收稿日期: 2024-10-30
网络出版日期: 2025-04-28
基金资助
国家中心自主设计项目软科学研究专项(R23F0003)
Psychological and social adaptation in children post-intensive care:a qualitative study
Received date: 2024-10-30
Online published: 2025-04-28
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。
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 . DOI: 10.3761/j.issn.2096-7446.2025.05.005
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.
[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. |
[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. |
[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. |
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