目的 了解ICU护士对以患者—家庭为中心照护模式的认知及其真实工作体验状况,为优化ICU照护模式、更好地满足患者及家属需求提供参考。方法 采用目的抽样法,选取山东省淄博市某三级甲等医院的15名ICU护士进行半结构式深入访谈,采用Colaizzi 7步分析法对访谈资料进行分析。结果 提炼出3个主题：ICU护士对实施以患者—家庭为中心照护模式的态度（赞同;怀疑或反对）;以患者—家庭为中心照护模式下ICU护士的工作体验（减轻了一定的工作压力;有利于构建良好的护患关系;造成护士安全意识淡薄;对ICU护士提出了更高要求）;现实困境（专业培训欠缺;相关标准与制度流程不完善;多学科合作不足）。结论 ICU护士对以患者—家庭为中心照护模式的实施态度因人而异,表现出多重工作体验,仍需要在临床实践中不断完善改进。建议ICU护士转变保守的照护理念,并加强专业培训,同时加快以患者—家庭为中心照护模式的专业规范和标准出台,促进跨学科合作,重视并推进以患者—家庭为中心照护模式的发展。
Objective To investigate the cognition and real work experience of ICU nurses on patient-family centered care mode,and to provide reference for optimizing ICU care mode and better meeting the needs of patients and their families. Methods With the method of objective sampling,15 ICU nurses from a tertiary class A hospital in Zibo City,Shandong Province were selected for semi-structured in-depth interviews. Colaizzi 7-step analysis was used to analyze the interview data. Results Three themes were identified：ICU nurses' attitudes towards the implementation of patient and family centered care（approval;skeptical or negative）;work experience of clinical nurses in ICU under patient and family centered care model（reduced work pressure;conducive to the construction of a good nurse-patient relationship;caused weak safety consciousness among nurses;higher requirements for ICU nurses）;practical difficulties（lack of professional training;incomplete standards and system processes;insufficient multidisciplinary cooperation）. Conclusion The attitude of ICU nurses towards the implementation of the patient-family-centered care model varies from person to person and shows multiple work experiences,which still needs to be improved continuously in clinical practice. It is suggested that ICU nurses should change the conservative concept of care and strengthen professional training. At the same time,more professional norms and standards should be issued for patient-family centered care model,and interdisciplinary cooperation should be promoted to pay attention to and promote the development of patient-family centered care model.
[1] 韩遵海,刘雪娇,何茵,等. ICU以患者家庭为中心探视模式的研究进展[J]. 中华护理杂志,2019,54(2):235-238.
Han ZH,Liu XJ,He Y,et al.Research progress of family-centered visitation mode in ICU[J]. Chin J Nurs,2019,54(2):235-238.
[2] 尉纳. 以患者家庭为中心的ICU探视方案的构建[D]. 湖州:湖州师范学院,2021.
Yu N.Construction of ICU visiting scheme centered on patients' families[D]. Huzhou:Huzhou Normal University,2021.
[3] 李奇,李真,李尊柱,等. 以患者和家庭为中心护理干预在成人ICU应用进展[J]. 护理学报,2020,27(9):23-26.
Li Q,Li Z,Li ZZ,et al.Application progress of patient-centered and family-centered nursing intervention in adult ICU[J]. J Nurs,2020,27(9):23-26.
[4] Meert KL,Clark J,Eggly S.Family-centered care in the pediatric intensive care unit[J]. Pediatr Clin North Am,2013,60(3):761-772.
[5] Goldfarb MJ,Bibas L,Bartlett V,et al.Outcomes of patient-and family-centered care interventions in the ICU:a systematic review and meta-analysis[J]. Crit Care Med,2017,45(10):1751-1761.
[6] Park M,Giap TT,Lee M,et al.Patient-and family-centered care interventions for improving the quality of health care:a review of systematic reviews[J]. Int J Nurs Stud,2018,87:69-83.
[7] Davidson JE,Aslakson RA,Long AC,et al.Guidelines for family-centered care in the neonatal,pediatric,and adult ICU[J]. Crit Care Med,2017,45(1):103-128.
[8] 董婧琦,李时雨,张欣. 美国重症医学会“以家庭为中心照护循证指南”解读[J]. 中国护理管理,2019,19(9):1426-1429.
Dong JQ,Li SY,Zhang X.Interpretation of the guidelines for family-centered care in the intensive care unit[J]. Chin Nurs Manag,2019,19(9):1426-1429.
[9] Athanasiou A,Papathanassoglou ED,Patiraki E,et al.Family visitation in Greek intensive care units:nurses' perspective[J]. Am J Crit Care,2014,23(4):326-333.
[10] 黄超,黄璜,吕显贵,等. ICU医务人员探视信念与态度现状及影响因素分析[J]. 成都医学院学报,2022,17(4):505-508.
Huang C,Huang H,Lü XG,et al.Current situation and influencing factors of beliefs and attitudes toward visitation of ICU medical staff[J]. J Chengdu Med Coll,2022,17(4):505-508.
[11] 高业兰,李超群,杨玉佩. 家庭参与模式在成人ICU中应用的研究进展[J]. 中国护理管理,2020,20(2):281-284.
Gao YL,Li CQ,Yang YP.Research progress on family-integrated care model in adult patients in ICU[J]. Chin Nurs Manag,2020,20(2):281-284.
[12] Westphal GA,Moerschberger MS,Vollmann DD,et al.Effect of a 24-h extended visiting policy on delirium in critically ill patients[J]. Intensive Care Med,2018,44(6):968-970.
[13] 张丛丛. ICU以患者-家庭为中心探视方案的构建及应用研究[D]. 青岛:青岛大学.
Zhang CC.Research on the construction and application of patient-family-centered visiting scheme in ICU[D]. Qingdao:Qingdao University.
[14] Davidson JE.Facilitated sensemaking:a strategy and new middle-range theory to support families of intensive care unit patients[J]. Crit Care Nurse,2010,30(6):28-39.
[15] 邓妙芹. 基于奥马哈系统的家庭参与式乳腺癌术后延续护理方案的构建与应用[D]. 湖州:湖州师范学院,2021.
Deng MQ.The construction and application of family participatory nursing scheme for postoperative breast cancer based on Omaha system[D]. Huzhou:Huzhou Normal University,2021.
[16] Wong P,Redley B,Digby R,et al.Families' perspectives of participation in patient care in an adult intensive care unit:a qualitative study[J]. Aust Crit Care,2020,33(4):317-325.
