tools in community elderly patients with mu-ltiple chronic conditions[J]. Chin J Nurs, 2022, 57(24):3017-3021.
[2]	Maddalena De Maria RN M, Manuela Saurini RN M, Ilaria Erba RN M, et al. Generic and disease-specific self-care ins-truments in older patients affected by multiple chronic condi-tions:a descriptive study[J]. J Clin Nurs, 2024:1-14.
[3]	Yang YT, Yang YW, Yao M, et al. Knowledge,attitude,beha-viour,and influencing factors of home-based medication safety among community-dwelling older adults with chronic diseases:a cross-sectional study[J]. BMC Geriatr, 2023, 23(1):256.
[4]	彭一航, 肖明朝, 谢莉玲. WHO关键行动领域的用药安全技术报告释义[J]. 中国医院管理, 2020, 40(8):33-36.
	Peng YH, Xiao MZ, Xie LL. Medication safety in WHO key action areas[J]. Chin Hosp Manag, 2020, 40(8):33-36.
[5]	Sarkhosh S, Abdi Z, Ravaghi H. Engaging patients in patient safety:a qualitative study examining healthcare managers and providers’ perspectives[J]. BMC Nurs, 2022, 21(1):374. DOI PMID
[6]	马腾宇. 照护者参与在提升其参与用药安全行为中的效果研究[D]. 北京: 北京协和医学院, 2023.
	Ma TY. Study on the effect of caregivers’ participation in pro-moting their participation in drug safety behavior[D]. Beijing: Peking Union Medical College, 2023.
[7]	梁巍. 家庭参与[J]. 中国听力语言康复科学杂志, 2013(6):457-460.
	Liang W. Family involvement[J]. Chin J Hear Speech Rehabil, 2013(6):457-460.
[8]	Khan A, Spector ND, Baird JD, et al. Patient safety after imple-mentation of a coproduced family centered communication pro-gramme:multicenter before and after intervention study[J]. BMJ, 2018, 363:k4764.
[9]	张习习, 李漓, 廖小妹. 急性白血病化疗患儿主要照顾者参与用药安全体验的质性研究[J]. 中华护理杂志, 2023, 58(16):1977-1983. DOI
	Zhang XX, Li L, Liao XM. Primary caregivers’ experience of engagement for medication safety in acute leukemia children with chemotherapy:a qualitative study[J]. Chin J Nurs, 2023, 58(16):1977-1983.
[10]	Michie S, van Stralen MM, West R. The behaviour change wheel:a new method for characterising and designing behaviour change interventions[J]. Implement Sci, 2011, 6:42. DOI PMID
[11]	Hsieh HF, Shannon SE. Three approaches to qualitative content analysis[J]. Qual Health Res, 2005, 15(9):1277-1288.
[12]	郭永攀, 潘婉玉, 张春慧, 等. 慢性病共病老年患者家庭照顾者照顾体验的Meta整合[J]. 中华护理杂志, 2023, 58(6):727-734. DOI
	Guo YP, Pan WY, Zhang CH, et al. Caring experience of family caregivers of aged patients with multi-morbidity:a qualitative Meta-synthesis[J]. Chin J Nurs, 2023, 58(6):727-734.
[13]	Pereira F, Bieri M, Martins MM, et al. Safe medication mana-gement for polymedicated home-dwelling older adults after hospital discharge:a qualitative study of older adults,informal caregivers and healthcare professionals’ perspectives[J]. Nurs Rep, 2022, 12(2):403-423.
[14]	Wood D, Bruner JS, Ross G. The role of tutoring in problem solving[J]. J Child Psychol Psychiatry, 1976, 17(2):89-100.
[15]	Manias E. Communication relating to family members’ involve-ment and understandings about patients’ medication manage-ment in hospital[J]. Health Expect, 2015, 18(5):850-866.
[16]	刘彩, 王晓方, 李莹, 等. 健康信念模型演进与应用的可视化文献分析[J]. 中国健康教育, 2020, 36(2):167-170.
	Liu C, Wang XF, Li Y, et al. Visualized literature analysis on evolution and application of health belief model[J]. Chin J Health Educ, 2020, 36(2):167-170.
[17]	崔娜娜. 脑卒中患者照护者照顾负担、自我效能与感知益处的相关性研究[D]. 延吉: 延边大学, 2021.
	Cui NN. Study on the correlation among care burden,self-efficacy and perceived benefits of caregivers of stroke patients[D]. Yanji: Yanbian University, 2021.
[18]	Su MZ, Yao NL, Liu L, et al. Older cancer survivors living with financial hardship in China:a qualitative study of family perspectives[J]. Psychooncology, 2022, 31(4):661-670.
[19]	孙柳, 王艳玲, 陈少华, 等. 慢性病共病空巢老年配偶压力感知和应对体验的质性研究[J]. 军事护理, 2022, 39(7):33-36.
	Sun L, Wang YL, Chen SH, et al. Stress perception and cop-ing experience of empty-nest elderly spouses caring for partners with multiple chronic conditions:a qualitative study[J]. Mil Nurs, 2022, 39(7):33-36.
[20]	Rn TCM, Rn RB, Hendron E, et al. Nursing interventions to redu-ce medication errors in paediatrics and neonates:systematic review and meta-analysis[J]. J Pediatr Nurs, 2022, 62:e139-e147.
[21]	Chen CF, Wang L, Chi HL, et al. Comparative efficacy of social media delivered health education on glycemic control:a meta-analysis[J]. Int J Nurs Sci, 2020, 7(3):359-368.
[22]	Look KA, Stone JA. Contextual factors influencing medication management by rural informal caregivers of older adults[J]. Res Social Adm Pharm, 2019, 15(10):1223-1229. DOI PMID
[23]	Ashforth BE, Kreiner GE, Fugate M. All in a Day’s work:boundaries and micro role transitions[J]. Acad Manag Rev, 2000, 25(3):472-491.
[24]	胡宇辰, 李梦晓. 移动互联技术背景下知识型员工角色整合与创新[J]. 科技进步与对策, 2018, 35(6):156-160. DOI
	Hu YC, Li MX. Knowledge workers’ role integration and in-novation in the context of using mobile technology[J]. Sci Tech-nol Prog Policy, 2018, 35(6):156-160.