护士主导的家庭支持干预对家属对重症监护的满意度和心理幸福感的影响：一项混合方法评估。

Impact of a nurse-led family support intervention on family members' satisfaction with intensive care and psychological wellbeing: A mixed-methods evaluation.

机构信息

Centre of Clinical Nursing Science, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland; Institute for Implementation Science in Health Care, Faculty of Medicine, University of Zurich, Universitätsstrasse 84, 8006 Zurich, Switzerland.

Department of Biostatistics, Institute of Epidemiology, Biostatistics, and Prevention, Faculty of Medicine, University of Zurich, Hirschengraben 84, 8001 Zurich, Switzerland.

出版信息

Aust Crit Care. 2021 Nov;34(6):594-603. doi: 10.1016/j.aucc.2020.10.014. Epub 2021 Feb 24.

DOI:10.1016/j.aucc.2020.10.014

PMID:33637427

Abstract

BACKGROUND

Families of critically ill persons face uncertainty and experience distress during and after their close other's stay in an intensive care unit (ICU). Proactive nurse engagement and support is recommended to meet families' needs in the ICU, but little is known about its impact on quality of family care. We introduced a family support intervention that consisted of an interprofessional family support pathway and a new role of an advanced practice family nurse.

OBJECTIVES

The aim of the study was to examine the effect of an advanced practice nurse-led family support intervention on family members' satisfaction, wellbeing, and psychological distress.

METHODS

We conducted a quasi-experimental before-and-after study with embedded qualitative interviews in a Swiss University Hospital from March 2018 to July 2019 using a questionnaire (Family Satisfaction in the ICU-24 Survey, Hospital Anxiety and Depression Scale, and Impact of Event Scale-Revised-6) and qualitative interviews (n = 19) after patient discharge.

RESULTS

Families in the intervention group (n = 75) showed a trend for increased overall satisfaction (difference of 5.544, 95% confidence interval [CI]: -0.11 to 11.20), a statistically significant increase in satisfaction with decision-making (7.258, 95% CI: 0.89 to 13.63), and a nonsignificant increase in satisfaction with care (4.178, 95% CI: -1.53 to 9.89). Psychological distress was higher in the intervention group, with depression reaching statistical significance (difference of 1.706, 95% CI: 0.16 to 3.25), which may be explained by longer ICU stays and higher proportion of deaths in the intervention group. Families receiving the intervention reported to be feeling cared for, well informed, and better able to cope. Data integration suggests that early onset, fit to need, and quality of intervention were the most important intervention characteristics impacting family wellbeing.

CONCLUSIONS

Our study found that family members experience a nurse-led support intervention as beneficial for their wellbeing. It increased their satisfaction, but was unable to demonstrate a favourable impact on psychological distress.

摘要

背景

危重病患者的家属在其亲属入住重症监护病房（ICU）期间和之后会面临不确定性并感到痛苦。建议积极的护士参与和支持来满足 ICU 中家庭的需求，但对其对家庭护理质量的影响知之甚少。我们引入了一种家庭支持干预措施，其中包括跨专业的家庭支持途径和一个新的高级实践家庭护士角色。

目的

本研究旨在探讨由高级实践护士领导的家庭支持干预对家庭成员满意度、幸福感和心理困扰的影响。

方法

我们在瑞士一所大学医院进行了一项准实验性的前后对照研究，采用问卷调查（重症监护病房家庭满意度-24 调查、医院焦虑抑郁量表和事件影响量表修订版-6）和定性访谈（n=19），在患者出院后进行。研究时间为 2018 年 3 月至 2019 年 7 月。

结果

干预组（n=75）的家庭整体满意度呈上升趋势（差异为 5.544，95%置信区间 [CI]：-0.11 至 11.20），决策满意度呈统计学显著增加（7.258，95% CI：0.89 至 13.63），护理满意度呈非显著增加（4.178，95% CI：-1.53 至 9.89）。干预组的心理困扰程度较高，抑郁达到统计学意义（差异为 1.706，95% CI：0.16 至 3.25），这可能是由于干预组 ICU 住院时间较长且死亡比例较高所致。接受干预的家庭报告感到被照顾、信息灵通，并且能够更好地应对。数据整合表明，干预的早期发生、符合需求和质量是对家庭幸福感影响最重要的干预特征。