ICU患者家属创伤后成长体验的质性研究

doi:10.3761/j.issn.0254-1769.2021.03.005

摘要/Abstract

摘要：

目的深入了解神经外科ICU患者家属创伤后成长的真实体验。方法采用质性研究中描述性现象学研究法,于2019年4月—8月对12名上海市某三级甲等综合医院神经外科ICU患者家属进行深入访谈,借助Nvivo 11软件管理访谈资料,采用Colaizzi 7步分析法进行归纳分析并提炼主题。结果共提炼出4个主题：人生哲学的改变,包括对生命的欣赏、关注自身健康、确立生活的优先次序、不确定的未来;个人力量增强,包括挖掘优势潜能、责任感增强、自我依靠感增强;与他人关系改善,包括“为己利他”行为、人际交往中获益;有效应对,包括设定希望、向下比较、学会自我调适。结论神经外科ICU患者家属在对抗逆境的过程中能体验到创伤后成长,呈现积极的自我变化现象,临床医护人员应关注患者家属的积极体验,将创伤后成长与临床心理护理整合,促成临床干预向以激发潜能、培养积极力量、促进成长为主题的范式转变。

关键词: 重症监护病房, 家属, 创伤后成长, 质性研究, 心理护理

Abstract:

Objective To deeply understand the real post-traumatic growth experience of the family members of ICU patients in neurosurgery. Methods The descriptive phenomenological method in qualitative research was used to conduct in-depth interviews with the family members of 12 ICU patients from neurosurgery of a tertiary hospital in Shanghai. Nvivo11 software was used to manage the interview data,and Colaizzi 7-step analysis was used to summarize and extract the topics. Results 4 themes are extracted：the change of philosophy of life,including the appreciation of life,attention to their own health,the establishment of life priorities,the uncertainty of the future;the enhancement of personal strength,including the exploitation of advantage potential,the enhancement of sense of responsibility,the enhancement of sense of self-dependence;improving relationships with others,including "altruistic behavior",and benefiting from interpersonal communication;coping effectively involves setting expectations,comparing downward,and learning to adjust. Conclusion Family members of neurosurgery ICU patients in the fight against adversity can experience the process of posttraumatic growth,present the positive self-change phenomenon;clinical medical personnel should pay attention to patients' family members experience actively,integrating posttraumatic growth and clinical psychological nursing care,clinical intervention to inspire potential and cultivate positive energy,promote growth,as the theme of paradigm shift.

Key words: Intensive Care Units, Family Member, Post-Traumatic Growth, Qualitative Research, Psychological Nursing

林琪, 曾莉, 任君红. ICU患者家属创伤后成长体验的质性研究[J]. 中华护理杂志, 2021, 56(3): 347-352.

LIN Qi, ZENG Li, REN Junhong. A qualitative research on post-traumatic growth experience of family members of ICU patients in neurosurgery[J]. Chinese Journal of Nursing, 2021, 56(3): 347-352.

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参考文献 24

[1]	Ortiz-Prado E, Mascialino G, Paz C , et al. A nationwide study of incidence and mortality due to traumatic brain injury in Ecuador(2004-2016)[J]. Neuroepidemiology, 2020,54(1):33-44.
[2]	Hendrickson CM, Howard BM, Kornblith LZ , et al. The acute respiratory distress syndrome following isolated severe traumatic brain injury[J]. J Trauma Acute Care Surg, 2016,80(6):989-997.
[3]	Korley FK, Kelen GD, Jones CM , et al. Emergency department evaluation of traumatic brain injury in the United States,2009-2010[J]. J Head Trauma Rehabil, 2016,31(6):379-387.
[4]	关玉珠, 孟萌, 李乐之 . 危重患者决策代理人心理体验及干预的研究进展[J]. 护理学杂志, 2019,34(23):99-102.
	Guan YZ, Meng M, Li LZ . Research progress on psychological experience of surrogate decision makers for critically ill patients[J]. J Nurs Sci, 2019,34(23):99-102.
[5]	Hacker P . Supporting family in their search for meaning and purpose during unexpected ICU admission improves coping,resilience and psychological outcomes[J]. Evid Based Nurs, 2020,23(1):15.
[6]	李真, 吴欣娟, 杨慧 , 等. ICU日记对患者及家属心理健康干预效果的Meta分析[J]. 中华护理杂志, 2020,55(7):1091-1096.
	Li Z, Wu XJ, Yang H , et al. The effectiveness of ICU diary on mental health status of ICU patients and their family mem-bers:a systematic review and meta-analysis[J]. Chin J Nurs, 2020,55(7):1091-1096.
[7]	Tedeschi RG, Calhoun LG . TARGET ARTICLE:“posttraumatic growth:conceptual foundations and empirical evidence”[J]. Psychol Inq, 2004,15(1):1-18.
[8]	雍海荣, 张卫 . 神经外科重症患者家属心理症状群及其影响因素分析[J]. 安徽医药, 2018,22(6):1195-1198.
	Yong HR, Zhang W . Psychological symptom clusters and its influence factors in the family members of severe neurosurgical patients[J]. Anhui Med Pharm J, 2018,22(6):1195-1198.
[9]	Lester EG, Silverman IH, Gates MV , et al. Associations between gender,resiliency factors,and anxiety in neuro-ICU caregivers:a prospective study[J]. Int J Behav Med, 2020: 1-10.
[10]	Meyers E, Lin A, Lester E , et al. Baseline resilience and depression symptoms predict trajectory of depression in dyads of patients and their informal caregivers following discharge from the Neuro-ICU[J]. Gen Hosp Psychiatry, 2020,62:87-92.
[11]	Dekel S, Ein-Dor T, Solomon Z . Posttraumatic growth and posttraumatic distress:a longitudinal study[J]. Psychol Trauma:Theory Res Pract Policy, 2012,4(1):94-101.
[12]	Picoraro JA, Womer JW, Kazak AE , et al. Posttraumatic growth in parents and pediatric patients[J]. J Palliat Med, 2014,17(2):209-218.
[13]	李丽雅, 姜男, 赵岳 . 孤独症儿童父母创伤后成长状况及其影响因素分析[J]. 中华护理杂志, 2015,50(3):317-321.
	Li LY, Jiang N, Zhao Y . The current status and impact factors of posttraumatic growth in parents of children with autism[J]. Chin J Nurs, 2015,50(3):317-321.
[14]	涂宗勍, 欧阳芸, 朱唯一 , 等. 骨肉瘤患者照顾者创伤后成长体验的现象学研究[J]. 上海护理, 2018,18(12):29-33.
	Tu ZQ, Ouyang Y, Zhu WY , et al. A qualitative research on posttraumatic growth in caregivers of patients with osteosarcoma[J]. Shanghai Nurs, 2018,18(12):29-33.
[15]	Shand LK, Brooker JE, Burney S , et al. Psychosocial factors associated with posttraumatic stress and growth in Australian women with ovarian cancer[J]. J Psychosoc Oncol, 2018,36(4):470-483.
[16]	杨阳, 肖红, 王丽萍 , 等. 育龄期宫颈癌子宫切除术后患者创伤后成长的质性研究[J]. 中国实用护理杂志, 2015,31(3):189-192.
	Yang Y, Xiao H, Wang LP , et al. A qualitative research on posttraumatic growth in patients with cervical cancer who had a hysterectomy at the childbearing age[J]. Chin J Pract Nurs, 2015,31(3):189-192.
[17]	鲁莎莎, 卢凌 . 滋养细胞肿瘤患者化疗期间创伤后成长的质性研究[J]. 中国护理管理, 2019,19(5):678-681.
	Lu SS, Lu L . Qualitative research on posttraumatic growth during chemotherapy inpatients with gestational trophoblastic tumor[J]. Chin Nurs Manag, 2019,19(5):678-681.
[18]	唐磊, 李静, 强万敏 . 中青年乳腺癌术后患者康复期创伤后成长体验的质性研究[J]. 护士进修杂志, 2019,34(8):747-750.
	Tang L, Li J, Qiang WM . Qualitative research on post-traumatic growth experience of young and middle-aged patients after breast cancer surgery[J]. J Nurses Train, 2019,34(8):747-750.
[19]	孙胜红, 刘安诺, 金宗兰 , 等. 接受父母供肾移植患者术后心理体验的质性研究[J]. 中华护理杂志, 2017,52(4):395-399.
	Sun SH, Liu AN, Jin ZL , et al. A qualitative research on postoperative psychological experiences of patients underwent kidney transplant donated by his/her parent[J]. Chin J Nurs, 2017,52(4):395-399.
[20]	王雪, 张国惠, 唐永利 . 意外创伤截肢患者创伤后成长体验的质性研究[J]. 护理学杂志, 2015,30(6):89-90,99.
	Wang X, Zhang GH, Tang YL . Qualitative research on posttraumatic growth in patients after traumatic amputation[J]. J Nurs Sci, 2015,30(6):89-90,99.
[21]	Byra S . Posttraumatic growth in people with traumatic long-term spinal cord injury:predictive role of basic hope and coping[J]. Spinal Cord, 2016,54(6):478-482.
[22]	Pérez-San-Gregorio MÁ, Martín-Rodríguez A, Borda-Mas M , et al. Family caregivers of liver transplant recipients:coping strategies associated with different levels of post-traumatic growth[J]. Transplant Proc, 2018,50(2):646-649.
[23]	Rzeszutek M, Oniszczenko W, Kwiatkowska B . Stress coping strategies,spirituality,social support and posttraumatic growth in a Polish sample of rheumatoid arthritis patients[J]. Psychol Health Med, 2017,22(9):1082-1088.
[24]	Hullmann SE, Fedele DA, Molzon ES , et al. Posttraumatic growth and hope in parents of children with cancer[J]. J Psychosoc Oncol, 2014,32(6):696-707.