心脏重症监护室患者对心电监护仪警报应对体验的质性研究

doi:10.3761/j.issn.2096-7446.2025.08.005

摘要/Abstract

摘要：

目的了解心脏重症监护室患者住院期间对心电监护仪警报的应对体验，为改善患者在心脏重症监护室的住院体验和提升护理工作质量提供依据。方法采用描述性现象学研究法，于2025年1月—2月在浙江省某三级甲等医院心脏重症监护室选取15例患者进行半结构化访谈，采用Colaizzi七步分析法分析访谈资料。结果分析得出4个主题及11个亚主题：患者对警报的认知存在不足（对警报原因了解有限、忽视或低估警报的意义、缺乏应对警报的措施）、患者呈现个性化的应对方式（消极应对、自我调节、主动寻求帮助）、警报对患者的双重冲击（引发身体对不确定性的过度反应、加重患者对自身病情的心理负担）、患者呈现多样化的护理干预需求（渴望得到陪伴与安慰、希望了解监护仪器相关知识、期待更为舒适的住院体验）。结论医护人员需改善患者对警报的认知调适，提高患者对心电监护仪警报的应对能力，重视警报对患者生理、心理的双重影响并采取综合干预，通过加强护士对警报管理的人文关怀、优化病房环境、改良心电监护仪及警报系统等措施满足患者多样化的需求。

关键词: 重症监护病房, 护理, 警报, 心电监护仪, 质性研究, 应激系统理论

Abstract:

Objective To understand the coping experience of patients in the cardiac intensive care unit on electrocardiogram（ECG） monitor alarm during hospitalization，to provide a theoretical basis for improving the experience of patients in CCU and improving the quality of nursing work. Methods From January to February 2025，15 patients in the cardiac intensive care unit of a tertiary hospital in Zhejiang Province were selected for semi-structured interviews using the phenomenological research method. The interview data were analyzed by Colaizzi’s seven-step analysis method. Results The analysis yielded 4 themes and 11 sub-themes：Patients had insufficient cognition of the alarm（limited knowledge of the cause of the alarm，ignoring or underestimating the significance of the alarm，lack of measures to deal with the alarm），patients presented personalized coping styles （negative coping，self-regulation，and active seeking help），the alarm caused double impact on patients（causing excessive reactions of the body to uncertainty and increasing the psychological burden of patients on their condition），and patients presented diversification nursing intervention needs（desire to be accompanied and comforted，want to understand the knowledge of monitoring equipment，and look forward to a more comfortable hospital experience）. Conclusion Medical staff should improve patients’ cognitive adjustment to the alarm，improve patients’ self-efficacy and ability to respond to the alarm，pay attention to the physiological and psychological effects of the alarm and take comprehensive intervention，strengthen the humanistic care of nurses for alarm management，optimize the ward environment，improve the ECG monitoring system and other measures to meet the diverse needs of patients.

Key words: Intensive Care Unit, Nursing Care, Alarm, ECG Monitor, Qualitative Research, Stress System Theory

陈蔚婧, 李嘉琳, 宋健屏, 肖涵瑜, 金金花, 张维镔. 心脏重症监护室患者对心电监护仪警报应对体验的质性研究[J]. 中华急危重症护理杂志, 2025, 6(8): 930-937.

CHEN Weijing, LI Jialin, SONG Jianping, XIAO Hanyu, JIN Jinhua, ZHANG Weibin. The experience of coping with electrocardiogram monitoring alarm among patients in cardiac intensive care unit：a qualitative study[J]. Chinese Journal of Emergency and Critical Care Nursing, 2025, 6(8): 930-937.

图/表 1

参考文献 35

[1]	Coelho AC, Santos VB, de Barros ALBL. Stressors in intensive cardiac care units:Patients’ perceptions[J]. Nurs Crit Care, 2022, 27(2):195-203.
[2]	Park M, Kohlrausch A, de Bruijn W, et al. Analysis of the soundscape in an intensive care unit based on the annotation of an audio recording[J]. J Acoust Soc Am, 2014, 135(4):1875-1886. doi: 10.1121/1.4868367 pmid: 25234986
[3]	Cho OM, Kim H, Lee YW, et al. Clinical alarms in intensive care units:perceived obstacles of alarm management and alarm fatigue in nurses[J]. Healthc Inform Res, 2016, 22(1):46-53.
[4]	吕静. PDCA循环管理对降低冠心病监护病房心电监护误报率的效果研究[J]. 护理研究, 2020, 34(10):1816-1818.
	Lü J. Effect of PDCA circulation management on reducing false alarm rate of coronary care unit electrocardiographic monitoring[J]. Chin Nurs Res, 2020, 34(10):1816-1818.
[5]	祝鲁丹. 开展PDCA循环管理在降低CCU心电监护误报率中的效果[J]. 中医药管理杂志, 2019, 27(18):130-131.
	Zhu LD. Effect of PDCA circulation management on reducing false alarm rate of CCU ECG monitoring[J]. J Tradit Chin Med Manag, 2019, 27(18):130-131.
[6]	Rahmani Vasokolaei Z, Rejeh N, Heravi-Karimooi M, et al. Comparison of the effects of hand reflexology versus acupressure on anxiety and vital signs in female patients with coronary artery diseases[J]. Healthcare, 2019, 7(1):26.
[7]	Meng’anyi LW, Omondi LA, Muiva MN. Assessment of nurses interventions in the management of clinical alarms in the critical care unit,Kenyatta National Hospital,a cross sectional study[J]. BMC Nurs, 2017, 16:41.
[8]	刘璞娉, 徐萌, 汪惠芝, 等. CCU病人监护仪报警的现状调查研究[J]. 中国医疗器械杂志, 2021, 45(4):450-453.
	Liu PP, Xu M, Wang HZ, et al. A survey of patient monitoring alarms in cardiac care units[J]. Chin J Med Instrum, 2021, 45(4):450-453.
[9]	黄爱玲, 张艳梅. 急性心肌梗死患者住CCU体验的质性研究[J]. 基层医学论坛, 2019, 23(30):4420-4422.
	Huang AL, Zhang YM. A qualitative study on the experience of patients with acute myocardial infarction living in CCU[J]. Med Forum, 2019, 23(30):4420-4422.
[10]	麻艳超. PCI术后患者环境压力源、社会支持对焦虑的影响[D]. 延吉: 延边大学, 2021.
	Ma YC. Influence of environmental stressors and social support on anxiety of patients after PCI[D]. Yanji: Yanbian University, 2021.
[11]	李良俊. CCU老年患者睡眠障碍影响因素及风险预测模型的构建[D]. 十堰: 湖北医药学院, 2022.
	Li LJ. Influencing factors of sleep disorder in elderly patients in CCU and construction of risk prediction model[D]. Shiyan: Hubei University of Medicine, 2022.
[12]	Ryan KM, Gagnon M, Hanna T, et al. Noise pollution:do we need a solution? An analysis of noise in a cardiac care unit[J]. Prehosp Disaster Med, 2016, 31(4):432-435.
[13]	Folkman S, Lazarus RS. If it changes it must be a process:study of emotion and coping during three stages of a college examination[J]. J Pers Soc Psychol, 1985, 48(1):150-170. doi: 10.1037//0022-3514.48.1.150 pmid: 2980281
[14]	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.
[15]	朱瑾, 张容, 张立力, 等. A型主动脉夹层患者住院期间心理体验的质性研究[J]. 中华护理杂志, 2024, 59(19):2369-2374. doi: 10.3761/j.issn.0254-1769.2024.19.009
	Zhu J, Zhang R, Zhang LL, et al. A qualitative study on psychological experience of Stanford Type A aortic dissection patients during hospitalization[J]. Chin J Nurs, 2024, 59(19):2369-2374. doi: 10.3761/j.issn.0254-1769.2024.19.009
[16]	姜乾金. 医学心理学:理论,方法与临床[M]. 北京: 人民卫生出版社, 2012.
	Jiang QJ. Medical psychology theories:theories,methods,and clinic[M]. Beijing: People’s Medical Publishing House, 2012.
[17]	周莉莉, 郭鸽, 杨丽莉, 等. 肥厚型梗阻性心肌病患者行经皮室间隔射频消融术并发症的护理[J]. 中华急危重症护理杂志, 2024, 5(8):728-730.
	Zhou LL, Guo G, Yang LL, et al. Nursing care of complications of percutaneous intramyocardial septal radiofrequency ablation in patients with hypertrophic obstructive cardiomyopathy[J]. Chin J Emerg Crit Care Nurs, 2024, 5(8):728-730.
[18]	付练, 丁彩艳, 薛佳韵, 等. 结直肠癌患者生存扩展期重返正常生活体验的质性研究[J]. 护理学报, 2025, 32(6):67-72. doi: 10.16460/j.issn1008-9969.2025.06.067
	Fu L, Ding CY, Xue JY, et al. Qualitative study on the experience of returning to normal life in patients with colorectal cancer during the extended period of survival[J]. J Nurs China, 2025, 32(6):67-72.
[19]	陈美佳, 胡玉玲, 王为杰, 等. 频繁急性加重COPD患者吸入药物依从性影响因素的质性研究[J]. 护理学杂志, 2025, 40(5):37-41,47.
	Chen MJ, Hu YL, Wang WJ, et al. Factors influencing inhaled medication adherence in patients with frequent acute exacerbations of chronic obstructive pulmonary disease:a qualitative study[J]. J Nurs Sci, 2025, 40(5):37-41,47.
[20]	Qian JL, McDonough DJ, Gao Z. The effectiveness of virtual reality exercise on individual’s physiological,psychological and rehabilitative outcomes:a systematic review[J]. Int J Environ Res Public Health, 2020, 17(11):4133.
[21]	章快芳, 詹海燕, 黄佩君. 卡片式健康教育处方在头面部皮肤病病人中的应用[J]. 全科护理, 2015, 13(6):519-521.
	Zhang KF, Zhan HY, Huang PJ. Application of card-type health education prescription in patients with head and face dermatosis[J]. Chin Gen Pract Nurs, 2015, 13(6):519-521.
[22]	谷瑞媛, 胡乔书, 靳珂, 等. 家属参与式人文护理对预防重症患者ICU后综合征的研究进展[J]. 中华急危重症护理杂志, 2023, 4(10):956-960.
	Gu RY, Hu QS, Jin K, et al. Research progress of family participatory humanistic nursing care in preventing post-ICU syndrome in critically ill patients[J]. Chin J Emerg Crit Care Nurs, 2023, 4(10):956-960.
[23]	米洁, 张川林, 赵庆华. 家属参与式人文护理在ICU患者中的应用研究[J]. 中国护理管理, 2021, 21(3):321-324.
	Mi J, Zhang CL, Zhao QH. Humanistic care with family participation for ICU patients[J]. Chin Nurs Manag, 2021, 21(3):321-324.
[24]	解艳红, 许瑛, 史平, 等. ICU患者不适现状调查及其影响因素分析[J]. 中国护理管理, 2016, 16(10):1357-1362.
	Xie YH, Xu Y, Shi P, et al. The status and impact factors of discomfort among Intensive Care Unit patients[J]. Chin Nurs Manag, 2016, 16(10):1357-1362.
[25]	蒋君芳, 潘梅霞, 莫瑕. ICU心脏手术患者睡眠障碍现状调查及影响因素分析[J]. 齐鲁护理杂志, 2018, 24(20):61-63.
	Jiang JF, Pan MX, Mo X. Investigation and analysis of influencing factors of sleep disorder in ICU patients undergoing cardiac surgery[J]. J Qilu Nurs, 2018, 24(20):61-63.
[26]	Cvach M. Monitor alarm fatigue:an integrative review[J]. Biomed Instrum Technol, 2012, 46(4):268-277.
[27]	王颖, 沙丽艳, 刘洋. 工作环境报警疲劳和情绪劳动对ICU护士职业倦怠的影响研究[J]. 中国护理管理, 2022, 22(9):1405-1410.
	Wang Y, Sha LY, Liu Y. The influence of working environment alarm fatigue and emotional labor on Intensive Care Unit nurses’ job burnout[J]. Chin Nurs Manag, 2022, 22(9):1405-1410.
[28]	韩颖, 张莉莉, 刘晓梅. 基于信息化平台的心理分级管理对心内科病人负性情绪的影响[J]. 护理研究, 2022, 36(17):3182-3185.
	Han Y, Zhang LL, Liu XM. Influence of psychological grading management based on information platform on negative emotion of patients in cardiology department[J]. Chin Nurs Res, 2022, 36(17):3182-3185.
[29]	陈璐. 重症监护室噪音污染与护理干预[J]. 当代护士(下旬刊), 2010(9):5-7.
	Chen L. Noise pollution in intensive care unit and nursing intervention[J]. Mod Nurse, 2010(9):5-7.
[30]	徐虹霞, 潘红英, 张菁菁. 基于磁性医院标准的普外科智慧病房建设[J]. 护理与康复, 2021, 20(8):91-94.
	Xu HX, Pan HY, Zhang JJ. Construction of general surgery intelligent ward based on magnetic hospital standard[J]. J Nurs Rehabil, 2021, 20(8):91-94.
[31]	石敏, 许莉钧, 彭华东. 可穿戴生理传感器驱动的深度学习情绪识别模型在心理健康评估中的应用[J]. 西南大学学报(自然科学版), 2024, 46(12):189-201.
	Shi M, Xu LJ, Peng HD. Application of wearable physiological sensor-driven deep learning emotion recognition model in mental health assessment[J]. J Southwest Univ Nat Sci Ed, 2024, 46(12):189-201.
[32]	Jonescu EE, Farrel B, Ramanayaka CE, et al. Mitigating intensive care unit noise:design-led modeling solutions,calculated acoustic outcomes,and cost implications[J]. HERD, 2024, 17(3):220-238.
[33]	杨春清, 罗铎麟, 高萍, 等. ICU医护人员临床警报管理体验及需求的质性研究[J]. 中华急危重症护理杂志, 2024, 5(8):689-694.
	Yang CQ, Luo DL, Gao P, et al. The experience and needs of clinical alarm management among ICU medical staff:a qualitative study[J]. Chin J Emerg Crit Care Nurs, 2024, 5(8):689-694.
[34]	孙中标, 叶继伦, 张旭, 等. 超低功耗可穿戴式无线心电测量系统的研制[J]. 中国医疗器械杂志, 2020, 44(1):28-32.
	Sun ZB, Ye JL, Zhang X, et al. Development of a wearable wireless ECG monitoring system with ultra-low power consumption[J]. Chin J Med Instrum, 2020, 44(1):28-32.
[35]	曹美凤, 余苗苗, 夏黎, 等. 多感官叠加教育对慢性牙周炎病人牙周指标及口腔健康素养的影响[J]. 循证护理, 2024, 10(13):2448-2451.
	Cao MF, Yu MM, Xia L, et al. Effect of multi-sensory superimposed education on periodontal indicators and oral health literacy in patients with chronic periodontitis[J]. Chin Evid Based Nurs, 2024, 10(13):2448-2451.