营养和疲乏在慢性心力衰竭病人社会支持与自我护理能力中的中介效应分析

张倩; 张侠; 刘丽侠; 李春美; 王楠

doi:10.13898/j.cnki.issn.1000-2200.2023.07.033

营养和疲乏在慢性心力衰竭病人社会支持与自我护理能力中的中介效应分析

Analysis of the mediating effect of nutrition and fatigue on social support and self-care ability of patients with chronic heart failure

摘要

摘要:
目的探讨慢性心力衰竭病人自我护理能力、社会支持、营养状况和疲乏水平的现状、相互关系及作用机制。
方法采用横断面研究, 以慢性心力衰竭病人为研究对象, 采用心力衰竭病人自理能力评估量表、社会支持评定量表、心衰特异性微型营养评价工具、中文版多维度疲乏量表开展调查, 在了解现状、相关性分析的基础上, 构建结构方程模型验证其相互关系, 并用Bootstrap法进行中介作用的检验与验证。
结果慢性心力衰竭病人自我护理能力总分为(19.740±11.656)分, 社会支持总分为(24.288±5.050)分, 营养总分为(17.266±4.703)分, 疲乏总分为(76.152±7.611)分, 各变量间均存在显著相关性(P < 0.05)。慢性心力衰竭病人社会支持对自我护理能力的直接效应显著(Z=3.138, P < 0.05)、总间接效应显著(Z=1.915, P < 0.05), 疲乏的中介路径显著(Z=1.423, P < 0.05), 营养和疲乏的链式中介路径显著(Z=1.567, P < 0.05)。
结论医护人员要多关注慢性心力衰竭病人的自我护理能力, 通过早期识别、监测个体的社会支持状况, 并通过疲乏水平的有效评估与管理, 以改善疲乏为切入点, 充分发挥社会支持对自我护理能力的提升作用, 改善个体健康; 同时, 基于链式中介效应, 仍需要重视营养在社会支持对自我护理能力作用机制中的积极影响。

Abstract:
ObjectiveTo explore the status, relationship and mechanism of self-care ability, social support, nutrition status and fatigue level in patients with chronic heart failure(CHF).
MethodsA cross-sectional study was conducted to investigate the CHF patients using the self-care ability assessment scale, social support rating scale, heart failure-specific micro-nutrition evaluation tool and Chinese multi-dimensional fatigue scale.On the basis of understanding the current situation and correlation analysis, a structural equation model was built to verify the mutual relationship, and Bootstrap method was used to test and verify the intermediary role.
ResultsThe total scores of self-care ability, social support, nutrition and fatigue in patients with CHF were (19.740±11.656) points, (24.288±5.050), (17.266±4.703) points and (76.152±7.611) points, respectively.There were significant correlations among all variables(P < 0.05).Among the CHF patients, the direct effect of social support on self-care ability was significant(Z=3.138, P < 0.05), the total indirect effect was significant(Z=1.915, P < 0.05), the mediating pathway of fatigue was significant(Z=1.423, P < 0.05), and the chain mediating pathway between nutrition and fatigue was significant(Z=1.567, P < 0.05).
ConclusionsMedical staff should pay more attention to the self-care ability of patients with CHF.Through early identification, monitoring of individual social support, effective assessment and management of fatigue level, and taking the improvement of fatigue as the starting point, the role of social support in improving self-care ability should be given full play to improve individual health.At the same time, based on the chain mediation effect, it is still necessary to pay attention to the positive impact of nutrition in the mechanism of social support on self-care ability.

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