同伴教育联合情景体验改善血液透析患者动静脉内瘘自我护理行为的实践研究

doi:10.3761/j.issn.1672-9234.2026.04.017

摘要/Abstract

摘要：

目的探讨同伴教育联合情景体验在改善血液透析患者动静脉内瘘自我护理行为中的应用成效。方法选取2025年4月—6月于某院血液净化中心经动静脉内瘘接受血液透析治疗的患者120例作为研究对象，采用随机数字表法将其分为对照组、试验组，每组各60例，试验组在对照组基础上接受同伴教育联合情景体验干预，对照组接受常规健康教育。比较两组干预前后血液透析患者知识水平问卷、抑郁自评量表、焦虑自评量表、康纳-戴维森心理弹性量表和血液透析患者动静脉内瘘自我护理行为量表得分。结果干预后试验组血液透析患者知识水平问卷各维度条目均分，抑郁自评量表、焦虑自评量表、康纳-戴维森心理弹性量表总得分，以及血液透析患者动静脉内瘘自我护理行为量表总得分及各维度得分均优于对照组（均P<0.05）。结论同伴教育联合情景体验在提高血液透析患者自我护理知识掌握程度、改善其心理状况和促进其动静脉内瘘自我护理行为发展方面具有良好效果，值得在临床应用和推广。

关键词: 血液透析, 动静脉内瘘, 自我护理, 同伴教育, 体验式教学

Abstract:

Objective To explore the effects of peer education combined with experiential scenario-based intervention in improving the self-care behavior for arteriovenous fistula in hemodialysis patients. Methods A total of 120 patients undergoing hemodialysis via arteriovenous fistula at the hospital from April to June 2025 were selected as the participants and randomly divided into a control group and an experimental group（60 cases each）. The experimental group received peer education combined with experiential scenario-based intervention in addition to the routine care，while the control group received routine health education. The scores of the Hemodialysis Patient Knowledge Questionnaire（HPKQ），Self-rating Depression Scale（SDS），Self-rating Anxiety Scale（SAS），Connor-Davidson Resilience Scale（CD-RISC），and Assessment of Self-care Behaviors with Arteriovenous Fistula in Hemodialysis（ASBHD-AVF） were compared between the two groups before and after the intervention. Results After the intervention，the experimental group showed superior performance in all dimensions of the HPKQ，total scores of the SDS，SAS，and CD-RISC，as well as the total scores and dimensional scores of the ASBHD-AVF compared to the control group（all P<0.05）. Conclusion Peer education combined with experiential scenario-based intervention demonstrates favorable effects in enhancing the mastery of self-care knowledge，improving psychological conditions，and promoting the development of arteriovenous fistula self-care behaviors among hemodialysis patients，making it worthy of clinical application and promotion.

Key words: Hemodialysis, Arteriovenous Fistula, Self-care, Peer Education, Experiential Teaching

吴海芳, 钱春燕, 沈波, 赵颖. 同伴教育联合情景体验改善血液透析患者动静脉内瘘自我护理行为的实践研究[J]. 中华护理教育, 2026, 23(4): 490-497.

WU Haifang, QIAN Chunyan, SHEN Bo, ZHAO Ying. Application of peer education combined with scenario-based intervention in improving self-care behaviors for arteriovenous fistula in hemodialysis patients[J]. Chinese Journal of Nursing Education, 2026, 23(4): 490-497.

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参考文献 24

[1]	Wang LM, Xu X, Zhang M, et al. Prevalence of chronic kidney disease in China:results from the sixth China chronic disease and risk factor surveillance[J]. JAMA Intern Med, 2023, 183(4):298-310. doi: 10.1001/jamainternmed.2022.6817
[2]	荣丹, 王桃霞, 叶涛, 等. 血管周围治疗方法抑制动静脉内瘘内膜增生的研究进展[J]. 中国血液净化, 2025, 24(2):153-156.
	Rong D, Wang TX, Ye T, et al. Research progress in local perivascular treatment methods for inhibiting intimal hyper-plasia in arteriovenous fistula[J]. Chin J Blood Purif, 2025, 24(2):153-156.
[3]	Lira MN, Sousa CN, Wanderley MCM, et al. Scale of assessment of self-care behaviors with arteriovenous fistula in hemodia-lysis:a psychometric study in Brazil[J]. Clin Nurs Res, 2021, 30(6):875-882. doi: 10.1177/1054773821989800
[4]	Özdemir C, Şendir M. The effect of fistula care education given with a mobile application on disease adherence and self-care behaviors in hemodialysis patients:a quasi-experimental study[J]. Flor Night J Nurs, 2025,33:e24057.
[5]	吴晓丽, 姜赞英, 曹利芬. 结构化教育对血液透析患者动静脉内瘘自我护理行为的影响研究[J]. 中国血液净化, 2022, 21(3):214-217.
	Wu XL, Jiang ZY, Cao LF. Investigating on the effect of structured education on self-care behavior towards arteriove-nous fistula in hemodialysis patients[J]. Chin J Blood Purif, 2022, 21(3):214-217.
[6]	李松, 陈娟, 朱超刚, 等. 基于同伴教育的5 g减盐在社区老年高血压患者自我管理的效果研究[J]. 昆明医科大学学报, 2022, 43(10):187-192.
	Li S, Chen J, Zhu CG, et al. Effect of 5 g salt reduction based on peer education in self-management of elderly hypertensive patients in the community[J]. J Kunming Med Univ, 2022, 43(10):187-192.
[7]	金清伟, 黄倩, 郭延昊, 等. 心智觉知训练联合情景体验式教育对腹部手术患者心理、生理应激及不良事件发生的影响[J]. 国际护理学杂志, 2024, 43(17):3224-3227.
	Jin QW, Huang Q, Guo YH, et al. Effect of mental awareness training combined with situational experiential education on psychological and physical stress and adverse events of pa-tients undergoing abdominal surgery[J]. Int J Nurs, 2024, 43(17):3224-3227.
[8]	陶朝云, 汤华萍, 卓银霞, 等. 基于微信小组的同伴教育在老年慢性病患者中的应用效果[J]. 保健医学研究与实践, 2023, 20(12):87-93.
	Tao ZY, Tang HP, Zhuo YX, et al. Application effect of peer education based on WeChat groups in elderly patients with chronic diseases[J]. Health Med Res Pract, 2023, 20(12):87-93.
[9]	敖华, 敖宁佳, 王路遥, 等. 构建动态体位辅助透析模型及稳定透析后期血流动力学的研究[J]. 生物医学工程与临床, 2025, 29(2):233-239.
	Ao H, Ao NJ, Wang LY, et al. Construction of a dynamic position-assisted dialysis model and study of hemodynamics in later stage of stable dialysis[J]. Biomed Eng Clin Med, 2025, 29(2):233-239.
[10]	李慧. 血液透析患者自我管理现状及影响因素的研究[D]. 北京: 北京协和医学院, 2011.
	Li H. Research on the condition and influencing factors of hemodialysis patients’ self management[D]. Beijing: Peking Union Medical College, 2011.
[11]	Zung WW. A self-rating depression scale[J]. Arch Gen Psychiatry, 1965,12:63-70.
[12]	Zung WW. A rating instrument for anxiety disorders[J]. Psy-chosomatics, 1971, 12(6):371-379.
[13]	Yu XN, Zhang JX. Factor analysis and psychometric evalua-tion of the Connor-Davidson Resilience Scale(CD-RISC) with Chinese people[J]. Soc Behav Pers, 2007, 35(1):19-30. doi: 10.2224/sbp.2007.35.1.19
[14]	杨淼淼, 赵慧华. 中文版血液透析患者动静脉内瘘自我护理行为量表信效度初步评价[J]. 中国实用护理杂志, 2017, 33(19):1467-1470.
	Yang MM, Zhao HH. Preliminary evaluation of reliability and validity of Chinese version of arteriovenous fistula self-care behavior scale for hemodialysis patients[J]. Chin J Pract Nurs, 2017, 33(19):1467-1470.
[15]	王娜, 周玲玲, 侯彤. 多媒体视频联合情景体验式健康教育在腹腔镜胆总管切开取石术患者中的应用效果[J]. 中国医药导报, 2023, 20(6):149-152.
	Wang N, Zhou LL, Hou T. Application effect of multimedia video combined with situational experiential health education in patients undergoing laparoscopic choledochotomy and stone extraction[J]. China Med Her, 2023, 20(6):149-152.
[16]	庞梦琳, 黄爱玲, 王琍, 等. 遗忘曲线干预模式对维持性血液透析患者动静脉内瘘血管防护知晓率、行为方式及自护能力的影响[J]. 国际护理学杂志, 2022, 41(12):2244-2249.
	Pang ML, Huang AL, Wang L, et al. Effect of forgetting curve intervention mode on awareness rate,behavior and self-care ability of arteriovenous fistula in maintenance hemodialysis patients[J]. Int J Nurs, 2022, 41(12):2244-2249.
[17]	Chen XL, Hua LH, Zhang C, et al. Effect of peer support on improving self-management ability in peritoneal dialysis patients:a randomized controlled trial[J]. Ann Palliat Med, 2021, 10(3):3028-3038. doi: 10.21037/apm
[18]	汪小冬, 秦秀芳, 吴美凤, 等. 基于泰勒原理的临床教学对提高护理实习生健康教育能力的效果研究[J]. 中华护理教育, 2025, 22(8):962-967.
	Wang XD, Qin XF, Wu MF, et al. Effects of Tyler’s Principles in enhancing health education ability among nursing interns[J]. Chin J Nurs Educ, 2025, 22(8):962-967.
[19]	朱小丽, 葛军琴, 夏海鹭, 等. 人文关怀联合情景体验式健康教育在结直肠癌造口患者护理中的应用[J]. 西部中医药, 2022, 35(4):131-134.
	Zhu XL, Ge JQ, Xia HL, et al. Application of humanistic care combined with situational experience-based health education in the nursing of patients with colostomy for colorectal cancer[J]. West J Tradit Chin Med, 2022, 35(4):131-134.
[20]	Liang DD, Jia RY, Zhou X, et al. The effectiveness of peer support on self-efficacy and self-management in people with type 2 diabetes:a meta-analysis[J]. Patient Educ Couns, 2021, 104(4):760-769. doi: 10.1016/j.pec.2020.11.011
[21]	Ryan RM, Deci EL. Self-determination theory and the facilita-tion of intrinsic motivation,social development,and well-being[J]. Am Psychol, 2000, 55(1):68-78. doi: 10.1037//0003-066x.55.1.68 pmid: 11392867
[22]	韩明辉, 李来有, 梁军利, 等. 同伴教育对食管癌放疗患者负性情绪的影响[J]. 国际护理学杂志, 2024, 43(12):2153-2157.
	Han MH, Li LY, Liang JL, et al. Effects of peer education on negative emotions in patients with radiotherapy for esophageal cancer[J]. Int J Nurs, 2024, 43(12):2153-2157.
[23]	何芳, 周文华, 董亚秀, 等. 护士主导的同伴教育在骨质疏松症患者中的应用效果[J]. 中华现代护理杂志, 2024, 30(29):4030-4034.
	He F, Zhou WH, Dong YX, et al. Effects of nurse-led peer education in patients with osteoporosis[J]. Chin J Mod Nurs, 2024, 30(29):4030-4034.
[24]	田玉泉, 张敏, 赵桂华. 基于同伴互助的缺陷式情景模拟法在手术室护理中的应用[J]. 齐鲁护理杂志, 2021, 27(14):93-95.
	Tian YQ, Zhang M, Zhao GH. Application of defective scena-rio simulation method based on peer mutual assistance in nursing of operating room[J]. J Qilu Nurs, 2021, 27(14):93-95.