家庭在 ICU 重新获得控制权的障碍：缺乏联系。
Barriers to families' regaining control in ICU: Disconnectedness.
机构信息
School of Nursing and Midwifery, Faculty of Health, Deakin University, Geelong, Australia.
School of Science and Health, Western Sydney University, Campbelltown Campus, Penrith, Australia.
出版信息
Nurs Crit Care. 2018 Mar;23(2):95-101. doi: 10.1111/nicc.12310. Epub 2017 Aug 28.
BACKGROUND
The nature of interactions between health care professionals and families may have a significant impact on families' experience and outcomes of critical illness. The value of encouraging positive relationships with families is well documented; however, it is argued that the lack of theoretical frameworks to guide practice in this area may be a barrier to improving patient- and family-centred care.
AIMS
The study on which this paper is based aimed to understand families' experiences of their interactions when a relative is admitted unexpectedly to an Australian intensive care unit and to generate a substantive theory that represents families' interactions that can be used to guide critical care nursing practice when caring for patients' families in this context.
DESIGN AND METHODS
A grounded theory methodology was adopted for the study. Data were collected between 2009 and 2013 using in-depth interviews with 25 family members of 21 critically ill patients admitted to a metropolitan, tertiary-level intensive care unit (ICU) in Australia.
FINDINGS
A core category of regaining control has been generated from our study. This paper focuses on Disconnectedness, which leads to increased emotional vulnerability and is also a barrier to families' regaining control. Families feel disconnected when staff emotionally and physically disengage from them, when staff interact insensitively and in a manner that offers families limited hope.
CONCLUSION
Our findings offer an in-depth understanding of staff engagement with families and its impact on the families' ability to regain control. Although some themes have been previously identified in the literature in isolation, the interrelationships of the categories within a theoretical framework to represent family resilience in the context of an ICU situated in the Australian health care system are a novel finding.
RELEVANCE TO CLINICAL PRACTICE
The findings can be used to support patient- and family-centred care interventions in the ICU.
背景
医护人员与患者家庭之间的互动性质可能对家庭在重症疾病期间的体验和结局产生重大影响。鼓励与家庭建立积极关系的价值已得到充分证明；然而，有人认为，缺乏理论框架来指导这一领域的实践可能是改善以患者和家庭为中心的护理的障碍。
目的
本研究旨在了解当亲属意外入住澳大利亚重症监护病房时家庭的互动体验，并生成一个实质性理论，代表家庭的互动，可用于指导在这种情况下护理患者家庭的重症监护护理实践。
设计和方法
本研究采用扎根理论方法。数据于 2009 年至 2013 年期间通过对 21 名入住澳大利亚大都市三级重症监护病房的重症患者的 25 名家属进行深入访谈收集。
结果
从我们的研究中产生了一个核心类别，即重新获得控制。本文重点介绍了脱节，这导致情绪脆弱性增加，也是家庭重新获得控制的障碍。当工作人员在情感和身体上与他们脱节、工作人员以不敏感和提供家庭有限希望的方式互动时，家庭会感到脱节。
结论
我们的研究结果深入了解了工作人员与家庭的互动及其对家庭重新获得控制能力的影响。尽管有些主题之前在文献中已经孤立地识别出来，但在代表 ICU 中家庭弹性的理论框架内，类别之间的相互关系是一个新的发现。
对临床实践的意义
研究结果可用于支持 ICU 中的以患者和家庭为中心的护理干预措施。
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