目的 基于健康信念模型(health belief model,HBM),探讨重症监护室(intensive care unit,ICU)护士推动患者参与预先护理计划(advance care planning,ACP)的阻碍与促进因素,为制定系统化干预策略提供依据。方法 采用描述性质性研究,于2025年11-12月,目的抽样法选取西安市某三级甲等医院综合ICU的15名护士进行半结构式访谈,以HBM为框架设计访谈提纲,运用Colaizzi 7步分析法对访谈资料进行分析。结果 提炼出信念驱动、多维阻碍、行动契机及效能支撑4个主题。结论 ICU护士对推动ACP存在高价值认同与低实践效能矛盾。未来应基于HBM,从制度层面破除结构性阻碍,从能力层面强化护士自我效能,从文化层面营造支持性环境并推进公众教育,以系统化策略推动ACP在ICU的临床实践。

Objective To explore the barriers and facilitators of ICU nurses in promoting patient participation in advance care planning (ACP) based on the health belief model (HBM),and to provide a basis for developing systematic intervention strategies.Methods A descriptive qualitative study was conducted.From November to December 2025,15 nurses from the comprehensive ICU of a tertiary A hospital in Xi'an were selected by purposive sampling for semi-structured interviews.The interview guide was designed using the HBM as a framework,and the interview data were analyzed using Colaizzi's 7-step analysis method.Results 4 themes were extracted:belief-driven motivation,multidimensional barriers,action triggers,and efficacy support.Conclusions ICU nurses face a contradiction between high value recognition and low practical efficacy in promoting ACP.In the future,based on the HBM,structural barriers should be removed at the institutional level,nurses' self-efficacy should be strengthened at the competency level,a supportive environment should be created at the cultural level,and public education should be promoted,so as to advance the clinical practice of ACP in the ICU through systematic strategies.

R473

陕西省重点研发计划(2023-YBSF-635)