| 摘要: | 對病人而言，插管後最大的壓力源是無法有效的與人溝通，造成病人因為無法順利表達自己的需要而感到焦慮。家庭是最親密的社會基本單位，家庭成員能使病人情緒獲得安慰與鼓勵，甚至給予實質性支持，提供病人實際的醫療照顧。本研究目的在了解「家屬叮嚀方案」對降低病人及家屬焦慮，提升病人及家屬對病人插氣管內管之認知程度，病人及家屬對接受氣管內管叮嚀方案之滿意度，及病人非計畫性氣管內管滑脫事件的影響。
本研究以立意取樣方式，收案加護病房接受插管治療之病人及其家屬各60位，實驗組30位、控制組30位。给予實驗組家屬氣管內管放置正確認知的護理指導，協助家屬錄製「預防非計畫性氣管內管滑脫家屬話語叮嚀方案」之影音帶，每日三次播放影音帶叮嚀病人，控制組接受常規照護。於介入前後測量兩組病人及家屬焦慮程度，拔管後測量兩組病人與家屬認知程度，實驗組病人每次介入前後測量生命徵象，調查實驗組病人與家屬滿意度，並追蹤病人非計畫性氣管內管滑脫事件。所得資料以SPSS for Windows 19.0統計套裝軟體進行描述性及推論性統計分析。
研究結果顯示實驗組家屬前、後測焦慮分數比較有統計上顯著差異(t = 12.616, p < .001)，控制組家屬前、後焦慮比較有統計上顯著的差異(t = 8.328, p< .001)，兩組病人及家屬焦慮後測分數明顯下降，當病人焦慮分數越高時，對插氣管內管的認知程度則越低(r =-.274, p＜.05)。家屬女性焦慮分數較高(t =2.102, p =.040)，家屬年齡越高，焦慮分數越高(t=2.805, p= .008)。實驗組家屬對氣管內管照護知識得分高於控制組 (t=-2.078, p =.042)。在叮嚀影音光碟介入後第2-7天病人心跳有顯著減緩(p＜.05)，第3-4天時收縮壓有顯著降低(p＜.05) 。對於叮嚀影音光碟介入滿意度結果顯示病人滿意度89％、家屬滿意度93.3％。控制組一例發生非計畫性氣管滑脫，實驗組沒有病人發生非計畫性氣管滑脫。
本研究護理措施「家屬話語叮嚀方案」係以家庭為中心之護理理念為基礎而設計的，提供加護病房插氣管內管家屬介入鼓勵病人及提醒病人管路安全的重要性，而結果的發現可提供醫護同仁做為加護病房介入性照護措施的參考。
Airway management is the top priority in critical patient care, and endotracheal intubation is one of method of management. The most stressful event for an intubation patient anise from inability to communicate with others and causes anxiety. Family members provide basic supporting unit that provide comfort and encouragement. Even to the extent of tendering help in the actual medical care of patient. The purposes of this study are to investigate the effects of family reminder project in affecting the cognition and anxiety of patients and their family. We also evaluate the satisfaction level of both patient and family and the incident of unplanned extubation.
60 intubated patients in the ICU and their family members were assigned into the experimental (30) and control group (30). Family members of the experimental group receive education on the nursing care of intubation and a videotape was and played three times each day to remind the patient .The control group received routine nurse care. The degree of anxiety of both experiment and control group were measured before and after intervention, and the degree of cognition was also measured after extubation. The vital sings of experiment patients before and after intervention, degree of satisfaction of patient and family members and incident of unplanned extubation were also measured. Date collected was analyzed by SPSS for Windows 19.0.
The result obtained showed a significant difference in pre- and post-test in experimental group family (t=12.616, p<.001) and control group family (t=8.328, p<.001).The post anxiety score decreased significantly in both group of family and patient. In patient with high anxiety score, the degree of cognition is low (r=-.274, p<.05); Female family has higher anxiety score(t =2.102, p =.040). Older family showed higher anxiety score(t =2.805, p =.008). The experimental group family were with better knowledge in the caring of endotracheal tube than the control group family in this category(t =-2.078, p =.042). The heart rate of experimental patient were decreased significantly on the 2-7th days of videotape intervention (p <.05), systolic blood pressure of experimental patient decreased significantly on 3-4th days of videotape intervention. There were 89% of patient and 93.3% of family satisfied with this videotape intervention. Unplanned extubated (UE) was noted in one control group patient during the whole intervention course, and is statistically insignificant.
This study of nurse family partnership model’s is based on the concept of family centered nursing care .It provide family involvement in encouraging and caring of intubated patient in the intensive care unit .And our result could serve as reference for medical personnel in caring intubated patient in the intensive care unit. |
