Gonzalez-Baz M D, Pacheco-Del Cerro E, Durango-Limárquez M I, Alcantarilla-Martín A, Romero-Arribas R, Ledesma-Fajardo J, Moro-Tejedor M N
Departamento de Apoyo a la Práctica Basada en la Evidencia, Hospital General Universitario Gregorio Marañón (Madrid), Departamento de Enfermería. Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain.
Departamento de Enfermería. Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutense de Madrid, Nursing Management, Hospital Clínico Universitario de San Carlos, Madrid, Spain.
Enferm Intensiva (Engl Ed). 2024 Oct-Dec;35(4):264-277. doi: 10.1016/j.enfie.2024.03.001. Epub 2024 Mar 27.
The stay in a critical care unit (CCU) has a serious impact on physical condition causing numerous discomfort factors such as pain or difficulty in communicating. All of these are associated with possible sequelae following discharge from the Intensive Care Unit (ICU) named post-ICU syndrome. The Kolcaba Comfort Theory allows, from a holistic approach, to identify care needs from the patient's perspective using instruments such as the General Comfort Questionnaire (GCQ).
To determine the comfort level of patients admitted to the CCU using the GCQ of Kolcaba and to identify the discomfort factors.
Cross-sectional descriptive observational prospective study.
580 patients admitted to adult CCU of two high complexity hospitals from June 2015 to March 2020 with stay ≥24 h were interviewed. Descriptive analysis, Student's t-test and ANOVA and multivariate analysis were performed using SPSS v26 and STATA v16.
The mean age was 52,62 (16,21), 357 (61,6%) were male and 434 (74,8%) were believers. The type of admission was planned in 322 (55,5%) and the most prevalent reason for admission was surgical 486 (83,8%). The median pain score (NRS) was 3,00 [0-4] and severity score (APACHE II) was 13,26 (5,89), the median length of stay was 4,00 [2-7] days. The mean comfort level was 3,02 (0,31) showing the highest value Reanimation 3.02 (0.30) and the lowest Trauma and Emergency Unit 2.95 (0.38). Statistically significant differences were found between the units in the comfort level of patients >65 years of age (p = 0.029). The Relief comfort type obtained the lowest mean 2.81 (0.33) and the physical context 2.75 (0.41) in the three units. In the multivariate analysis, statistically significant differences were found between the comfort level and the pain level: no pain (p = 0,000) OR 4,361 CI [2,184-8,707], mild pain (p = 0,000) OR 4,007 CI [2,068-7,763], moderate pain (p = 0,007) OR 2,803 CI [1,328-5,913], and the APACHE II score equal to or greater than 10 (p = 0,000) OR 0,472 CI [0,316-0,705].
The comfort level showed high scores in all three units. The physical and environmental contexts and the relief comfort type negatively affected the perception of comfort. The variables that explained comfort were pain and severity of illness. The evaluation of comfort from the patient's perspective through the GCQ could be considered an indicator of quality of nursing interventions.
在重症监护病房（CCU）的住院经历会对身体状况产生严重影响，引发诸多不适因素，如疼痛或沟通困难。所有这些都与重症监护病房（ICU）出院后可能出现的后遗症相关，即所谓的ICU后综合征。科尔卡巴舒适理论允许从整体方法出发，使用诸如一般舒适问卷（GCQ）等工具从患者角度确定护理需求。
使用科尔卡巴的GCQ确定入住CCU患者的舒适水平，并识别不适因素。
横断面描述性观察性前瞻性研究。
对2015年6月至2020年3月期间入住两家高复杂性医院成人CCU且住院时间≥24小时的580例患者进行了访谈。使用SPSS v26和STATA v16进行描述性分析、学生t检验、方差分析和多变量分析。
平均年龄为52.62岁（16.21岁），男性357例（61.6%），信徒434例（74.8%）。322例（55.5%）为计划性入院，最常见的入院原因是手术，共486例（83.8%）。疼痛评分中位数（NRS）为3.00[0 - 4]，严重程度评分（APACHE II）为13.26（5.89），住院时间中位数为4.00[2 - 7]天。平均舒适水平为3.02（0.31），其中复苏科室得分最高，为3.02（0.30），创伤与急诊科得分最低，为2.95（0.38）。在65岁以上患者的舒适水平方面，各科室之间存在统计学显著差异（p = 0.029）。在三个科室中，缓解舒适类型的平均得分最低，为2.81（0.33），身体环境方面为2.75（0.41）。在多变量分析中，舒适水平与疼痛水平之间存在统计学显著差异：无疼痛（p = 0.000），比值比（OR）为4.361，置信区间（CI）为[2.184 - 8.707]；轻度疼痛（p = 0.000），OR为4.007，CI为[2.（此处原文有误，应为2.068） - 7.763]；中度疼痛（p = 0.007），OR为2.803，CI为[1.328 - 5.913]；以及APACHE II评分等于或大于10（p = 0.000），OR为0.472，CI为[0.316 - 0.705]。
所有三个科室的舒适水平得分都较高。身体和环境背景以及缓解舒适类型对舒适感的认知产生了负面影响。解释舒适感的变量是疼痛和疾病严重程度。通过GCQ从患者角度评估舒适感可被视为护理干预质量的一个指标。
