【作者】 周妹；

【导师】 周兰姝；

【作者基本信息】 第二军医大学 ， 护理学， 2012， 硕士

【摘要】 一、研究目的目前，上海市是全国老龄化程度最高的城市，居家养老是其主要养老模式。老年人因为各方面的原因，存在自我照护缺陷，需要他人活社会提供不同程度的照护，因而，成为居家养老中需重点关注的问题。本研究基于居家养老的大背景下，旨在探寻老年人自我照护缺陷的构成要素和影响因素，以期为社区护理人员制定有针对性的护理干预措施提供理论依据。二、研究方法本研究主要分为二大部分：（一）第一部分：上海市居家养老老年人自我照护缺陷的探索性研究该部分研究根据扎根理论方法论原则，采用目的抽样、理论抽样、滚雪球抽样的方法，对上海市居家养老老年人进行深入访谈和参与式观察等质性研究的方法，对老年人自我照护缺陷的感知、体验等进行研究。所有访谈均进行录音，并整理成word文字文档，采用质性研究资料分析软件Nvivo8中文版对收集的资料进行整理，通过运用开放式编码、主轴式编码和选择式编码的策略析出主题。（二）第二阶段：上海市居家养老老年人自我照护缺陷的量性研究根据前期质性的研究结果，选取研究变量及合适的测评工具，对老年人自我照护缺陷的构成要素及影响因素展开研究。采用方便抽样的方法选取上海市居家养老老年人进行量性研究；使用SPSS17.0软件做统计分析，了解上海市居家养老老年人自我照护缺陷的水平和相关因素的影响作用。三、研究结果（1）质性研究本研究运用扎根理论的研究方法，对上百名老年人进行了参与式观察以及对15名老年人进行了深度访谈，访谈时间总计1225分钟，平均81.6分钟；访谈资料转录文字及田野笔记共十万多余字，最终形成上海市居家养老老年人自我照顾缺陷的理论框架如下图所示：自我照护缺陷的理论模型共四个构成要素，即：自我存在延续的缺陷、自我健康恢复的缺陷、自我健康维护的缺陷和自我社会发展的缺陷。自我照护缺陷的影响因素可分为个人因素（个人社会学特征、健康状况、健康/疾病知识、老化自我感知、生活经历）和环境因素（物理环境和社会支持）。四个构成要素之间是动态发展并相互影响的。（2）量性研究1．上海市居家养老老年人自我存在延续的缺陷得分为(8.731.72)分，处于轻度缺陷水平；自我社会发展的缺陷得分(7.342.74)分，处于中度缺陷水平。老年人的自觉健康得分均值为（3.070.63）分，处于中等水平的健康；健康/疾病知识得分（5.671.34）分，处于不理想的水平；社会支持得分为（7.041.22）分，处于较为理想的水平。2．对上海市居家养老老年人自我存在延续的缺陷的单因素分析后，老年人的自我存在延续的缺陷得分按年龄、性别、养育子女、患病情况、宗教信仰、婚姻状态和家庭月收入分组差异有统计学意义，与其健康状况、健康/疾病知识和社会支持具有相关性。再进一步地进行逐步回归分析后得出，自我存在延续的缺陷的主要影响因素有年龄（=-0.206）、性别（=-0.115）、健康状况（=0.184）、健康/疾病知识（=0.260）和社会支持（=0.172）。3．对上海市居家养老老年人自我社会发展的缺陷的单因素分析后，老年人的自我发展缺陷的缺陷得分按年龄、性别、婚姻状态、文化程度、患病情况、医保形式、月家庭收入、宗教信仰和养育子女分组差异有统计学意义，与其健康状况、健康/疾病知识和社会支持具有相关性，再进一步地进行逐步回归分析后得出，自我社会发展的缺陷的主要影响因素有年龄（=-0.262）、健康状况（=0.151）、健康/疾病知识（=0.338）和社会支持（=0.141）。四、结论构建了上海市居家养老老年人自我照护缺陷的理论框架，说明了自我照护缺陷的基本构成要素及影响因素，为社区护理人员实施有针对性的护理干预措施提供理论依据。更多还原

【Abstract】 Objective: Shanghai has the highest percentage of aging population in China, and home care is themost important models for the aged. The elderly have self-care deficits due to various reasons, andneed different levels of care from others. This study aims to explore the components andinfluencing factors of self-care defects of the home dwelling elderly’s in Shanghai, to furtherprovide theory basis for nursing interventions regarding home care.Methods: The first phase of this study was carried out to explore components of self-care deficitsby interviewing home dwelling elderly. A purposive sampling strategy incorporated with theoreticalsampling and snowball sampling was used to recruit participants from6communities in Shanghai.A total of15elderly were interviewed.They were asked to tell their experiences regard toself-deficits, including their perceptions of self-deficits and how they acted to ensure theirself-deficits. All the interviews were recorded on digital recorders, and then transcribed into worddocuments. Nvivi8.0was used to analyse data. Important themes of experience of home dwellingelderly were extracted through open, axial and selective coding strategy guided by the groundedtheory.Based on the results of the first phase, the second phase employed a quantitative design toexamine the levels of self-care defects of home dwelling elderly and relevant influencing factors.In this phase, data was collected by a cross-sectional survey in Shanghai. Therefore, the instrumentfor the survey was developed including the General information scale, the Self Perceptions ofHealth Scale, the Life Habits, and the Health Quotient Scale. SPSS17.0was adopted to establishdatabase and analysis.Results：1. The conceptual model of self-care defects was initially developed with four dimensions:continuity of self-survival deficits, self-health recovery deficits, self-health maintenance deficitsand self-social development deficits, the factors of self-deficit were personal and environmentalfactors.2. The self-survival deficits score of home dwelling elderly in Shanghai was (8.73±1.72), theself-social development deficits deficits score was (7.34±2.74).3. Age, gender, health status, health/diseases knowledge, and social support were found to bestatistically significantly associated with self-survival deficits.4. Age, health status, health knowledge, and social support had statistically significantcorrelations with self-social development deficits. Conclusion: A theoretical framework for self-deficits of home dewelling elderly was developed,which would guide the development of strategies for home care.更多还原