ICU患者家属不同阶段照护体验的质性研究

目的探讨ICU患者家属在疾病不同阶段的照护体验。方法采用现象学研究法,对36名处于不同照护阶段的ICU患者家属进行非结构式访谈,用质性研究分析法对资料进行分析。结果ICU患者家属不同阶段的照护体验分别为:诊断期,应激反应强烈;治疗期,信息支持不足;转科准备期,缺乏人性化管理;临终期,提倡临终关怀。结论患者入住ICU期间,患者家属在不同照护阶段的需求是动态变化的,医护人员应针对性地提供个性化服务,不断提高医疗服务质量。     

关怀日记在ICU患者人文护理中的应用

目的探讨关怀日记在ICU患者人文关怀中的实施效果。方法将2018年综合ICU收治的患者按时间顺序分为对照组318例和干预组403例。对照组接受ICU常规护理,干预组在此基础上,聚焦人文关怀护理,将ICU日记调整为ICU关怀日记并应用。比较两组入ICU 24 h内及转出ICU时焦虑、抑郁发生率,并收集干预组患者及家属对ICU关怀日记实施的满意度。结果干预组转出ICU时,焦虑、抑郁发生率显著低于对照组(P<0.05,P<0.01);干预组患者及家属对ICU关怀日记满意度得分8.75±0.56。结论记录ICU关怀日记能帮助危重患者及家属降低焦虑、抑郁发生率,提升对危重护理工作满意度。     

危重症患儿ICU过渡期护理的研究现况

总结危重患儿ICU过渡期护理的内容(包括转出前的客观评估与综合干预、过渡期间规范的病情交接、转出后的个性化随访和风险预测)、存在的问题(包括缺乏对负性心理情况的关注、过渡期间缺乏连续性照护、非计划ICU重返率高)并分析原因.提出促进患儿安全过渡的改善策略,包括促进良好的沟通、给予人力支持、促进患儿及家属心理健康.     

ICU过渡期患者家属需求量表的构建和信效度检验

目的 编制ICU过渡期患者家属需求量表并检验其信效度.方法 通过文献回顾、半结构式访谈、专家函询和预调查形成ICU过渡期患者家属需求量表;便利抽取186名ICU转出患者家属对量表进行信效度检验.结果 探索性因子分析提取5个公因子,累积方差贡献率为61.976％;最终形成量表包括5个维度22个条目.总量表的内容效度指数为0.898;Cronbach's α系数为0.895,折半信度为0.807,1周后重测信度为0.874.结论 ICU过渡期患者家属需求量表具有良好的信效度,可用于ICU过渡期患者家属需求评估.     

新疆多民族地区ICU临终患者家属放弃治疗真实体验的质性研究

目的了解新疆多民族地区ICU临终患者家属对放弃治疗的真实体验,为制定有效的干预措施、促进ICU放弃治疗的临终患者家属身心健康提供依据。方法采用质性研究中的现象学研究方法,对15名ICU放弃治疗的临终患者家属进行半结构式深入访谈,应用Colaizzi分析法进行资料分析。结果 ICU临终患者家属放弃治疗的真实体验提炼出5个主题:预后差,救治希望渺茫;文化背景及宗教信仰;经济负担过重;注重患者的生命质量;放弃治疗后表现出复杂的负性心理。结论新疆多民族地区ICU临终患者家属放弃治疗的原因多样,家属经历严重的负性情绪。需构建更完善的社会支持系统,逐步建立由患者、家属和医护人员共同组成的决策共享模式,以减轻家属因签署放弃治疗而导致的巨大心理压力。     

精神分裂症患者家属照护体验的质性研究

目的深入了解精神分裂症患者家属(下称患者家属)的照护体验及照护对自身造成的影响,为针对性社区干预提供参考。方法对20名患者家属采取深入访谈和观察法获得其真实感受和体验,采用现象学分析提炼主题。结果获得照护缺乏系统性,获取精神康复知识渠道单一,身心负担过重,经济压力过大,家庭关系恶化5个主题。结论患者家属在照护过程中存在较多问题,应针对性地完善社区护理机构,提供知识、心理援助,减轻其负担,提高照护水平。     

ICU护士与患者家属沟通影响因素的质性研究

目的探讨影响ICU护士与患者家属沟通的相关因素。方法采用半结构式访谈方法,收集12名ICU护士与患者家属的沟通感受,用质性研究内容分析法对收集的资料进行分析。结果影响ICU护士与患者家属沟通的因素包括沟通环境不良、缺乏沟通意识(沟通准备不足;忽视主动沟通等)、缺乏沟通自信(专业知识储备不足;缺乏沟通技巧)、同情心疲乏与职业倦怠。结论护理管理者应重视ICU护士沟通能力的培养,有计划地为护士提供沟通培训及指导,以期能有效提高ICU护士的临床沟通能力,使ICU护士与患者家属达到有效沟通。     

家属对晚期肿瘤患者实施预立医疗照护计划态度的质性研究

目的 了解家属对晚期肿瘤患者实施预立医疗照护计划的态度,为姑息照护领域相关医疗决策的制定提供依据.方法 对17名晚期肿瘤患者家属进行深度访谈,采用现象学分析法分析资料.结果 家属对预立医疗照护计划的态度提炼出4个主题:如患者主动提出,自己愿意支持;预立医疗照护计划本意较好,但不忍患者面对;预立医疗照护计划本身存在一定缺陷,效果令人质疑;目前实施有难度,将来有望推广.家属对晚期肿瘤患者终末治疗的选择提炼出2个主题:不忍患者受苦,选择放弃抢救;进退两难,抢救为无奈之举.结论 晚期肿瘤患者家属在认可预立医疗照护计划的同时存在很多顾虑,知晓抢救的无效性但因外在压力和良心不安选择抢救;医护人员应做好家属健康教育,并协助家属与患者、家属与家属之间进行坦诚沟通,以推广预立医疗照护计划的理念.     

序贯性早期床上运动对ICU老年患者肌力及自理能力的影响

目的探讨序贯性早期床上运动对ICU老年患者肌力及自理能力的影响。方法将80例ICU老年患者按随机数字表法分为干预组42例和对照组38例。对照组予ICU常规护理及运动,干预组在对照组基础上实施序贯性早期床上运动。比较两组干预前及转出ICU时MRC肌力评分、Barthel指数评分及机械通气时间、ICU住院时间及总住院时间。结果干预组转出ICU时MRC肌力评分及Barthel指数评分显著高于对照组,机械通气时间及ICU住院时间显著短于对照组(P0.05,P0.01)。结论序贯性早期床上运动有利于提高老年患者肌力,改善其自理能力,缩短机械通气时间及ICU治疗时间。     

对短暂性脑缺血患者实施家属参与照护模式的效果

目的探讨家属参与照护模式对短暂性脑缺血患者疾病认知水平及治疗依从性的影响。方法将82例短暂性脑缺血患者以随机数字表法分为研究组和对照组各41例,对照组按常规实施护理干预,研究组在对照组基础上引入家属共同参与照护模式。干预后测评患者治疗依从性、疾病知识掌握情况。结果干预后研究组治疗依从性、疾病知识掌握程度显著优于对照组(均P0.01)。结论对短暂性脑缺血患者引入家属共同参与照护模式,有助于提高患者的认知水平,提高其治疗依从性,有利于延缓疾病进程。     

心外科监护室病人家属需求及其心理状况调查

目的了解心外科监护室(ICU)病人家属的需求和心理状况。方法自行设计问卷对174例病人家属进行调查。结果病人家属对ICU的各项需求值为3.88-4.72分;对ICU各方面满意值为4.52-4.72;焦虑值(33.08±8.39)分与常模(29.78±10.07)分比较,差异有显著性意义(P<0.05);焦虑值与家属对病人病情严重程度的认知呈正相关,与其对探视制度的满意程度呈负相关(均P<0.05)。结论 病人家属焦虑程度高,对ICU有较高要求,医护人员应尽量满足其合理需求,减轻其焦虑心理,以更好地发挥家属对ICU病人的正性支持作用。     

以家庭为中心的探视对ICU肿瘤重症患者谵妄的影响

目的探讨以家庭为中心的探视模式预防ICU肿瘤重症患者谵妄发生的作用。方法将164例ICU肿瘤重症患者按照入院时间分为对照组和干预组各82例。对照组采用常规探视模式,干预组实施以家庭为中心的探视模式。比较两组谵妄发生率、ICU住院时间、ICU获得性感染发生率及ICU患者家属满意度。结果干预组谵妄发生率显著低于对照组,ICU住院时间显著短于对照组,ICU患者家属满意度显著高于对照组(P<0.05,P<0.01);两组ICU获得性感染发生率比较,差异无统计学意义(P>0.05)。结论实施以家庭为中心的探视模式可有效降低ICU肿瘤重症患者谵妄发生率,提高患者家属的满意度,且对ICU获得性感染发生率无明显影响。     

Who's Listening? Experiences of Women with Breast Cancer in Communicating with Physicians

The purpose of this qualitative study was to describe communication behaviors and attitudes of physicians that were most important to women living with breast cancer. Two focus group sessions were conducted, 1 month apart, involving 15 women who were members of a community-based breast cancer support group in Vancouver, British Columbia, Canada. Group dialogue was audiotaped, and notes were taken at each session by the coinvestigators, also members of the support group. Audiotapes, coinvestigators' written notes from the two focus group sessions, and the written homework assignments were used in the qualitative data analysis. Conceptual themes were identified and grouped to discern patterns within the data. The women were asked the following: (a) What were the most helpful things your doctor said or did at the time of your diagnosis? (b) What does a good intervention feel or look like? They were then asked to describe behaviors and attitudes they would like to influence in medical students who might later be communicating with women facing a diagnosis of breast cancer and to indicate which behaviors and attitudes they felt were most important. Women's positive experiences with physicians were characterized by communication based on active listening, awareness of the women's knowledge of their illness, honesty, and partnership. Physicians who showed interest in their patients as persons and who used touch to communicate caring were perceived as supportive communicators. Not surprisingly, there were similarities between the participants' positive experiences with their own physicians and the behaviors and attitudes desired in future physicians. Once again, “listening” was ranked as most important, followed by willingness to discern the individual patient's knowledge level.     

特重度烧伤患者家属心理需求的调查

目的：调查特重度烧伤患者家属的心理需求，为临床医患沟通提供有力的参考依据。方法：50名特重度烧伤患者家属于患者进入病房24～36小时后接受危重患者家属需求量表（critical care family needs inventory，CCFNX）的调查。结果：患者家属需求的重要程度由高到低依次为病情保证、获取信息、接近患者、获得支持和自身舒适。结论：特重度烧伤患者家属心理需求与ICU患者家属家庭需求的调查研究结果基本一致，这要求医护人员在救治患者的同时要注重患者家属的心理需求，避免家属的压力情境变成危机情境，促进医患和谐。     

Resilience in children and their parents enduring pediatric medical traumatic stress

Due to the general lack of familiarity with the concept in the medical field, resilience is rarely considered in pediatric medical traumas. Resilience is an ability that enables recovery after adversities such as traumas, surgeries, serious health problems, or social issues. Stress from medical traumas encompasses both the psychological and physical responses of children and their families. Lack of resilience in children with medical traumatic stress may contribute to poor adjustment, slow recovery, disruptive behaviors, and psychiatric disorders. Furthermore, persistent parental distress increases the child's risk of low resilience. Consequently, these patients and their parents require early identification. This is achievable using a common stress measure such as the Perceived Stress Scale. Moreover, health care providers can screen patients’ risks for low resilience, which include few social contacts, poor family functioning, and low cohesion among family members. Findings from the stress scale and screened risks could indicate the need for additional psychosocial support at the time of diagnosis of a serious illness, soon after injuries, and before and after operations. Such interventions can include decreasing distress, counseling children and their parents, and enabling strong connections to health care providers. Health care providers can help parents to minimize distress and adjust to their child's illness, thereby supporting the child's resilience, adjustment, and recovery.     

Discomfort, awareness and recall in the intensive care-still a problem?

INTRODUCTION: During surgery, anesthetists take extra care to prevent patient awareness done mainly under general anesthesia either by using inhalational or intravenous medications. However, patients in the ICU mainly those on ventilatory support with intubation and sedation, pass through lot of psychological stress and frustration. Most of the times this stress phenomenon is not documented in the general intensive care. This is the first report in our general ICU. AIM OF THIS STUDY: Assessment of this stress phenomenon in order to avoid it in future, and to elicit proper consensus regarding its existence and offer methods of re-solution. METHODS: Seventy patients aged (20-60) years were interviewed one day after discharge from the ICU, about their memory of events during their stay. Patients with head injury, CNS infection and those who were disoriented at the time of interview were excluded from the study. The remaining 55 patients were oriented as to place and time. Intravenous morphine was used for analgesia as required, while sedation was achieved using midazolam and morphine infusions in appropriate doses as decided by the attending doctors and nurses, to achieve appropriate Ramsay sedation score. Questions asked were patient's memory of events and their distressing experiences regarding pain, anxiety, dreams, fear, noises, and other discomforts. The same questions were repeated 5 days later. RESULTS: The sample of patients were representative of our regular ICU admissions in their age group, APACHE II score and duration of stay. The most distressing experiences recalled were: Anxiety (68%), discomfort from endotracheal tube (60%), fear (54%), pain (52%), discomfort from N/G tube (48%), difficulty in communicating (33%), dreams and hallucinations (31%), discomfort from physiotherapy (24%), noise (15%), insomnia (13%), thirst (10%), muscle paralysis (100%), some of these like anxiety, fear, dreams, hallucinations and insomnia had continued since discharge in 6% of patients. None of the studied experiences correlated with age, sex or with the APACHE II score. On interviewing the patient 5 days later, there were no significant change in their responses. CONCLUSION: Our sedation and analgesia in the ICU is not enough to prevent unpleasant experiences, mainly those related to patient awareness. More work is still needed i.e. using sedation measuring systems, to improve our sedation and analgesia in the ICU.     

ICU家属接待制度的建立与实施

目的探索ICU家属接待制度,深化优质护理服务.方法 建立家属接待制度,分为每日定时接待、即刻接待、预约接待3种形式,与实施前的常规探视制度进行效果比较.结果 与常规探视制度比较,接待制患者家属投诉和滞留显著减少,点名表扬显著增加(均P<0.01).结论 接待制度将制度管理与人性化关怀相结合,强化主动服务意识,深化了优质...     

Depression in diabetic foot ulcer: Associated factors and the impact of perceived social support and anxiety on depression

Diabetic foot ulcer (DFU) exerts a heavy physical and emotional burden on patients with diabetes mellitus. The purpose of the present study was to explore the impact of anxiety and perceived social support on depression of DFU patients well as patients'' characteristics associated with depression. The sample of the study consisted of 180 DFU patients. Data collected by the completion of “Self‐rating Depression/Anxiety Scale‐ Zung” (SDS/SAS) and the Multidimensional Scale of Perceived Social Support (MSPSS). Patients had moderate levels of anxiety and depression (median: 36, 42, respectively) and high levels of perceived social support from their significant ones, their family and friends (median: 24, 24, 17, respectively). After multiple regression factors that were found to have an impact on depression after taking into account all other factors, were patient''s age of above 70 years, patient''s anxiety and the social support they received from their significant ones. More specifically, patients aged above 70 years had 9.51 points higher depression than patients aged <50 years of age (β = 9.51, 95% CI: [0.76, 18.25], P = .034). Moreover, one point increase in patient''s anxiety score indicated an increase of 0.71 points in patient''s depression (β = 0.71, 95% CI: [0.43, 1.00], P = .001). On the contrary, one point increase in patient''s social support from their significant ones indicated a decrease of 1.52 points in patient''s depression (β = −1.52, 95% CI: [−0.25, −2.79], P = .020). Clinically, a better understanding of factors having an impact on depression on DFU may provide an essential in planning cost effective interventions.