Abstract:

Objective To develop and validate a graded and categorized symptom recognition tool for patients with chronic heart failure（CHF），and to evaluate its effectiveness in improving patients’ symptom recognition，self-management behaviors，and delays in seeking care，thereby providing evidence for clinical nursing interventions. Methods The tool was developed through systematic literature review，Delphi expert consultation，and patient usability feedback，followed by content validity and reliability testing. A non-randomized controlled trial was conducted from July 2023 to June 2024 in the cardiovascular department of a tertiary hospital in Zhejiang Province，China. A total of 160 hospitalized CHF patients were enrolled. Those admitted from January to June 2024 were assigned to an intervention group（n=80），and those admitted from July to December 2023 to a control group （n=80）. The intervention group received routine health education plus the graded and categorized symptom recognition intervention（including standardized education sessions，pictorial card-based training，and follow-up），while the control group received routine standardized health education and follow-up alone. Symptom recognition ability，self-management behavior（reverse scoring），and care-seeking delay were assessed at baseline and after 3 months of intervention. Results During the study，a case died and 2 cases were lost to follow-up，resulting in 78 cases in the experimental group and 79 cases in the control group being ultimately enrolled. After 3 months of intervention，the symptom recognition score in the intervention group was（9.28±1.19） points，which was significantly higher than that of the control group（4.34±1.89） points and its baseline score（4.38±1.02） points（P<0.001）. The self-management score was（16.62±5.59） points，lower than that of the control group（19.28±5.84） points and its baseline value（18.73±5.69）（P<0.05）. The incidence of delayed medical visits in the intervention group was 14.1%，significantly lower than the 43.0% of the control group（P<0.001）. The 3-month readmission rate in the intervention group was 26.9%，compared with 64.6% in the control group（P<0.001）. In addition，the scores for all dimensions of symptom recognition in the intervention group were significantly higher than those in the control group（P<0.001）. Conclusion The graded and categorized symptom recognition tool effectively improved CHF patients’ ability to recognize and respond to symptoms，enhanced self-management behaviors，and reduced delays in seeking care. The tool demonstrated good scientific rigor，validity，reliability，and clinical applicability，offering a practical nursing-led approach for structured health education and risk intervention in CHF management.

Key words: Chronic Heart Failure, Symptom Recognition, Self-Management, Care-Seeking Delay, Nursing Care

摘要：

目的 开发并验证一种适用于慢性心力衰竭（chronic heart failure，CHF）患者的分级分类症状识别工具，评价其对患者症状识别能力、自我管理行为及就医延迟的干预效果，为临床护理干预提供参考。方法 通过文献分析、德尔菲专家函询及患者试用反馈，形成分级分类症状识别工具并完成内容效度和信度检验。采用非随机对照试验设计，于2023年7月至2024年6月，选取浙江省某三级医院心血管内科住院的160例CHF患者作为研究对象，其中2024年1—6月入院的患者为试验组（n=80），2023年7—12月入院的患者为对照组（n=80）。试验组在常规健康宣教基础上增加分级分类症状识别干预（标准化健康教育、图卡训练及随访），对照组接受标准化健康宣教及随访。比较两组干预前及干预3个月后的症状识别及处理能力、自我管理能力、就医延迟、出院3个月再住院情况的差异。结果 研究过程中1例死亡、2例失访，最终试验组纳入78例，对照组纳入79例。干预3个月后，试验组症状识别及处理能力得分为（9.28±1.19）分，高于对照组的（4.34±1.89）分以及干预前的（4.38±1.02）分（P<0.001）；自我管理能力得分为（16.62±5.59）分，低于对照组的（19.28±5.84）分以及干预前的（18.73±5.69）分（P<0.05）；试验组就医延迟发生率为14.1%，低于对照组的43.0%（P<0.001）；试验组出院3个月再住院率为26.9%，对照组为64.6%，差异具有统计学意义（P<0.001）。试验组症状识别能力各维度得分均高于对照组（P<0.001）。结论 构建的分级分类症状识别工具能有效提升CHF患者症状识别能力、改善自我管理行为、减少就医延迟，具有良好的科学性、信效度及临床推广价值。

关键词: 慢性心力衰竭, 症状识别, 自我管理, 就医延迟, 护理