Abstract: Objective To understand the experience of intolerance of uncertainty in patient with repeated hospital admission and no clear diagnosis. Methods From December 2018 to March 2019,21 patients with repeated hospital admission and no clear diagnosis were recruited from a tertiary hospital in Beijing by maximum variation sampling. Semi-structured interviews were conducted to collect data. Results Ten themes were grouped into three major themes including the manifestations of intolerance of uncertainty in patients with repeated hospital admission and no clear diagnosis,the factors associated with intolerance of uncertainty,and needs of patients. Conclusion Effective communication between healthcare professionals and patients should be promoted to provide patients with comprehensive and clear information,and multidisciplinary diagnosis and treatment mode should be developed to enhance patient experience.

Key words: Diagnosis, Intolerance of Uncertainty, Psychological Experience, Qualitative Research, Nursing Administration Research

摘要： 目的 了解反复入院仍不能明确疾病诊断情境下患者无法容忍不确定性的体验。方法 采用最大差异抽样法选取2018年12月—2019年3月北京市某三级甲等医院中多次入院仍不能明确疾病诊断的患者21例进行半结构式访谈,并对访谈资料进行转录、编码、类属分析、描述和组织。结果 通过对访谈资料的分析,提炼出“患者无法忍受不确定性的表现”“影响患者无法忍受不确定性的因素”“患者在诊疗过程中的需求”3部分内容,以及“不确定性规避”“负性情绪”“认知与行为偏差”“对医院的预期过高”“反复辗转造成的经济压力“等10个一级主题。结论 针对反复入院仍不能明确疾病诊断的患者,护理人员需进一步增加与患者之间有针对性的沟通,为患者提供充分且清晰的信息,避免其负性情绪背后的认知行为偏差导致的错误决策。同时,完善多学科诊疗模式是促进患者科学决策、优化就医体验的发展方向。

关键词: 诊断, 无法忍受不确定性, 心理体验, 质性研究, 护理管理研究