| 摘要: | 背景:重症病人的照護與照護病人死亡是造成加護病房護理人員壓力的來源之一，而過多的壓力會導致護理人員身心出現異常，進而提升護理人員離開臨床的機率。
研究目的: 探討加護病房護理人員在面對病人不同的死亡型態與急性壓力症狀之間的關係。
研究方法: 本研究為橫斷式研究，在2018年7月到11月間於台北某醫學中心加護病房護理人員經歷病人死亡後2-7天進行收案，共收案109人。運用急性壓力症量表、貝克焦慮症及憂鬱症量表，並以描述性統計、卡方檢定、獨立樣本t檢定、二元邏輯式迴歸進行資料分析。
研究結果:加護病房護理人員經歷病患死亡後有30位(27.5%)出現急性壓力症狀；其中，出現急性壓力症狀的護理人員中接受過安寧緩和照護之課程比沒有接受安寧緩合照護之課程的人較多（n=23, 76.7% vs n=7,23.3%, p=.019）、發生急性壓力症狀之護理人員在經歷病人死亡後曾經尋求家人或朋友協助比沒有急性壓力症狀的護理人員為多(χ2=9.543, p=0.002)，護理人員在經歷(Acute physiology and Chronic Health Evaluation , APACHE II)較低分的病人死亡比APACHE II高分的病人死亡較容易出現急性壓力症(t=2.084,p=0.041)，出現急性壓力症狀的護理師照護病人天數比沒有急性壓力症狀護理師的天數為長(t=-2.959, p=0.005)，護理人員面對病人CPR (cardiopulmonary resuscitation)後死亡比面對沒有接受任何醫療急救措施(do-not-resuscitate, DNR)後死亡有13.898倍(95%CI= 2.455~ 78.682)高的比例會出現急性壓力症狀；遭受家屬言語暴力者比沒有遭受家屬言語暴力者有4.687倍(95%CI=1.079 ~20.358)的機會出現急性壓力症。
結論: 經歷病人死亡的加護病房護理人員有相當高出現急性壓力症狀發生機會，尤其是經歷病患急救後死亡及遭受家屬言語暴力的護理人員，更是高危險群，值得臨床上關注。
Background : Due to the complexing of patient care and frequent patient deaths, the ICU nurses easily withstand high stress, which is associated with burnout and turnover.
Study purpose : The relationship between different patient death types and acute stress disorder among ICU nurses.
Study method: This was a cross-sectional study. From July, 2018 to November, 2018, the ICU nurses in a single medical center in Taipei, who experienced patient death within 2-7 days, were recruited. Total 109 participants met the criteria. Acute stress disorder scales, Beck Anxiety Inventory, and Beck Depression Inventory-II were used for survey. The results were analyzed through descriptive statistics, chi-square test, independent sample t-test, and binary logical regression.
Study results : Thirty (27.5%) ICU nurses with recent patient death reported heavy ASD. The number of nurses with acute stress was higher in those who received palliative care courses than those without (n=23, 76.7% vs n=7, 23.3%, p=.019). Highly number of nurses with acute stress disorder seeked helps from their family and friends than those without ASD (χ2=9.543, p=0.002). There severity of patient’s (APACHE II) condition was significant lower among nurse with ASD than those without ASD (t = 2.084, p = 0.041) after patient’s death. Nurses with ASD had longer duration in primary care to the patient’s prior their death (t=-2.959, p=0.005). Nurses whose patient passed away after Cardiopulmonary Resuscitation were 13.898 (95%CI=2.455~78.682) times higher than those nurses whose patient’s passed away without CPR and emergency meds to experience ASD. For those who experienced verbal violence from patient’s family were 4.687 (95%CI = 1.079~20.358) times higher than those without verbal violence to report ASD.
Conclusion: Nurses who experience patient death have a high incidence of acute stress disorder in intensive care unit. Especially , Nurses who experience patient expire after CPR or verbal violence from patients families are more likely to occur acute stress disorder. |
