社会生态系统理论视角下ICU患者情感支持体验的质性研究

doi:10.3761/j.issn.2096-7446.2025.01.003

摘要/Abstract

摘要：

目的基于社会生态系统理论，探讨ICU患者、家属及医护人员在患者住院期间情感支持的体验和期望，为制订ICU患者心理及情感支持方案提供参考依据。方法按照描述性质性研究，采用目的抽样法，选取2023年9月15日—11月15日在南通市某三级甲等医院重症医学科就诊的12组患者、家属及其诊疗医护人员作为研究对象，对其进行半结构式深度访谈，采用内容分析法对资料进行分析、归纳并提炼主题。结果基于社会生态系统理论模型，共归纳出3个主题。①宏观系统：ICU以挽救生命、治疗疾病为主要任务，对患者情感的关注和支持不足，以致重视生命长度还是质量的社会观点冲突。②中观系统：患者和家属对ICU治疗环境及方式有陌生感、恐惧感，医护人力紧张且对情感支持认知欠缺，造成患者情感需求被忽视。③微观系统：由于个体差异，每例患者或家属的情感需求不同，每名医护人员表达情感方式不同。结论 ICU患者及家属在住院期间对情感支持有较高的需求和期待，但往往由于自身及外界环境等因素导致心理需求不能得到满足。临床医护人员可尝试改善ICU“软环境”，构建“患者-医护人员-家属”共同参与的人文关怀护理模式，借助智能化网络平台采取合适的人文关怀措施，提高患者及家属情感支持的获得感。

关键词: 社会生态系统理论, ICU患者, 家属, 情感支持, 人文关怀, 质性研究, 护理

Abstract:

Objective To explore the experience and expectation of emotional support of ICU patients，their family members and medical staff during hospitalization based on the social ecological system theory，so as to provide a reference for formulating psychological and emotional support programs for ICU patients. Methods According to the descriptive qualitative research，using the purposive sampling method，12 groups of patients，family members and medical staff who were treated in the Department of Critical Care Medicine of a Class Ⅲ Grade A hospital in Nantong from September 15，2023 to November 15，2023 were selected as the research objects，and semi-structured in-depth interviews were conducted. The content analysis method was used to analyze，summarize and refine the data. Results Based on the social ecological system theoretical model，a total of 3 themes were summarized：①Macro system：the main task of ICU is to save lives and treat diseases，but the lack of attention and support for patients’ emotions leads to social conflicts between focusing on the length or quality of life of patients；②Meso-system：patients and their family members had strangeness and fear of the ICU treatment environment and methods，and the shortage of medical staff and lack of understanding of emotional support have led to the neglect of patients’ emotional needs；③Micro-system：due to individual differences，each patient or family member has different emotional needs，and each medical staff has different ways of expressing emotions. Conclusion ICU patients and their family members have high needs and expectations for emotional support during hospitalization，but their psychological needs are often not met due to their own and external environment and other factors. Clinical medical staff can try to improve the “soft environment” of ICU，build a humanistic care nursing model involving “patients，medical staff，and family members”，and use intelligent network platforms to take appropriate humanistic care measures to enhance the sense of emotional support for patients and family members.

Key words: Social Ecological System Theory, ICU Patients, Relation, Emotional Support, Humanistic Care, Qualitative Study, Nursing Care

金静怡, 许钦雯, 刘红梅, 张燕, 季建红. 社会生态系统理论视角下ICU患者情感支持体验的质性研究[J]. 中华急危重症护理杂志, 2025, 6(1): 24-30.

JIN Jingyi, XU Qinwen, LIU Hongmei, ZHANG Yan, JI Jianhong. A qualitative study on emotional support experience of ICU patients from the perspective of social ecological system theory[J]. Chinese Journal of Emergency and Critical Care Nursing, 2025, 6(1): 24-30.

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参考文献 15

[1]	Pearson SD, Patel BK. Evolving targets for sedation during mechanical ventilation[J]. Curr Opin Crit Care, 2020, 26(1):47-52. doi: 10.1097/MCC.0000000000000687 pmid: 31764193
[2]	王莉, 何雪花, 陈香萍, 等. 成人ICU患者镇痛镇静护理质量评价指标体系的构建研究[J]. 中华急危重症护理杂志, 2023, 4(9):773-778.
	Wang L, He XH, Chen XP, et al. Establishment of quality evaluation indicator system of analgesia and sedation care in adult ICUs[J]. Chin J Emerg Crit Care Nurs, 2023, 4(9):773-778.
[3]	朱向伟, 卢根娣. ICU患者家属决策困境研究现状及启示[J]. 中国医学伦理学, 2024, 37(2):168-176.
	Zhu XW, Lu GD. Research status and inspiration on decision-making dilemmas on family members of intensive care unit patients[J]. Chin Med Ethics, 2024, 37(2):168-176.
[4]	师海玲, 范燕宁. 社会生态系统理论阐释下的人类行为与社会环境:2004年查尔斯·扎斯特罗关于人类行为与社会环境的新探讨[J]. 首都师范大学学报(社会科学版), 2005(4):94-97.
	Shi HL, Fan YN. Human behavior and social environment from the perspective of social ecosystem theory Charles Zastro’s new discussion on human behavior and social environment in 2004[J]. J Cap Norm Univ, 2005(4):94-97.
[5]	Boehm LM, Jones AC, Selim AA, et al. Delirium-related distress in the ICU:a qualitative meta-synthesis of patient and family perspectives and experiences[J]. Int J Nurs Stud, 2021,122:104030.
[6]	林琪, 曾莉, 任君红. ICU患者家属创伤后成长体验的质性研究[J]. 中华护理杂志, 2021, 56(3):347-353. doi: 10.3761/j.issn.0254-1769.2021.03.005
	Lin Q, Zeng L, Ren JH. A qualitative research on post-traumatic growth experience of family members of ICU patients in neurosurgery[J]. Chin J Nurs, 2021, 56(3):347-353. doi: 10.3761/j.issn.0254-1769.2021.03.005
[7]	Swanberg JE, Vanderpool RC, Tracy JK. Cancer-work management during active treatment:towards a conceptual framework[J]. Cancer Causes Control, 2020, 31(5):463-472.
[8]	Hua WZ, Fang Q, Lin WD, et al. The level and influencing factors of graduating nursing students’ professional commitment from the perspective of ecological systems theory:a cross-sectional study[J]. Nurse Educ Today, 2022,119:105567.
[9]	Kiwanuka F, Sak-Dankosky N, Alemayehu YH, et al. The evidence base of nurse-led family interventions for improving family outcomes in adult critical care settings:a mixed method systematic review[J]. Int J Nurs Stud, 2022,125:104100.
[10]	Harlan EA, Miller J, Costa DK, et al. Emotional experiences and coping strategies of family members of critically ill patients[J]. Chest, 2020, 158(4):1464-1472. doi: 10.1016/j.chest.2020.05.535 pmid: 32454044
[11]	Karnatovskaia LV, Schultz JM, Niven AS, et al. System of psychological support based on positive suggestions to the critically ill using ICU doulas[J]. Crit Care Explor, 2021, 3(4):e0403.
[12]	Kalolo AM, Mula C, Gundo R. Family members’ perception of their needs in critical care units at a tertiary hospital in Malawi:a qualitative study[J]. BMC Nurs, 2023, 22(1):274.
[13]	潘盼, 解立新. 智慧重症监护病房助力重症医疗可及性[J]. 中华医学杂志, 2023, 103(26):1966-1969.
	Pan P, Xie LX. Intelligent intensive care unit makes medicine more accessible[J]. Natl Med J China, 2023, 103(26):1966-1969.
[14]	Haines KJ, Quasim T, McPeake J. Family and support networks following critical illness[J]. Crit Care Clin, 2018, 34(4):609-623. doi: 10.1016/j.ccc.2018.06.008
[15]	Ostermann M, Vincent JL. ICU without borders[J]. Crit Care, 2023, 27(1):186.