基于社会生态系统理论的慢性心力衰竭病人社会隔离影响因素研究

目的探讨基于社会生态系统理论下慢性心力衰竭(CHF)病人的社会隔离相关影响因素，以期为临床护理干预提供参考。方法采用Lubben社会网络量表-6、简化版孤独量表、心力衰竭症状状态问卷、社区自我效能量表、疾病接受度量表、家庭关怀度指数问卷及自编一般情况问卷对100例CHF病人进行问卷调查，分析CHF病人的社会隔离微观、中观和宏观层面相关影响因素。结果不同年龄、婚姻、居住情况、文化程度、自感经济水平、是否使用智能手机CHF病人，客观社会隔离和主观社会隔离得分差异均有统计学意义(P<0.01)；小区周围娱乐设施对CHF病人客观社会隔离得分的影响差异有统计学意义(P<0.05)，而对主观社会隔离得分的影响差异无统计学意义(P>0.05)。相关分析显示，心力衰竭症状总分与疾病接受度、家庭关怀度总分、客观社会隔离均呈负相关关系(P<0.05~P<0.01)，与主观社会隔离呈正相关关系(P<0.05)；社区自我效能总分与疾病接受度、家庭关怀总分、客观社会隔离均呈明显正相关关系(P<0.01)，与主观社会隔离呈明显负相关关系(P<0.01)；疾病接受度与家庭关怀总分、客观社会隔离均呈明显正相关关系(P<0.01)，与主观社会隔离呈明显负相关关系(P<0.01)；家庭关怀总分与主观社会隔离呈明显负相关关系(P<0.01)；客观社会隔离与主观社会隔离呈明显负相关关系(P<0.05)。多元回归分析显示，是否独居、文化程度和心力衰竭症状是客观社会隔离的影响因素(P<0.05~P<0.01)，是否独居、社区自我效能、疾病接受度和家庭关怀度是主观社会隔离的影响因素(P<0.05~P<0.01)。结论临床护理工作可根据CHF病人的社会隔离类型和影响因素特点，制定针对性的干预措施，主观社会隔离多是心理因素造成的，要联合家庭进行干预，积极提升病人社区自我效能，普及疾病知识。

Study on influencing factors of social isolation in patients with chronic heart failure based on social ecosystem theory

ObjectiveTo explore the influencing factors of social isolation in patients with chronic heart failure(CHF) based on social ecosystem theory, to provide reference for clinical nursing intervention.MethodsOne hundred patients with CHF were surveyed with Lubben social network scale-6, simplified loneliness scale, heart failure symptom status questionnaire, community self-efficacy scale, disease acceptance scale, family care index questionnaire and self-made general questionnaire to analyze the influencing factors of social isolation in patients with CHF at micro, meso and macro levels.ResultsThere were significant differences in the scores of objective social isolation and subjective social isolation between CHF patients with different age, marriage, residence status, education level, self-perceived economic level and using smart phones or not(P<0.01).The influence of recreational facilities around the community on the objective social isolation score of CHF patients was statistically significant(P<0.05), while the influence on the subjective social isolation score was not statistically significant(P>0.05).Correlation analysis showed that the total score of heart failure symptom was negatively correlated with disease acceptance, total score of family care and objective social isolation(P<0.05 to P<0.01), and positively correlated with subjective social isolation(P<0.05);the total score of community self-efficacy was significantly positively correlated with disease acceptance, total score of family care and objective social isolation(P<0.01), and significantly negatively correlated with subjective social isolation(P<0.01);the disease acceptance was significantly positively correlated with the total score of family care and objective social isolation(P<0.01), and negatively correlated with subjective social isolation(P<0.01);the total score of family care was significantly negatively correlated with subjective social isolation(P<0.01);and the objective social isolation was negatively correlated with subjective social isolation(P<0.05).Multiple regression analysis showed that living alone or not, education level and heart failure symptom were the influencing factors of objective social isolation(P<0.05 to P<0.01), and living alone or not, community self-efficacy, disease acceptance and family care were the influencing factors of subjective social isolation(P<0.05 to P<0.01).ConclusionsTargeted intervention measures can be formulated according to the types of social isolation and the characteristics of influencing factors of patients with CHF in clinical nursing work.Subjective social isolation is mostly caused by psychological factors.It should be combined with family intervention to actively improve patients' community self-efficacy and popularize disease knowledge.