Campbell Grace B, Happ Mary Beth
University of Pittsburgh School of Nursing, Pittsburgh, Pennsylvania 15261, USA.
AACN Adv Crit Care. 2010 Jan-Mar;21(1):64-79. doi: 10.1097/NCI.0b013e3181c932a8.
Ascertaining the symptom experience of chronically critically ill (CCI) patients is difficult because of communication impairment and fluctuations in patient cognition and physiologic conditions. The use of checklist self-report ratings is hampered by the inability of most CCI patients to respond verbally to symptom queries. In addition to the communication problems caused by mechanical ventilation, the apparently diverse idioms of symptom expression add to the potential for miscommunication regarding symptom experience. Although patient communication impairment is a major barrier to symptom identification, symptom assessment and treatment are fundamental components of nursing care for CCI. This article reviews and describes the unique constellation of symptoms experienced by many critically ill patients. We report our observations of symptom communication among CCI patients and nurses and discuss inconsistency in the language of symptom expression among nurses and patients. Clinically applicable strategies to improve nurse-patient symptom communication and suggestions for refinement of symptom assessment in chronic critical illness are provided.
由于存在沟通障碍以及患者认知和生理状况的波动，确定慢性危重症（CCI）患者的症状体验颇具难度。大多数CCI患者无法对症状询问进行口头回应，这使得使用清单自我报告评级受到阻碍。除了机械通气导致的沟通问题外，症状表达明显多样的习语增加了症状体验方面沟通错误的可能性。尽管患者沟通障碍是症状识别的主要障碍，但症状评估和治疗是CCI护理的基本组成部分。本文回顾并描述了许多危重症患者所经历的独特症状群。我们报告了对CCI患者与护士之间症状沟通的观察结果，并讨论了护士与患者在症状表达语言上的不一致。提供了改善护患症状沟通的临床适用策略以及完善慢性危重症症状评估的建议。
