| 任萌,马军华,秦渝琴,杨子佳,邓凤英.首诊终末期肾病血液透析患者出院准备服务体验与需求的质性研究[J].上海护理,2026,26(3): |
| 首诊终末期肾病血液透析患者出院准备服务体验与需求的质性研究 |
| Discharge Preparation Experiences and Needs of Patients Newly Diagnosed with End-Stage Renal Disease: A Qualitative Study |
| 投稿时间：2025-06-10 修订日期：2026-03-02 |
| DOI： |
| 中文关键词: 终末期肾病 血液透析 出院准备 质性研究 行为改变轮 |
| 英文关键词:End-stage renal disease Hemodialysis Discharge preparation Qualitative study Behaviour Change Wheel |
| 基金项目:2020年度湖南省社会科学成果评审委员会课题 |
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| 中文摘要: |
| 摘要 目的：探讨在行为改变轮理论指导下，首诊终末期肾病血液透析患者的出院准备服务体验困境与核心需求，为构建出院准备服务干预方案提供依据。方法：基于现象学研究，采用目的抽样法，选取2024年12月—2025年3月在衡阳市某三级甲等医院肾内科14例首次确诊终末期肾病并接受血液透析治疗的患者，进行半结构式访谈，运用Colaizzi七步分析法对资料进行分析。结果：共提炼出3个主题及10项亚主题：能力障碍（疾病认知偏差与心理拒斥共存、血管通路自我护理不足、饮食管理知识欠缺）；动机受挫（治疗压力与生活目标动摇、家庭角色功能转移与自我价值感丧失、职业中断危机与社会认同受损）；机会缺失与支持系统建设需求（信息获取渠道与内容传递方式优化需求、出院后医疗响应体系与责任对接需求、照护协同支持与资源可及性需求、心理护理与社会融入支持体系建设需求）。结论：首诊终末期肾病血液透析患者在出院准备过程中存在认知技能障碍、动机受挫与机会缺失等困境，强调需从能力提升、动机激发与机会优化多维干预，构建分阶段、个性化、智能化的出院准备支持体系。 |
| 英文摘要: |
| [Abstract] Objective:To explore the discharge preparation experiences, challenges, and core needs of patients newly diagnosed with end-stage renal disease (ESRD) undergoing hemodialysis under the guidance of the Behaviour Change Wheel (BCW) theory, and to provide evidence for the development of targeted discharge preparation interventions.Methods:A phenomenological research design was adopted. Using purposive sampling, 14 patients who were newly diagnosed with end-stage renal disease (ESRD) and initiated maintenance hemodialysis at the nephrology department of a tertiary hospital in Hengyang between December 2024 and March 2025 were recruited. Data were collected through semi-structured, in-depth interviews and analyzed using Colaizzi’s 7-step method.Results:Three major themes and ten subthemes were identified: capability barriers (cognitive misunderstanding and psychological rejection; insufficient self-care skills for vascular access; lack of dietary management knowledge); motivational setbacks (treatment-induced life goal disruption, loss of self-worth due to family role changes, and occupational interruption with impaired social identity); opportunity deficits and support system needs (comprising the need to optimize channels and formats of health information delivery, demands for a responsive post-discharge medical system with clear accountability, needs for coordinated caregiving and accessible support resources, and the construction of psychological care and social reintegration support systems.). Conclusion:Patients newly diagnosed with ESRD undergoing hemodialysis experience multifaceted challenges related to cognitive and skill barriers, motivational setbacks, and opportunity deficiencies during the discharge preparation process. It is essential to design multi-dimensional interventions focusing on capability enhancement, motivation reinforcement, and opportunity optimization to build a staged, collaborative, and technology-assisted discharge preparation support system. |
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