A qualitative study of the experience of kinesiophobia in elderly patients with chronic obstructive pulmonary disease on stress process model
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摘要:
目的 老年慢性阻塞性肺疾病患者心肺功能逐渐降低，运动耐力明显下降，其担心运动会进一步加重呼吸困难症状而对运动产生恐惧心理。本研究从应激过程模型视角进行访谈，深入探究老年慢性阻塞性肺疾病患者运动恐惧的心理体验及其关键影响因素，为临床医护人员制定相关干预措施提供参考依据。 方法 采用目的抽样法，选取2024年5—8月贵州医科大学附属医院收治的老年慢性阻塞性肺疾病患者作为研究对象，进行半结构式访谈，最终访谈患者12例。采用传统内容分析法对资料进行分析归纳并提炼主题。 结果 老年慢性阻塞性肺疾病患者运动恐惧心理体验共归纳出4个主题：(1)运动相关压力源感知与认知偏差(运动诱发不适的威胁感、对运动获益/风险的失衡认知、自我效能低下)。(2)支持系统匮乏(家庭支持不足、医疗信息不准)。(3)消极应对策略(主动回避、情感聚焦式应对如焦虑/无助)。(4)负性身心结局(运动恐惧加剧、功能活动受限)。 结论 老年慢性阻塞性肺疾病患者运动恐惧受多因素的共同影响，在临床实践中，医护人员应及时纠正患者对运动的认知偏差，提供多元支持，引导患者采取积极的应对方式以及为患者提供相应的心理疏导，从而帮助患者减轻运动恐惧体验，促进患者康复。 Abstract:Objective It has been observed that elderly patients suffering from chronic obstructive pulmonary disease (COPD) have experienced a gradual decline in cardiopulmonary function, resulting in a substantial reduction in their exercise endurance levels. Their concerns include the potential adverse effects of exercise on their respiratory function and the emergence of a fear of exercise. The present study conducted interviews from the perspective of a stress process model to explore in depth the psychological experience and key influencing factors of exercise fear in elderly patients with chronic obstructive pulmonary disease, providing a reference for clinical medical staff to develop relevant intervention measures. Methods Purposive sampling was utilized to select elderly patients suffering from chronic obstructive pulmonary disease from Affiliated Hospital of Guizhou Medical University from May to August 2024, for the purpose of serving as research subjects. Semi-structured interviews were conducted, and a total of 12 patients were interviewed. The utilization of conventional content analysis methodologies is imperative for the purpose of data analysis, summarization and theme extraction. Results The psychological experience of exercise fear in elderly patients with chronic obstructive pulmonary disease was summarized into four themes: (1) Perception and cognitive bias of exercise related stressors (threat of exercise-induced discomfort, imbalanced cognition of exercise benefits/risks, low self-efficacy). (2) The absence of support system (insufficient family support, inaccurate medical information). (3) The utilization of negative coping strategies (active avoidance, emotional focus coping such as anxiety/helplessness). (4) The occurrence of adverse physical and mental consequences (increased fear of movement, restricted functional activities). Conclusion The impact of exercise on the fear experienced by elderly patients diagnosed with chronic obstructive pulmonary disease is influenced by multiple factors. In clinical practice, it is incumbent upon medical staff to promptly correct patients ' cognitive biases towards exercise, provide diverse support, guide patients to adopt positive coping strategies, and provide corresponding psychological counselling to help patients alleviate their experience of exercise fear and promote their recovery. -
表 1 12例受访者一般资料
Table 1. General information of 12 respondents
编号 性别 年龄 文化程度 居住地 婚姻状况 病程 退休前职业 P1 男性 74岁 初中 农村 已婚 25年 个体户 P2 女性 79岁 大专 城镇 丧偶 20年 会计 P3 男性 65岁 初中 城镇 已婚 8年 工人 P4 男性 81岁 文盲 农村 丧偶 32年 农民 P5 女性 68岁 初中 城镇 已婚 12年 自由职业 P6 男性 76岁 小学 农村 已婚 15年 农民 P7 女性 83岁 小学 农村 已婚 30年 农民 P8 女性 72岁 高中 城镇 已婚 5年 教师 P9 男性 77岁 本科 城镇 离婚 18年 公务员 P10 男性 62岁 初中 农村 已婚 20年 司机 P11 男性 67岁 小学 农村 已婚 10年 养殖业 P12 女性 63岁 文盲 农村 已婚 16年 农民 
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