Abstract:

Objective This study aimed to explore the potential categories and characteristics of the fear of falling in the initial ambulation day among patients who underwent major abdominal surgery, analyze the factors influencing different potential categories, and propose implications for the care of such patients. Methods A total of 213 patients who underwent elective major abdominal surgery in the Department of Gastrointestinal Gland Surgery and Hepatobiliary Surgery in the First Affiliated Hospital of Guangxi Medical University from April to August 2023 were selected as the study subjects. The general data questionnaire and the Revised Version of the Fall Fear Scale and Patient Fall Risk Perception Scale were used to investigate the patients on the day they first got out of bed after surgery. The potential profile of the fall fear characteristics of the study subjects was analyzed, and the relevant influencing factors among different categories were explored by univariate analysis, variance analysis, and logistic regression analysis. Results A total of 202 patients who underwent major abdominal surgery were included in this study. The total score of the fear of falling when getting out of bed for the first time was（35.28±8.85）. The fear of falling showed 3 potential categories：low-level fear（22.28%），medium-level fear（47.52%），and high-level fear（30.20%）. A significant difference was found in the first time of getting out of bed among different types of fear（H=19.292，P<0.001）. Results of multi-factor logistic regression analysis showed that patients with high levels of personal activity factors in fall perception and those who underwent pancreatic surgery were likely to develop medium-level fear（P=0.037）. Patients with high levels of perceived environmental factors, high levels of perceived personal activity factors，and low self-efficacy were likely to develop high-level fear（P<0.05）. Conclusion The fear of falling on the initial ambulation day in patients who underwent major abdominal surgery was distributed in categories, and the proportion of patients with medium and high fear levels was high. Patients’ fall risk perception, self-efficacy, and surgical site are important factors influencing fear of falling. Therefore, postoperative nursing staff should focus on developing targeted health education and activity programs to reduce the level of fall fear.

Key words: Fear, Accidental Falls, Abdomen, Early Ambulation out of Bed, Latent Profile Analysis, Nursing Care, Root Cause Analysis

摘要：

目的 探索腹部大手术患者首次下床跌倒恐惧的潜在类别及特征，分析不同潜在类别的影响因素，并提出对腹部手术护理工作的启示。方法 采用便利抽样法，选取2023年4月—8月在广西医科大学第一附属医院胃肠腺体外科和肝胆外科择期行腹部大手术的213例患者作为调查对象，在其术后首次下床活动当天采用一般资料调查表、修订版跌倒恐惧量表、患者跌倒风险感知量表和一般自我效能感量表进行调查，对调查对象的跌倒恐惧特征进行潜在剖面分析，并通过单因素方差分析和Logistic分析探索不同类别间的相关影响因素。结果 共纳入202例腹部大手术患者，首次下床跌倒恐惧总分为（35.28±8.85）分。其跌倒恐惧表现为3个潜在类别：低水平恐惧型（22.28%）、中水平恐惧型（47.52%）、高水平恐惧型（30.20%）。不同恐惧类别的首次下床时间比较，差异有统计学意义（H=19.292，P<0.001）。Logistic回归分析结果显示，行胰腺外科手术者发展为中水平恐惧型的可能性更大（P=0.037）；跌倒感知环境因素水平高、感知个人活动因素水平高和自我效能感低的患者发展为高水平恐惧型的可能性更大（P<0.05）。结论 腹部大手术患者首次下床跌倒恐惧潜在剖面存在异质性，中高恐惧水平患者占比较高，跌倒风险感知、自我效能感和手术部位是跌倒恐惧的重要影响因素，医护人员应制订针对性健康教育和早期活动方案，以降低其下床跌倒恐惧水平。

关键词: 恐惧, 意外跌倒, 腹部, 早期下床活动, 潜在剖面分析, 护理, 影响因素分析