社区老年糖尿病患者自我忽视的诠释性现象学研究

doi:10.3761/j.issn.0254-1769.2024.02.011

摘要/Abstract

摘要：

目的探索社区老年糖尿病患者自我忽视的体验和原因，为社区护理人员识别和干预老年糖尿病患者自我忽视行为提供参考。方法采用诠释性现象学方法，通过目的抽样，2023年3月—5月，选取浙江省杭州市3个社区卫生服务中心登记的老年糖尿病患者进行半结构式访谈，采用Van Manen方法分析质性资料。结果社区老年糖尿病患者自我忽视的体验共归纳为4个主题和10个亚主题，包括忽视个人健康（自我价值感较低、自尊水平过高、担心拖累家庭），忽视血糖管理（健康意识薄弱、血糖管理困难），自我照护能力不足（经济状况不佳、个人时间有限、活动能力减弱）和支持感知不足（社会支持较低、情感支持不足）。结论社区老年糖尿病患者自我忽视的体验和原因是多元化的，社区卫生服务机构及护理人员需重视老年糖尿病患者自我忽视行为的表现，并积极探索有效的防治措施。

关键词: 自我忽视, 糖尿病, 老年护理, 社区护理, 质性研究

Abstract:

Objective To explore the experience and causes of self-neglect of elderly diabetic patients in community，so as to provide references for community nursing workers to identify and intervene the self-neglect behavior of elderly diabetic patients. Methods An interpretative phenomenological method was used to collect data from elderly diabetic patients registered in 3 community health service centers in Hangzhou，Zhejiang Province through semi-structured interviews. Van Manen’s method was used to analyze qualitative data. Results The experience and reasons of self-neglect of elderly diabetic patients in community were summarized into 4 themes and 10 sub-themes，including neglecting personal health（low sense of self-worth，high level of self-esteem，being afraid of compromising the family），neglecting blood glucose management（weak health awareness，difficulty in blood glucose management），inadequate self-care capacity（poor financial situation，insufficient personal time，diminished mobility） and inadequate perceived support（low social support，insufficient emotional support）. Conclusion The experience and reasons of self-neglect of elderly diabetic patients in community are diversified. Community health services and nursing workers should pay attention to the performance of self-neglect behavior of elderly diabetic patients and actively explore effective prevention and intervention measures.

Key words: Self-Neglect, Diabetes Mellitus, Elderly Care, Community Care, Qualitative Research

骆雅萍, 于淑娟, 朱苗苗, 潘红英. 社区老年糖尿病患者自我忽视的诠释性现象学研究[J]. 中华护理杂志, 2024, 59(2): 203-209.

LUO Yaping, YU Shujuan, ZHU Miaomiao, PAN Hongying. Self-neglect in elderly diabetic patients in the community：an interpretive phenomenological study[J]. Chinese Journal of Nursing, 2024, 59(2): 203-209.

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参考文献 26

[1]	Pickens S, Daniel M, Jones EC, et al. Development of a conce-ptual framework for severe self-neglect(SN) by modifying the CREST model for self-neglect[J]. Front Med (Lausanne), 2021, 8:654627.
[2]	董莉. 失能老年人自我忽视现状及影响因素研究[D]. 沈阳: 中国医科大学, 2023.
	Dong L. Study on the status and influencing factors of self-neglect in the disabled elderly[D]. Shenyang: China Medical University, 2023.
[3]	袁胜楠, 周静, 李敏. 住院老年病人自我忽视与衰弱的相关性研究[J]. 全科护理, 2022, 20(12):1602-1605.
	Yuan SN, Zhou J, Li M. Correlation between self-neglect and frailty in hospitalized elderly patients[J]. Chin Gen Pract Nurs, 2022, 20(12):1602-1605.
[4]	易子涵, 李茜, 张海茹, 等. 农村独居老年人的自杀意念与自我忽视现状及二者的关系[J]. 广西医学, 2022, 44(10):1145-1149, 1161.
	Yi ZH, Li Q, Zhang HR, et al. Current situations of suicidal ideation and self-neglect in the elderly living alone in rural areas and their relationship[J]. Guangxi Med J, 2022, 44(10):1145-1149,1161.
[5]	Bolkan C, Teaster PB, Ramsey-Klawsnik H. The context of elder maltreatment:an opportunity for prevention science[J]. Prev Sci, 2023, 24(5):911-925. DOI PMID
[6]	王梦莹, 张俊梅, 常陆, 等. 社区老年人自我忽视现状及影响因素分析[J]. 临床心身疾病杂志, 2022, 28(4):131-134.
	Wang MY, Zhang JM, Chang L, et al. Analysis on the current situation and influencing factors of self-neglect of the elderly in the community[J]. J Clin Psychosom Dis, 2022, 28(4):131-134.
[7]	张彩元, 李春玉, 陈琦琦, 等. 老年人自我忽视行为发生率的meta分析[J]. 职业与健康, 2021, 37(8):1122-1126.
	Zhang CY, Li CY, Chen QQ, et al. Incidence of elder self-neglect:a meta-analysis[J]. Occup Health, 2021, 37(8):1122-1126.
[8]	温敬冬, 宁松毅, 周胜蓝, 等. 老年糖尿病患者自我忽视现状及影响因素研究[J]. 护理管理杂志, 2022, 22(10):723-728.
	Wen JD, Ning SY, Zhou SL, et al. The status and influencing factors of self-neglect in elderly diabetic patients[J]. J Nurs Adm, 2022, 22(10):723-728.
[9]	中国老年2型糖尿病防治临床指南编写组, 中国老年医学学会老年内分泌代谢分会, 中国老年保健医学研究会老年内分泌与代谢分会, 等. 中国老年2型糖尿病防治临床指南(2022年版)[J]. 中华内科杂志, 2022, 61(1):12-50.
	Chinese Clinical Guidelines for the Prevention and Treatment of Type 2 diabetes in the Elderly,Chinese Geriatric Society of Endocrinology and Metabolism,Chinese Geriatric Health Care Medicine Society of Endocrinology and Metabolism in the Elderly,et al. Chinese clinical guidelines for the prevention and treatment of type 2 diabetes in the elderly(2022 edition)[J]. Chin J Int Med, 2022, 61(1):12-50.
[10]	吕京鸿, 钱敏, 于明明. 老年自我忽视的概念分析[J]. 中华护理教育, 2022, 19(9):852-856.
	Lü JH, Qian M, Yu MM. Concept analysis of elder self-neglect by Rodgers’ evolutionary method[J]. Chin J Nurs Educ, 2022, 19(9):852-856.
[11]	王航赛. 老年人自我忽视评估量表的汉化及其应用[D]. 杭州: 杭州师范大学, 2019.
	Wang HS. Research on Chinese version of the Elder Self Neglect Assessment Scale and its application[D]. Hangzhou: Hangzhou Normal University, 2019.
[12]	Alberti KG, Zimmet PZ. Definition,diagnosis and classification of diabetes mellitus and its complications. Part 1:diagnosis and classification of diabetes mellitus provisional report of a WHO consultation[J]. Diabet Med, 1998, 15(7):539-553. DOI URL
[13]	徐辉富. 现象学研究方法与步骤[M]. 上海: 学林出版社, 2008.
	Xu HF. Phenomenological research methods and procedures[M]. Shanghai: Xuelin Publishing House, 2008.
[14]	Dossett LA, Kaji AH, Cochran A. SRQR and COREQ repor-ting guidelines for qualitative studies[J]. JAMA Surg, 2021, 156(9):875-876. DOI PMID
[15]	van Manen M. Phenomenology in its original sense[J]. Qual Health Res, 2017, 27(6):810-825. DOI PMID
[16]	T Buckingham J, Lam TA, Andrade FC, et al. Reducing con-tingent self-worth:a defensive response to self-threats[J]. J Soc Psychol, 2019, 159(3):284-298. DOI PMID
[17]	吴昊, 姚怡梦, 周淑莹, 等. 中年糖尿病患者自我忽视及影响因素研究[J]. 护理与康复, 2023, 22(7):56-59.
	Wu H, Yao YM, Zhou SY, et al. Study on self-neglect and its influencing factors in middle-aged patients with diabetes[J]. Nurs Rehabil, 2023, 22(7):56-59. DOI URL
[18]	高倩倩, 梅凡, 赵黎, 等. 老年糖尿病患者衰弱发生率的系统评价[J]. 中华护理杂志, 2021, 56(5):686-693. DOI
	Gao QQ, Mei F, Zhao L, et al. Prevalence of frailty in older patients with diabetes:a systematic review[J]. Chin J Nurs, 2021, 56(5):686-693.
[19]	潘晶雪, 陈利群, 王敬丽, 等. 社区老年慢性病患者认知功能的现状调查[J]. 中华护理杂志, 2021, 56(1):109-115. DOI
	Pan JX, Chen LQ, Wang JL, et al. Study on the status of cognitive function in community elderly adults with chronic diseases[J]. Chin J Nurs, 2021, 56(1):109-115. DOI
[20]	Dahl N, Ross A, Ong P. Self-neglect in older populations:a des-cription and analysis of current approaches[J]. J Aging Soc Policy, 2020, 32(6):537-558. DOI URL
[21]	Yu MM, Gu LB, Shi YX, et al. A systematic review of self-neglect and its risk factors among community-dwelling older adults[J]. Aging Ment Health, 2021, 25(12):2179-2190. DOI URL
[22]	Su H, Zhou YQ, Wang HN, et al. Social support,self-worth,and subjective well-being in older adults of rural China:a cross-sectional study[J]. Psychol Health Med, 2022, 27(7):1602-1608. DOI URL
[23]	王娜, 付明晶, 朱亚茹, 等. 社区空巢老人心理弹性与自我忽视的关系:抑郁的中介效应[J]. 中华现代护理杂志, 2022, 28(8):1041-1045.
	Wang N, Fu MJ, Zhu YR, et al. Correlation between psycho-logical resilience and self-neglect of community empty-nest elderly:the mediating effect of depression[J]. Chin J Mod Nurs, 2022, 28(8):1041-1045.
[24]	薛文俊, 牛晓丹, 王艳红. 老年2型糖尿病患者医院-家庭过渡期用药偏差的调查研究[J]. 中华护理杂志, 2021, 56(2):225-232. DOI
	Xue WJ, Niu XD, Wang YH. Research on the condition of medication discrepancy in hospital-family transitional period in elderly patients with type 2 diabetes mellitus[J]. Chin J Nurs, 2021, 56(2):225-232. DOI
[25]	Yu MM, Wang WR, Gu LB, et al. Perspectives and experien-ces of living with self-neglect among older adults:a systema-tic review and meta-synthesis[J]. J Nurs Scholarsh, 2023, 55(4):771-781. DOI URL
[26]	冀云, 李进伟. 中国老年人自我忽视的现状及影响因素研究[J]. 中国健康教育, 2018, 34(11):968-972,978.
	Ji Y, Li JW. The status and influence factors of self-neglect among Chinese elderly persons[J]. Chin J Health Edu, 2018, 34(11):968-972,978.