College of Nursing, Pusan National University, Republic of Korea.
Center for Nursing Excellence in Palliative Care, Nell Hodgson Woodruff School of Nursing, Emory University, United States.
Int J Nurs Stud. 2019 Jul;95:34-39. doi: 10.1016/j.ijnurstu.2019.03.020. Epub 2019 Apr 5.
BACKGROUND: Effective communication between family and clinicians has been identified as one of the most important factors in end-of-life care. Family members' perception of communication quality with clinicians may be associated with their psychological symptoms. OBJECTIVES: To examine the association between family-clinician (physicians or nurses) communication quality and symptoms of anxiety, depression, and stress among family members of chronically critically ill patients in intensive care units (ICUs). DESIGN: A cross-sectional study. SETTINGS AND PARTICIPANTS: The participants were 71 adult family members of 71 patients who required prolonged mechanical ventilation in ten ICUs at three medical centres in Korea. METHODS: Participants completed the Quality of Communication (QOC) questionnaire, Hospital Anxiety and Depression Scale (HADS), and Impact of Event Scale-Revised (IES-R). The data were analysed using correlation, bivariate regression, and multiple regression analysis. RESULTS: The mean (SD) QOC score for physicians and nurses was 50.3 (15.2) and 42.9 (14.2), respectively. Forty-six participants (64.8%) were identified as being at risk for having anxiety symptoms; 22 (31%) had a mild risk and 24 (33.8%) had a moderate or severe risk. More family members (76.1%) were at risk for having depressive symptoms; 15 (21.1%) had a mild risk and 39 (54.9%) had a moderate or severe risk. For post-traumatic stress symptoms, 48 (67.6%) were at risk. While the QOC scores for nurses were negatively associated with participants' HADS-depression scores (β = -.01, p = .03), the QOC scores for physicians were not associated with the HADS or IES-R scores. This conclusion held after consideration of covariates. CONCLUSIONS: The findings suggest that communication between family members and ICU nurses may be more influential than that with ICU physicians on psychological distress of family members in Korea. However, further research is warranted to confirm this relationship. Future interventions to reduce psychological distress in family members of chronically critically ill patients may need to target ICU nurses for improving communication skills.
背景：家庭与临床医生之间的有效沟通已被确定为临终关怀最重要的因素之一。家庭成员对与临床医生沟通质量的感知可能与他们的心理症状有关。
目的：研究重症监护病房（ICU）慢性重病患者家属与临床医生（医生或护士）沟通质量与焦虑、抑郁和压力症状之间的关系。
设计：横断面研究。
地点和参与者：参与者为韩国三个医疗中心的十个 ICU 中需要长时间机械通气的 71 名患者的 71 名成年家属。
方法：参与者完成了沟通质量（QOC）问卷、医院焦虑抑郁量表（HADS）和修订后的事件影响量表（IES-R）。使用相关分析、双变量回归和多元回归分析对数据进行分析。
结果：医生和护士的 QOC 得分平均值（标准差）分别为 50.3（15.2）和 42.9（14.2）。46 名参与者（64.8%）被确定为有焦虑症状风险；22 名（31%）有轻度风险，24 名（33.8%）有中度或重度风险。更多的家庭成员（76.1%）有抑郁症状风险；15 名（21.1%）有轻度风险，39 名（54.9%）有中度或重度风险。创伤后应激症状方面，有 48 名（67.6%）有风险。虽然护士的 QOC 评分与参与者 HADS 抑郁评分呈负相关（β=-0.01，p=0.03），但医生的 QOC 评分与 HADS 或 IES-R 评分无关。在考虑了协变量后，这一结论仍然成立。
结论：研究结果表明，在韩国，家庭成员与 ICU 护士的沟通可能比与 ICU 医生的沟通对家庭成员的心理困扰更有影响。然而，需要进一步的研究来证实这种关系。未来减少慢性重病患者家属心理困扰的干预措施可能需要针对 ICU 护士，以提高沟通技巧。
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