经历重症监护患儿心理与社会适应过程的质性研究

doi:10.3761/j.issn.2096-7446.2025.05.005

摘要/Abstract

摘要：

目的探讨儿童在重症监护后所经历的心理与社会适应过程，为临床干预和家庭支持提供科学依据。方法采用描述性现象学研究方法，使用目的抽样法对2023年7月—9月曾在杭州市某三级甲等儿童专科医院PICU住院治疗的15例患儿进行访谈。结果共提炼出3个主题和9个亚主题：重症监护经历的影响（恐惧与不适的记忆、睡眠紊乱与节律失调、情绪波动与性格转变），家庭与社会的再适应（家庭氛围的陌生与适应、社交能力的退化与重建、学习能力的恢复与挑战），康复过程中的心理调整（健康意识的提升与管理、自我认知的重塑与接纳、社会支持的获得与感激）。结论经历重症监护后患儿会面临多种心理和社会适应困难，加强患儿情绪管理，建立以医院、家庭和学校为核心的联动支持体系，优化随访服务并提升家庭健康教育，对改善其长期适应具有重要意义。

关键词: 儿童, 急危重症, 重症监护病房, 体验, 儿科护理, 质性研究

Abstract:

Objective This study explored the psychological and social adaptation process of children after intensive care，aiming to provide scientific evidence for clinical interventions and family support. Methods A descriptive phenomenological approach was employed，using purposive sampling to recruit 15 children who had been hospitalized in the PICU of a tertiary pediatric hospital in Hangzhou from July to September 2023. Results Three themes and nine subthemes were identified：impact of the intensive care experience（memories of fear and discomfort，sleep disturbances and rhythm disruption，emotional fluctuations and personality changes）；re-adaptation to family and society（unfamiliarity and adaptation to the family environment，deterioration and rebuilding of social skills，recovery and challenges in learning abilities）；and psychological adjustment during rehabilitation（enhanced health awareness and self-management，reformation and acceptance of self-identity，acquisition of social support and gratitude）. Conclusion Children who experience intensive care face various psychological and social adaptation challenges. Strengthening emotional management，establishing a hospital-family-school integrated support system，optimizing follow-up services，and enhancing family health education are essential for improving their long-term adaptation.

Key words: Children, Critical Illness, Intensive Care Units, Experience, Pediatric Nursing, Qualitative Study

朱佳佳, 炊琳博, 金泓丞, 诸纪华. 经历重症监护患儿心理与社会适应过程的质性研究[J]. 中华急危重症护理杂志, 2025, 6(5): 543-547.

ZHU Jiajia, CHUI Linbo, JIN Hongcheng, ZHU Jihua. Psychological and social adaptation in children post-intensive care：a qualitative study[J]. Chinese Journal of Emergency and Critical Care Nursing, 2025, 6(5): 543-547.

图/表 1

参考文献 21

[1]	Ko MSM, Poh PF, Heng KYC, et al. Assessment of long-term psychological outcomes after pediatric intensive care unit admission:a systematic review and meta-analysis[J]. JAMA Pediatr, 2022, 176(3):e215767.
[2]	Lulgjuraj D, Maneval RE. Unaccompanied hospitalized children:an integrative review[J]. J Pediatr Nurs, 2021,56:38-46.
[3]	Gillian C. The psychological impact of admission to intensive care[D]. London, UK: Goldsmiths College, 2021.
[4]	Manning JC, Pinto NP, Rennick JE, et al. Conceptualizing post intensive care syndrome in children-the PICS-p framework[J]. Pediatr Crit Care Med, 2018, 19(4):298-300.
[5]	Bossen D, de Boer RM, Knoester H, et al. Physical functioning after admission to the PICU:a scoping review[J]. Crit Care Explor, 2021, 3(6):e0462.
[6]	Tang MT, Chui PL, Chong MC, et al. Post-traumatic stress disorder in children after discharge from the pediatric intensive care unit:a scoping review[J]. Eur Child Adolesc Psychiatry,2024:1-14.
[7]	Rennick JE, Knox AM, Treherne SC, et al. Family members’ perceptions of their psychological responses one year following pediatric intensive care unit(PICU) hospitalization:qualitative findings from the caring intensively study[J]. Front Pediatr, 2021,9:724155.
[8]	Atkins EK, John M, Colville G. Families’ experiences of life in the year after a child’s critical illness:navigating the road to a “new normal”[J]. J Pediatr Intensive Care, 2020, 9(3):188-195. doi: 10.1055/s-0040-1705132 pmid: 32685246
[9]	杨露, 李斌, 曾艳, 等. “候鸟”老年人急诊异地就医真实体验的质性研究[J]. 中华急危重症护理杂志, 2024, 5(6):525-529.
	Yang L, Li B, Zeng Y, et al. The non-local emergency medical treatment experience in migratory Elders:a qualitative study[J]. Chin J Emerg Crit Care Nurs, 2024, 5(6):525-529.
[10]	刘明. Colaizzi七个步骤在现象学研究资料分析中的应用[J]. 护理学杂志, 2019, 34(11):90-92.
	Liu M. Using an example to illustrate Colaizzi’s phenomenological data analysis method[J]. J Nurs Sci, 2019, 34(11):90-92.
[11]	Hordijk JA, Verbruggen SC, Buysse CM, et al. Neurocognitive functioning and health-related quality of life of children after pediatric intensive care admission:a systematic review[J]. Qual Life Res, 2022, 31(9):2601-2614. doi: 10.1007/s11136-022-03124-z pmid: 35357629
[12]	Bury M. Chronic illness as biographical disruption[J]. Sociol Health Illn, 1982, 4(2):167-182.
[13]	Sansone V, Cancani F, Gagliardi C, et al. Narrative diaries in the paediatric intensive care unit:a thematic analysis[J]. Nurs Crit Care, 2022, 27(1):45-54.
[14]	Abel MR, Hambrick EP, Vernberg EM. Talking with children about natural disasters:maternal acknowledgment,child emotion talk,and child posttraumatic stress symptoms[J]. Child Youth Care Forum, 2021, 50(5):947-968.
[15]	何雪松, 侯慧. “过坎”:终末期肾病患者的疾痛体验[J]. 社会学研究, 2020, 35(5):25-50,242-243.
	He XS, Hou H. “To overcome(Guo Kan)”:suffering experiences of end-stage renal disease patients[J]. Sociol Stud, 2020, 35(5):25-50,242-243.
[16]	Turner AD, Sullivan T, Drury K, et al. Cognitive dysfunction after analgesia and sedation:out of the operating room and into the pediatric intensive care unit[J]. Front Behav Neurosci, 2021,15:713668.
[17]	Tekin BH, Corcoran R, Gutiérrez RU. A systematic review and conceptual framework of biophilic design parameters in clinical environments[J]. HERD, 2023, 16(1):233-250.
[18]	Su ZY, Kamath SP, Tirakitsoontorn P, et al. The hidden burden:encountering and managing(unintended) stigma in children with serious illnesses[J]. Proc ACM Hum Comput Interact, 2024, 8(CSCW1):1-35.
[19]	陈美旭, 吕利明, 杨晓霞, 等. 儿童癌症幸存者社会融入的研究进展[J]. 护理学杂志, 2022, 37(22):98-101.
	Chen MX, Lü LM, Yang XX, et al. Research progress on social inclusion of childhood cancer survivors[J]. J Nurs Sci, 2022, 37(22):98-101.
[20]	刘文崇, 程方方, 尚美美, 等. 儿童肿瘤幸存者重返校园研究进展[J]. 军事护理, 2022, 39(10):21-24.
	Liu WC, Cheng FF, Shang MM, et al. Research progress of childhood cancer survivors’ return-to-school studies[J]. Mil Nurs, 2022, 39(10):21-24.
[21]	刘洁, 周进芳, 刘莉莉, 等. 神经内科重症患儿转出指导手册对患儿家属迁移应激水平的影响[J]. 安徽医学, 2020, 41(1):95-98.
	Liu J, Zhou JF, Liu LL, et al. Effect of transferring out instruction manual for critically ill children in neurology department on migration stress level of their families[J]. Anhui Med J, 2020, 41(1):95-98.