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[重症监护病房中与患者的沟通]

[Communication with patients in the intensive care unit].

作者信息

Jöbges Susanne

机构信息

Klinik für Anästhesiologie, operative Intensivmedizin, Schmerz- und Palliativmedizin, Klinikum Dortmund gGmbH, Klinikum der Universität Witten/Herdecke, Beurhausstraße 40, 44137, Dortmund, Deutschland.

出版信息

Med Klin Intensivmed Notfmed. 2022 Nov;117(8):595-599. doi: 10.1007/s00063-022-00957-x. Epub 2022 Sep 9.

Abstract

Communication is one of the fundamental human needs. It includes not only expressing oneself but also verbal and nonverbal communication and establishing contact to other people. In the context of intensive care treatment, influences such as sedation, delirium or the need for an artificial airway, be it a tube or tracheostomy, can make verbal communication almost impossible. In addition, nonverbal communication possibilities are often restricted by physical weakness or illness. Despite these difficulties, there is always a communication relationship, verbal or nonverbal, between patients in the intensive care unit (ICU) and the team. A lack of willingness in the team or mistakes in communication leave patients with a perception of not being heard or not being noticed. As a result, the patients can develop an impression of powerlessness and helplessness. It is precisely in these situations of dependency that there is a risk of overriding the patient's will and exercising coercion. Communication with patients in the ICU is a challenging process. Difficulties that arise here not only burden patients in the ICU but can also lead to frustration and moral stress in the team. The team should reflect on the imbalance of influences on communication between patients and the team in order to help the patients to survive and cope with the critical period by using tools and appreciative communication.

摘要

沟通是人类的基本需求之一。它不仅包括自我表达,还包括言语和非言语沟通以及与他人建立联系。在重症监护治疗的背景下,诸如镇静、谵妄或需要人工气道(无论是气管插管还是气管切开术)等因素,几乎会使言语沟通变得不可能。此外,非言语沟通的可能性也常常受到身体虚弱或疾病的限制。尽管存在这些困难,但重症监护病房(ICU)的患者与医护团队之间始终存在着言语或非言语的沟通关系。团队缺乏沟通意愿或沟通失误会让患者感觉自己没有被倾听或被关注。结果,患者可能会产生无力感和无助感。正是在这些依赖的情况下,存在着凌驾于患者意愿并实施强制手段的风险。与ICU患者沟通是一个具有挑战性的过程。这里出现的困难不仅给ICU患者带来负担,还可能导致团队的挫败感和道德压力。团队应该反思患者与团队之间沟通影响力的不平衡,以便通过使用工具和进行赏识性沟通来帮助患者度过危险期并应对关键时期。

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