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半封闭病房危重症住院患者家属心理需求的横断面研究及影响因素分析

[A cross-sectional study on psychological needs of family members of critically ill inpatients in semi-closed wards and analysis of influence factors].

作者信息

Xu Q Q, Wang W L, Zhang Y, Wang M X, Dong Z C

机构信息

Department of Burns and Plastic Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China.

Department of Social Work, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China.

出版信息

Zhonghua Shao Shang Za Zhi. 2021 May 20;37(5):475-484. doi: 10.3760/cma.j.cn501120-20200314-00160.

Abstract

To analyze and discuss the psychological needs of family members of critically ill burn inpatients in semi-closed wards and their related influence factors. A cross-sectional survey was conducted among the 82 burn patients, who met the inclusion criteria and were admitted to the Department of Burns and Plastic Surgery of Ruijin Hospital of Shanghai Jiao Tong University School of Medicine from October 2018 to April 2019, and their family members. A general condition questionnaire of 15 indexes was applied to investigate the general data of burn patients and their family members including cause of burn, gender, age, total burn area, burn depth, burn severity, burn site, and type of medical insurance of patients, kinship with the patients, gender, age, experience of accompanying in intensive care isolation wards, occupation, education level, and monthly income of their family members. The Critical Care Family Needs Inventory (CCFNI) was used to assess each item, each factor, and total scores of the family members of patients including 5 factors and 45 items such as support scale (SS), comfort scale (CS), information scale (IS), proximity scale (PS), assurance scale (AS). CCFNI was used to assess the total scores of patients and their family members after classification according to the general data, the data were statistically analyzed with one-way analysis of variance or independent sample test. Indicators with statistical significance in the above analysis were selected for multiple linear regression analysis to screen the independent influence factors of psychological needs of patients' family members. CCFNI was used to assess each dimension scores of patients and their family members after classification according to the aforementioned selected independent influence factors including age and burn area of patients, gender, educational level, and experience of accompanying in intensive care isolation wards of their family members, and the data were statistically analyzed with one-way analysis of variance or independent sample test. A total of 82 questionnaires were sent out in this study, and 80 were effectively received, with s a recovery rate of 97.6%. In 80 patients, there were 45 males and 35 females; 35 cases (43.75%) were ≤14 years; most of the patients had flame and thermal burns; 33 patients (41.25%), 21 patients (26.25%), and 26 patients (32.50%) had moderate, severe, and extremely severe burns, respectively; and only 3 patients (3.75%) had no health insurance. In 80 family members of patients, 34 (42.50%) were males and 46 (57.50%) were females; 62.50% in the family members of patients were concentrated between 18 and 45 years old; and 12 family members of patients had experience of accompanying in intensive care isolation wards, accounting for 15.00%. The total CCFNI score of the family members was (141±14) points, and the scores of AS, PS, IS, CS, and SS were (3.77±0.23), (3.43±0.37), (3.53±0.34), (2.50±0.59), and (2.69±0.45) points, respectively. The top five items of the psychological needs of family members of patients were concentrated in three factors (AS, PS, and IS), and the item "ensuring that patients receive the best treatment" ranked the first, with a score of (3.99±0.11) points. There were significant differences on the CCFNI total scores of patients with different age, total burns area, and severity of burns and of their family members with different gender, education level, and whether or not experience of accompanying in intensive care isolation unit (=4.378, 5.481, 5.913, =4.027, 14.339, 7.265, <0.05 or <0.01). Multiple linear regression analysis showed that the patient's age (≤14, 15-45 years) and total burn area (11%-30%, 31%-49%, ≥50% TBSA) and the patient's family members' gender, educational level, experience of accompanying in intensive care isolation unit could affect the psychological needs of family members of patients (=3.133, 2.260, 2.297, 2.433, 3.015, 2.200, 2.102, 2.463, <0.05 or <0.01). There was statistically significant difference in AS score of the patients' family members with different age (=4.390, <0.05). There were significant differences in both IS and AS scores of the patients' family members of patients with different burn area (=5.042, 3.131, <0.05 or <0.01). The AS score of the patients' family members with experience of accompanying in intensive care isolation unit was significantly lower than those without (=-1.040, <0.05). The SS score of the patients' family members with college education or above was significantly higher than those with high school (technical secondary school) or below (=0.657, <0.05). The IS score of the patients' family members with college education or above was significantly lower than those with high school (technical secondary school) or below (=-1.438, <0.05). The SS score of male family members of patients was significantly lower than those of female patients (=4.149, <0.05). The family members of burn patients in semi-closed ward have the most urgent need to ensure the patients receive the best treatment. Patients' age, total burn area, and their family members' gender, education level, experience of accompanying in intensive care isolation unit are the main factors affecting the psychological needs of family members of patients.

摘要

分析并探讨半封闭病房中重症烧伤住院患者家属的心理需求及其相关影响因素。对2018年10月至2019年4月在上海交通大学医学院附属瑞金医院烧伤整形科住院、符合纳入标准的82例烧伤患者及其家属进行横断面调查。应用包含15项指标的一般情况问卷,调查烧伤患者及其家属的一般资料,包括烧伤原因、性别、年龄、烧伤总面积、烧伤深度、烧伤严重程度、烧伤部位、患者医保类型、与患者的亲属关系、家属性别、年龄、在重症监护隔离病房陪伴经历、职业、文化程度及月收入等。采用重症监护家属需求量表(CCFNI)评估患者家属的各项、各因子及总分,该量表包括支持量表(SS)、舒适量表(CS)、信息量表(IS)、亲近量表(PS)、安心量表(AS)5个因子共45个条目。根据一般资料分类后,用CCFNI评估患者及其家属总分,数据采用单因素方差分析或独立样本t检验进行统计学分析。将上述分析中有统计学意义的指标进行多元线性回归分析,筛选出患者家属心理需求的独立影响因素。根据上述筛选出的独立影响因素,包括患者年龄和烧伤面积、家属性别、文化程度、在重症监护隔离病房陪伴经历等分类后,用CCFNI评估患者及其家属各维度得分,数据采用单因素方差分析或独立样本t检验进行统计学分析。本研究共发放问卷82份,有效回收80份,回收率为97.6%。80例患者中,男性45例,女性35例;35例(43.75%)年龄≤14岁;多数患者为火焰和热烧伤;中度、重度、特重度烧伤患者分别为33例(41.25%)、21例(26.25%)、26例(32.50%);仅3例(3.75%)无医保。80例患者家属中,男性34例(42.50%),女性46例(57.50%);患者家属年龄62.50%集中在18~45岁;12例患者家属有在重症监护隔离病房陪伴经历,占15.00%。患者家属CCFNI总分(141±14)分,AS、PS、IS、CS、SS得分分别为(3.77±0.23)、(3.43±0.37)、(3.53±0.34)、(2.50±0.59)、(2.69±0.45)分。患者家属心理需求前五位集中在三个因子(AS、PS、IS),“确保患者得到最佳治疗”条目位居首位,得分(3.99±0.11)分。不同年龄、烧伤总面积、烧伤严重程度的患者及其家属,不同性别、文化程度、是否有在重症监护隔离病房陪伴经历的家属CCFNI总分比较,差异有统计学意义(F=4.378、5.481、5.913,t=4.027、14.339、7.265,P<0.05或P<0.01)。多元线性回归分析显示,患者年龄(≤14岁、15~45岁)、烧伤总面积(11%~30%、31%~49%、≥50%TBSA)及患者家属性别、文化程度、在重症监护隔离病房陪伴经历可影响患者家属心理需求(β=3.133、2.260、2.297、2.433、3.015、2.200、2.102、2.463,P<0.05或P<0.01)。不同年龄患者家属AS得分比较,差异有统计学意义(F=4.390,P<0.05)。不同烧伤面积患者家属IS、AS得分比较,差异有统计学意义(F=5.042、3.131,P<0.05或P<0.01)。有在重症监护隔离病房陪伴经历的患者家属AS得分显著低于无陪伴经历者(t=-1.040,P<0.05)。大专及以上文化程度患者家属SS得分显著高于高中(中专)及以下者(t=0.657,P<0.05)。大专及以上文化程度患者家属IS得分显著低于高中(中专)及以下者(t=-1.438,P<0.05)。男性患者家属SS得分显著低于女性患者家属(t=4.149,P<0.05)。半封闭病房中烧伤患者家属最迫切的需求是确保患者得到最佳治疗。患者年龄、烧伤总面积及家属性别、文化程度、在重症监护隔离病房陪伴经历是影响患者家属心理需求的主要因素。

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