A型主动脉夹层患者住院期间心理体验的质性研究

doi:10.3761/j.issn.0254-1769.2024.19.009

摘要/Abstract

摘要：

目的探讨Stanford A型主动脉夹层患者住院期间不同阶段的心理体验。方法采用目的抽样法，选取2022年5月—8月在广东省某三级甲等综合医院收治的Stanford A型主动脉夹层患者10例作为研究对象。进行半结构访谈，并采用解释现象学分析方法分析资料、提炼主题。结果共提炼出3个一级主题、14个二级主题。①诊断期不确定感增加，信息与情感支持需求强烈，包括对急诊环境的恐惧、未知感增强、渴望医护人员关注、希望尽快手术；②治疗期存在认知偏差，治疗依从性较低，包括对仪器报警声的恐惧、对医疗设备及管路的排斥、治疗期间的尊严缺失、身体受限的无助感、长期入住ICU的绝望；③康复期生活重大转折后的憧憬与担忧，包括积极面对未来生活、对家人的愧疚感、对人工血管植入的担忧、社会参与的担忧、疾病自我管理与预后的担忧。结论 Stanford A型主动脉夹层患者住院期间不同阶段的心理体验及心理需求不断变化，医护人员在诊断期应加强患者信息与情感支持；治疗期加强沟通解释与心理疏导；康复期加强患者疾病自我管理能力，提升其社会支持水平，并引导正性心理体验的唤醒。

关键词: 主动脉夹层, Stanford A型, 心理体验, 质性研究, 护理

Abstract:

Objective This study aims to explore the psychological experiences of patients with Stanford Type A aortic dissection during different stages of their hospital stay. Methods Using purposive sampling，10 patients treated for Stanford Type A aortic dissection from May to August 2022 at a tertiary A general hospital in Guangdong Province were selected as study subjects. Semi-structured interviews were conducted，and the data were analyzed using interpretative phenomenological analysis to extract themes. Results 3 primary themes and 14 sub-themes were identified. 1. During the diagnosis phase，patients experienced increased uncertainty，with a strong need for information and emotional support. This included fear of the emergency environment，enhanced sense of the unknown，a desire for attention from medical staff，and hope to have surgery soon. 2. During the treatment phase，patients had cognitive bias and low treatment compliance，including fear of monitor alarms，rejection of medical devices and tubes，a sense of lost dignity during treatment，feelings of helplessness due to physical restrictions，and despair over prolonged ICU stays. 3. In the recovery phase，patients anticipated and were worried about significant life changes，including a shift in mindset to actively face future life，feelings of guilt towards family members，concerns about artificial blood vessel implants，anxiety about social participation，and worries about disease self-management and prognosis. Conclusion The psychological experiences and needs of patients with Stanford Type A aortic dissection vary during different stages of their hospital stay. During the diagnosis phase，medical staff should strengthen information and emotional support；during the treatment phase，they should enhance communication and psychological counseling；and during the recovery phase，medical staff should improve patients’ disease self-management skills，enhance their level of social support，and guide the awakening of positive psychological experiences.

Key words: Aortic Dissection, Stanford Type A, Psychological Experience, Qualitative Study, Nursing Care

朱瑾, 张容, 张立力, 谭雯渲. A型主动脉夹层患者住院期间心理体验的质性研究[J]. 中华护理杂志, 2024, 59(19): 2369-2374.

ZHU Jin, ZHANG Rong, ZHANG Lili, TAN Wenxuan. A qualitative study on psychological experience of Stanford Type A aortic dissection patients during hospitalization[J]. Chinese Journal of Nursing, 2024, 59(19): 2369-2374.

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