实用老年医学 ›› 2024, Vol. 38 ›› Issue (12): 1189-1193.doi: 10.3969/j.issn.1003-9198.2024.12.001

• 专题研究 •    下一篇

社会生态系统理论视角下老年糖尿病高危足病人足部管理体验的质性研究

刘静, 张宁, 翁亚娟   

  1. 210008 江苏省南京市,南京大学医学院附属鼓楼医院伤口护理室(刘静);内分泌科(张宁);护理部(翁亚娟)
  • 收稿日期:2024-09-01 出版日期:2024-12-20 发布日期:2024-12-19
  • 通讯作者: 翁亚娟,Email:faith830406@hotmail.com
  • 基金资助:
    南京鼓楼医院2024年护理科研项目(2024-1-1786)

A qualitative study of foot management experience in elderly patients with high-risk diabetic foot: based on the social ecological theory

LIU Jing, ZHANG Ning, WENG Yajuan   

  1. Wound Care Unit(LIU Jing); Department of Endocrinology (ZHANG Ning); Nursing Department (WENG Yajuan), Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, China
  • Received:2024-09-01 Online:2024-12-20 Published:2024-12-19
  • Contact: WENG Yajuan, Email: faith830406@hotmail.com

摘要: 目的 探索老年糖尿病高危足病人足部自我管理体验,为医护工作者制定针对性干预方案提供参考。方法 采用质性研究方法,基于社会生态系统理论设置访谈提纲,于2024年3月1日至5月31日半结构式访谈15例老年糖尿病高危足病人,运用内容分析法归纳和提炼主题。结果 老年糖尿病高危足病人足部管理体验可归纳为3个主题:微观系统—生物-心理-行为困扰,包括症状痛苦、睡眠障碍、社会退缩、防护意识参差、就医意识薄弱、信息规避、足部管理困境;中观系统—利益相关者互动度,包括医护人员沟通欠缺、病友正-负性影响、家庭支持影响、其他人员影响;宏观系统—社会支持困境,包括宣教效果、思想桎梏、早期筛查未落实、就医过程不佳。结论 老年糖尿病高危足病人足部管理体验受生理和共病多种因素影响,足部预防应重于治疗,未来该类病人和利益相关者均可采取结构化教育,改良信息传播媒介、提高足部教育效果;针对病人足部管理体验痛点,采取针对性健康管理方案,同时进一步优化基层资源配置,提供匹配的筛查、监测、双向转诊、干预链,提高资源利用度。

关键词: 糖尿病高危足, 足部管理, 质性研究

Abstract: Objective To explore the foot self-management experience in the elderly patients with high-risk diabetic foot, so as to provide reference for targeted intervention programs. Methods From March 1 to May 31, 2024, a semi-structured interview was conducted among 15 elderly patients with high-risk diabetic foot based on the social ecological system theory. Content analysis was used to summarize and refine themes. Results In the elderly patients with high-risk diabetic foot, foot management experience was divided into three themes. The micro system—biological-psychological-behavior problems, including symptoms of pain, sleep disorder, social withdrawal, protective consciousness jagged, willingness to seek medical treatment, difficulties to evade and foot management information. The medium system—stakeholder interaction, including medical staff lack of communication, patients’ positive and negative influence, family support and other influence. The macroscopic system—social support dilemma, including the effect of education, shackles of thought, early screening not been implemented, poor medical treatment process. Conclusions The incidence of diabetic foot in the elderly is influenced by multiple factors including physical and comorbidities. Foot prevention is more important. Patients and stakeholders in the future all can take structured education to improve information dissemination media and the effect of foot management education. Foot management needs adopt the health management program, and further optimize the allocation of resources at the grassroots level to provide matching screening, monitoring, two-way referral and intervening in the chain, and improve the degree of resource utilization.

Key words: high-risk diabetic foot, foot management, qualitative study

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