| Objective: The purpose of this study is to investigate the current situation of the elderly with demoralization syndrome in pension institutions through quantitative research methods,analyze the relationship between the physical condition,psychological flexibility,social support,self-perceptions of aging,coping style and the comprehensive demoralization syndrome in pension institutions,and clarify the influencing factors of the syndrome.The descriptive research method was adopted to further explore the influencing factors of the syndrome of the elderly in nursing institutions,and to clarify the care needs of the elderly.Based on the results of quantitative research,qualitative research,literature analysis and expert meeting,the comprehensive nursing intervention scheme of elderly demoralization syndrome in pension institutions is constructed,in order to provide basis for the intervention and prevention of elderly demoralization syndrome in pension institutions in China.Methods:This study adopts a mixed research method,which is divided into three parts.Part I: Quantitative study on the status quo and influencing factors of demoralization syndrome among the elderly in nursing institutionsThis part of the study is a cross-sectional study of quantitative research.1,046 elderly people from 35 pension institutions in Tangshan City from August 2021 to November2021 are selected as research objects by random cluster sampling method.The General Data Questionnaire,the Chinese Version of the Demoralization Scale,the Psychological Resilience Questionnaire,the Self-perceived Aging Questionnaire,the Social Support Rating Scale,the Simple Coping Style Questionnaire and the Barthel Index Questionnaire were used to conduct a face-to-face questionnaire survey.SPSS 23.0software was used to describe the status quo of the elderly with demoralization syndrome and analyze its influencing factors by using descriptive statistics,single factor analysis,correlation analysis and multiple linear regression.AMOS 24.0 software was used to establish the structural equation,and the relationship,action path and effect between the influencing factors and the elderly with demoralization syndrome were analyzed.P<0.05 represents a statistically significant difference.Part II: Qualitative research on the influencing factors and care needs of the elderly with demoralization syndrome in nursing institutions.This part of the study adopts the descriptive research method,adopts the purpose sampling method and follows the principle of maximum differential sampling of samples.From December 2021 to April 2022,18 elderly people from the pension institutions meeting the inclusion and exclusion criteria were selected as the study objects,and faceto-face and one-to-one semi-structured interviews are conducted.NVivo12.0 software was used to organize and analyze the transcribed text data by content analysis method.Part III: The construction of the intervention plan for the elderly with demoralization syndrome.This part of the study is guided by the stress theory,combined with the results of quantitative and qualitative studies and related literature content analysis,the preliminary construction of the elderly demoralization syndrome intervention program in pension institutions.Through the expert meeting,the intervention plan was revised and improved to form the final draft of the intervention plan for the elderly with demoralization syndrome in the nursing home.SPSS 23.0 software was used to evaluate the expert enthusiasm,authority coefficient,coordination coefficient and item variation coefficient.Results:Part I: Quantitative study on the status quo and influencing factors of demoralization syndrome among the elderly in nursing institutions.(1)Analysis result of current situation The total average score of the elderly in pension institutions with demoralization was(49.29±15.26).872 people(83.4%)had high demoralization and 174 people(16.6%)had low demoralization.The scores of each dimension were as follows: feeling of depression(10.76±3.86),feeling of failure(9.53±3.14),feeling of meaninglessness(9.51±4.01),feeling of emotional insecurity(9.37±3.65),feeling of helplessness(7.77±3.42).The top three items were: “I can do a lot of valuable things for others,” “I am a valuable person,” and “I feel bitter about what happened to me”.(2)Results of univariate analysis There were statistically significant differences in the total score of disability of the elderly in 13 variables including gender,education level,residence,occupation,number of chronic diseases,monthly income,spouse,willingness to live in the institution,satisfaction with living conditions,service attitude,frequency of visits,making new friends and whether to adapt to institutional life(P<0.05).(3)Results of correlation analysis The total score of self-perceived aging was positively correlated with the total score of disenthusiasm of the elderly in pension institutions(r=0.60,P<0.05).The total score of mental resilience was negatively correlated with the total score of demoralization of the elderly in pension institutions and had statistical significance(r=-0.49,P<0.05),and the score of social support was negatively correlated with the total score of demoralization of the elderly in pension institutions(r=-0.17,P<0.05).The score of daily living ability was negatively correlated with the total score of demoralization of the elderly(r=-0.27,P<0.05).(4)Results of multiple linear regression The multiple linear regression results of the total score of the loss of memory showed that: self-perceived aging,mental resilience,daily living ability,whether to adapt to the life in the nursing institution,monthly income,chronic illness,family visits,making new friends,negative coping,9 variables entered the regression equation;The model accounted for 56.3% of the total variation.(5)Structural equation model test results(1)The estimated indirect effect of adaptation to institutional life was-0.505.The standardized factor loading of five mediating factors,“self-perceived aging”,“psychological resilience”,“frequency of visits”,“negative coping” and “making close friends”,were-0.646,0.521,0.210,-0.226,0.248,respectively.(2)The estimated direct effect(total effect)of monthly income on disincentive was-0.077,with a 95% confidence interval of(-0.143,-0.009).The estimated indirect effect of monthly income on disincentive was-0.143,with a 95%confidence interval of(-0.223,-0.065).The standardized estimate of the mediating effect was-0.143,accounting for 65% of the total effect.The standardized factor loading of five indicators reflecting the mediating factors,“self-perceived aging”,“psychological resilience”,“visit frequency”,“negative coping” and “making close friends”,were-0.657,0.501,0.172,-0.254,0.239,respectively.(3)The estimated direct effect(total effect)of physical stress(ability of daily living,chronic disease)on asthenia was 0.449,and its 95%confidence interval was(0.318,0.658).The estimated indirect effect of psychosomatic stress on asthenia was 0.197,with a 95% confidence interval of(0.060,0.316).The standardized estimate of mediating effect was 0.197,accounting for 30.50% of the total effect.The standardized factor loading of five mediating factors,“self-perceived aging”,“psychological resilience”,“frequency of visits”,“negative coping” and “making close friends”,were-0.664,0.530,0.219,-0.261,0.258,respectively.All P values were <0.05.Part II: Qualitative research on the influencing factors and care needs of the elderly with demoralization syndrome in nursing institutions.In this part of the study,18 elderly people with demoralization syndrome were selected as the subjects,aged 61-88 years,the average age was(72.67±7.07)years,10 of them were male(55.6%);There were 13 cases(72.2%)in primary school and below,13 cases(72.2%)in rural area,16 cases(88.9%)in bereavement,7 cases(38.9%)with 0-1 child,10 cases(55.7%)with more than two kinds of chronic diseases,11 cases(61.1%)who had been in the nursing home for more than one year,and the DS score ranged from 31 to63,with an average score of(43.17±9.53).Two themes(contributing factors and relieving factors)and eight sub-themes were extracted from the Content analysis data,two themes(nursing content and humanistic environment)were extracted from the nursing needs.Part III: The establishment of the nursing institution of the elderly with demoralization syndrome cultivation intervention programThis part of the study firstly analyzes the contents of the 9 intervention studies on demoralization.Combining the quantitative and qualitative research results,the first draft of the intervention program for demoralization syndrome of the elderly in nursing home institutions is constructed,including 2 modules,8 intervention topics and 12 intervention content.Among the 5 experts who participated in the expert meeting,the expert authority coefficient was 0.89,the enthusiasm was 100%,the coordination coefficient was 0.40(P<0.05),and the variation coefficient of all levels of items was 0.09-0.22.A total of 9suggestions were put forward by the experts.The researchers revised and improved the draft according to the experts’ opinions,and finally formed a comprehensive nursing intervention plan for the elderly with demoralization syndrome in the nursing institution,which includes 2 modules,8 intervention topics and 11 intervention contents. |
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