【作者】 胡玉兰；

【导师】 陈英；

【作者基本信息】 华中科技大学 ， 护理（专业学位）， 2023， 硕士

【摘要】 目的:了解儿科护士对慢病患儿过渡期护理的认知与实践现况;构建《儿科护士对慢病患儿过渡期护理态度调查问卷》,并进行信效度检验,为评估儿科护士对慢病患儿过渡期护理态度提供研究工具;调查儿科护士对慢病患儿过渡期护理态度,分析儿科护士对慢病患儿过渡期护理的认知、情感、行为意向之间的联系,为制定针对性干预措施提高儿科护士对慢病患儿过渡期护理实践积极性提供参考依据,从而为慢病患儿过渡期护理的实践发展奠定基础。方法:本研究采用了质性研究与量性研究相结合的研究方法。首先,质性研究采用面对面访谈法,采取方便抽样法,于2021年7月～8月选取武汉市某三甲医院11名儿科护士为研究对象,采用面对面半结构式访谈法,对研究对象进行深入访谈,使用Cloaizzi七步资料分析法分析访谈资料。基于ABC态度理论,结合德尔菲专家咨询编制《儿科护士对慢病患儿过渡期护理态度问卷》,采用方便抽样法于2022年10月选取武汉市某三甲医院181名儿科护士作为研究对象,对问卷进行信效度检验。使用自行编制的一般资料调查表、前期编制且经过信效度检验的《儿科护士对慢病患儿过渡期护理态度问卷》于2022年11月选取武汉市某三甲医院241名儿科护士作为研究对象进行现况调查,并探索儿科护士对慢病患儿过渡期护理的态度,及认知、情感、行为倾向之间的关联,使用SPSS 26.0和Amos 24.0软件进行统计分析。对数据进行正态性检验,问卷数据不符合正态分布,故采用非参数检验,使用百分位数、频数对数据进行描述性统计、使用2个独立样本独立秩和检验和多个独立样本秩和检验分析一般资料对问卷各维度及问卷总分的影响,使用Spearman相关性分析法分析儿科护士对慢病患儿过渡期护理认知、情感、行为倾向之间的相关性。结果:访谈共获取3个主题:认知与态度;实践;阻碍因素,7个副主题:访谈对象对慢病患儿向成人过渡期护理的认知有待提高,高度肯定其实践意义;慢病患儿过渡期护理实践包括疾病管理相关宣教;缺乏对患儿系统性地培训与支持;缺乏结构化过渡期护理流程;缺乏过渡期护理平台;过渡期护理理论知识欠缺;患儿及家属过度依赖儿科对过渡认知不足等是阻碍过渡期护理发展的主要原因。《儿科护士对慢病患儿过渡期护理态度问卷》包括认知、情感、行为倾向3个维度共29个条目。问卷总Cronbach’sα系数为0.973,折半信度为0.970,问卷总内容效度指数为0.984,各条目内容效度指数为0.875～1.000。探索性因子分析共提取3个公因子,累积方差贡献率为89.438%(KMO=0.932,近似卡方=11210.996,df=406),P<0.05),问卷因子结构良好。通过问卷星共回收问卷250份,有效问卷241份,问卷有效回收率为96.4%。《儿科护士对慢病患儿过渡期护理态度问卷》平均分为(111.751±19.241)分,得分率为77.07%,认知、情感、行为倾向维度平均得分分别为(40.091±10.900)分、(33.826±5.925)分、(37.834±6.471)分。各维度条目平均得分率从高到低依次为情感、行为倾向、认知,分别为84.57%、84.08%、66.82%。不同特征儿科护士对慢病患儿过渡期护理态度得分比较显示:调查对象职称、儿科工作时间、是否有慢病患儿过渡期护理学习经历、每周护理12岁以上患儿比例是儿科护士对慢病患儿过渡期护理态度的影响因素。(1)从护师、主管护师到副主任护师及以上,随着职称的上升认知维度得分和总分均显著提高(P<0.05);(2)儿科工作时间>20年的儿科护士在情感维度得分显著高于工作时间<20年的护士(P<0.05);(3)有慢病患儿过渡期护理相关学习经历的儿科护士在认知、情感、行为倾向各维度和总分均显著高于无相关学习经历的儿科护士(P<0.05);(4)每周护理12岁以上患儿比例越高,问卷总分和认知、情感、行为倾向各维度得分越高(P<0.05);(5)儿科护士对慢病患儿过渡期护理认知、情感、行为倾向之间显著相关且均呈正相关(P<0.01)。结论:1.《儿科护士对慢病患儿过渡期护理态度问卷》信效度良好,为今后评价儿科护士对慢病患儿过渡期护理态度提供了有效的测评工具,为慢病患儿过渡期护理的开展提供了基础。2.儿科护士对慢病患儿过渡期护理态度整体处于中等偏上水平,对慢病患儿过渡期护理在情感上认可度较高,行为意愿较强,在对慢病患儿过渡期护理的认知方面整体处于中等偏下水平,需进一步提升。3.具有较高儿科工作年限、较高职称、有慢病患儿过渡期护理相关学习经历、护理12岁以上慢病患儿比例较高等特征的儿科护士对慢病患儿过渡期护理表现出较高的积极性。未来可进一步探讨其他因素对慢病患儿过渡期护理态度的影响,为提高儿科护士的积极性,为制定针对性提高儿科护士积极性的措施提供依据,从而促进慢病患儿过渡期的开展,改善慢病患儿过渡结局。4.儿科护士对慢病患儿过渡期护理认知、情感、行为倾向之间表现正相关,对慢病患儿过渡期护理认知越高,在情感上就越认可,在实践中行为意向就越高。未来需重视提高儿科护士对慢病患儿过渡期护理相关认知,从而增强其行为意愿,助力慢病患儿过渡期护理的开展。更多还原

【Abstract】 Objective:To understand the current status of pediatric nurses’ cognition and practice of transitional care for children with chronic diseases;The "Questionnaire on Pediatric Nurses’ Transitional Nursing Attitudes to Children with Chronic Diseases" was constructed,and the reliability and validity tests were carried out to provide research tools for evaluating the attitude of pediatric nurses towards transitional nursing of children with chronic diseases.This paper investigates the attitude of pediatric nurses to transitional nursing of children with chronic diseases,analyzes the relationship between cognitive,emotional and behavioral intentions of pediatric nurses in transitional nursing of children with chronic diseases,and provides a reference for formulating targeted interventions to improve the enthusiasm of pediatric nurses in transitional nursing practice for children with chronic diseases,so as to lay a foundation for the practice development of transitional nursing for children with chronic diseases.Method:In this study,a combination of qualitative and quantitative research was used.First,the qualitative study adopted the face-to-face interview method and the convenient sampling method,and 11 pediatric nurses from a tertiary hospital in Wuhan were selected as the research subjects in July to August 2021,and the face-to-face semi-structured interview method was used to conduct in-depth interviews with the research subjects,and the Cloaizzi seven-step data analysis method was used to analyze the interview data.Based on ABC attitude theory,combined with Delphi expert consultation,the "Pediatric Nurses to Transitional Nursing Attitude Questionnaire for Children with Chronic Diseases" was compiled,and 181 pediatric nurses from a third-class hospital in Wuhan were selected as research subjects in October 2022 to test the reliability and validity of the questionnaire.In November 2022,241 pediatric nurses from a tertiary hospital in Wuhan were selected to investigate the current situation,and the relationship between pediatric nurses’ attitudes and cognitive,emotional and behavioral tendencies in transitional care for children with chronic diseases was explored,and SPSS 26.0 and Amos 24.0 software were used for statistical analysis.The normality test was carried out on the data,and the questionnaire data did not conform to the normal distribution,so the nonparametric test was used,the percentile and frequency were used to descriptive statistics of the data,the independent rank sum test of 2independent samples and the test of multiple independent sample rank were used to analyze the influence of general data on the dimensions of the questionnaire and the total score of the questionnaire,and the correlation between the cognitive,emotional and behavioral tendencies of pediatric nurses in the transitional nursing of children with chronic diseases was analyzed by Spearman correlation analysis.Result:The interviews yielded three themes: cognition and attitudes;Practice;Hindrance factors,7 sub-themes: the interviewee’s understanding of the transition care of children with chronic diseases to adults needs to be improved,and its practical significance is highly affirmed;Transitional care practices for children with chronic diseases include education on disease management;lack of systematic training and support for children;lack of structured transitional care processes;lack of transitional care platforms;lack of theoretical knowledge of transitional nursing;Over-reliance on pediatric children and their families is the main reason hindering the development of transitional care."Pediatric Nurses’ Transitional Nursing Attitude Questionnaire for Children with Chronic Diseases" includes 29 items and 29 items in three dimensions of cognitive,emotional and behavioral tendencies.The total Cronbach’s α coefficient was 0.973,the halffold reliability was 0.970,the total content validity index of the questionnaire was 0.984,and the content validity index of each item was 0.875-1.000 A total of 3 common factors were extracted from exploratory factor analysis,and the cumulative variance contribution rate was 89.438%(KMO=0.932 approximate chi-square=11210.996,df=406),P<0.05),and the questionnaire factor structure was good.A total of 250 questionnaires were collected through the questionnaire star,241 valid questionnaires,and the effective recovery rate of questionnaires was 96.4%.The average score of the "Pediatric Nurses’ Transitional Nursing Attitude Questionnaire for Children with Chronic Diseases" was(111.751±19.241),the score rate was 77.07%,and the average scores of cognitive,emotional and behavioral tendencies were(40.091±10.900),(33.826±5.925)and(37.834±6.471),respectively.The average score rates of each dimension were emotion,behavioral tendency and cognition,which were 84.57%,84.08%and 66.82%,respectively.The scores of pediatric nurses’ transitional nursing attitudes towards children with chronic diseases with different characteristics showed that the professional title,pediatric working hours,whether there was transitional nursing learning experience for children with chronic diseases,and the proportion of children over 12 years old who nursed weekly were the influencing factors of pediatric nurses’ attitudes towards transitional nursing of children with chronic diseases.(1)From nurse,nurse in charge to deputy chief nurse and above,with the increase of professional title,the cognitive dimension score and total score were significantly improved(P<0.05);(2)Nurses with 20 years of pediatric working time > significantly higher scores in the emotional dimension than nurses<with 20 years of working time(P<0.05);(3)Pediatric nurses with transitional nursing related learning experience for children with chronic diseases had significantly higher scores in cognitive,emotional,The dimensions and total scores of behavioral tendency were significantly higher than those of nurses with no relevant learning experience(P<0.05);(4)The higher the proportion of children over 12 years old in weekly nursing,the higher the total score of the questionnaire and the scores of cognitive,emotional and behavioral tendencies(P<0.05);(5)There was a significant correlation between pediatric nurses and the cognitive,emotional and behavioral tendencies of children with chronic diseases during the transitional period(P<0.01).Conclusion:1.The "Questionnaire on Pediatric Nurses’ Transitional Nursing Attitudes to Children with Chronic Diseases" has good reliability and validity,which provides a targeted evaluation tool for evaluating the attitude of pediatric nurses to transitional nursing of children with chronic diseases in the future,and provides a basis for the development of transitional nursing for children with chronic diseases.2.The overall attitude of pediatric nurses to transitional nursing of children with chronic diseases is at the upper middle level,and the emotional recognition of transitional nursing of children with chronic diseases is higher and their willingness to act is strong,but the overall cognition of transitional nursing of children with chronic diseases is at the lower middle level,which needs to be further improved.3.Pediatric nurses with higher pediatric working age,higher professional titles,relevant learning experience in transitional nursing of children with chronic diseases,and a higher proportion of nursing children over 12 years old with chronic diseases show high enthusiasm for transitional care of children with chronic diseases.In the future,the influence of other factors on the transitional nursing attitude of children with chronic diseases can be further explored,so as to provide a basis for improving the enthusiasm of pediatric nurses and formulating targeted measures to improve the enthusiasm of pediatric nurses,so as to promote the development of the transition period of children with chronic diseases and improve the transitional outcomes of children with chronic diseases.4.Pediatric nurses have a positive correlation between cognition,emotion and behavioral tendencies in transitional nursing of children with chronic diseases,and the higher the cognition of transitional nursing of children with chronic diseases,the more emotionally recognized and the higher the behavioral intention in practice.In the future,it is necessary to pay attention to improving the awareness of transitional nursing of children with chronic diseases,so as to enhance their willingness to act and help the development of transitional care for children with chronic diseases.更多还原