社会生态系统理论视角下维持性血液透析患者饮食管理体验的质性研究

A Qualitative Study of Dietary Management Experience of Maintenance Hemodialysis Patients from the Perspective of Social Ecological Model

摘要: 目的：了解维持性血液透析患者日常饮食管理的真实体验，以期为该类患者制定针对性的护理干预措施提供参考。方法：采用社会生态系统理论为概念框架，运用质性研究中的现象学研究法和目的抽样法抽取14例患者进行面对面、半结构式深入访谈，采用扎根理论分析方法及Nvivo12.0软件对访谈资料进行整理、分析、归纳及主题提炼。结果：共析出3个主题，6个亚主题：微观系统(负性情绪及症状减轻的成就感、接受度与自我价值感)；中观系统(经济压力、家庭、朋友应对方式)；宏观系统(社会支持系统薄弱、医院支持系统有待改善)。结论：维持性血液透析患者社会生态系统不容乐观，医护人员应根据患者病情制定个性化方案并完善管理平台，有利于改善患者的饮食管理体验并提高生活质量。

Abstract: Objective: The objective of this study is to explore the authentic experiences of patients undergoing maintenance hemodialysis (MHD) in their daily dietary management. This exploration aims to yield insights that can serve as the foundation for devising tailored nursing interventions. Method: This qualitative investigation, grounded in the Social Ecological Model as a conceptual framework, utilized phenomenological methodology and purposive sampling techniques to carry out comprehensive, semi-structured, face-to-face interviews with 14 participants. The collected data were systematically organized, scrutinized, and interpreted through grounded theory analysis, employing Nvivo12.0 software for theme extraction. Results: Three main themes and six sub-themes were identified: microsystem (negative emotions and a sense of achievement in symptom relief, acceptance, and self-worth); mesosystem (economic pressure, family and friends’ coping methods); macrosystem (weak social support systems, need for improved hospital support). Conclusion: The Social Ecological Model of MHD patients is challenging. Healthcare professionals should develop personalized plans and enhance management platforms to improve patients’ dietary management experiences and quality of life.