基于可接受性理论的ICU机械通气患者沟通障碍因素的现象学研究  

Factors of communication disorders in ICU machinery ventilates patients based on the theoretical framework of acceptability:a phenomenological study

作　　者：杨云静 张振宇[1] 高明晓 李英[2] 徐洪妮 Yang Yunjing;Zhang Zhenyu;Gao Mingxiao;Li Ying;Xu Hongni(Department of Eastern Intensive Care Unit,Yantai Yuhuangding Hospital,Yantai 264099,China;Department of Cardiovascular Medicine,Ward 2,Yantai Yuhuangding Hospital,Yantai 264099,China)

机构地区：[1]烟台毓璜顶医院东区重症医学科,烟台264099 [2]烟台毓璜顶医院心血管内科二病区,烟台264099

出　　处：《中国实用护理杂志》2024年第4期302-307,共6页Chinese Journal of Practical Nursing

摘　　要：目的从患者和医护人员两个视角探讨导致ICU患者在机械通气期间沟通障碍的因素,并运用可接受性理论识别通过干预可改善的障碍因素。方法2022年7—8月采用质性研究中的描述性现象学研究法,运用目的抽样法选取烟台市毓磺顶医院综合ICU 11例机械通气患者和8名医护人员进行访谈,了解机械通气患者沟通障碍的因素。对患者的访谈选在脱机后,结合参与式观察。借助Nvivo12.0 Plus软件,采用Colaizzi现象学7步分析法归纳主题,运用可接受性理论识别通过干预可改善的障碍因素。结果11例患者年龄18~66岁,机械通气时长9.5~312.3 h。8名医护人员年龄26~54岁,ICU工作年限2~30年。共提炼出主题14个。患者方面:抵触情绪,信息表达困难,性格内敛,沟通工具使用不便,紧急救治冲突,否定自身沟通能力,思维迟钝;医护人员方面:抵触情绪,认知负荷及时间成本高,人性化沟通策略缺乏,培训欠佳,其他优先工作事宜,丧失有效沟通的信心,对沟通重要性的认知度不高。结论可改善的ICU机械通气患者沟通障碍因素较多,建议国内加快对高科技、个性化替代交流工具的研发,减少医患、护患的负向沟通,实施以证据为基础的多模式、渐进式沟通干预策略。Objective To explore the factors leading to communication disorders in ICU patients during mechanical ventilation from the perspective of both patients and medical staff,and to use the theoretical framework of acceptability to identify the barriers that can be improved by intervention.Methods Using the method of descriptive phenomenology from July to August 2022,11 patients with mechanical ventilation and 8 medical staff in the comprehensive ICU of a Yuhuangding Hospital in Yantai were selected for interviews by the purpose sampling method,combined with participatory observation.The interviews of patients were conducted off ventilator.With Nvivo12.0 Plus software,the seven-step analysis method of Colaizzi phenomenology was adopted to summarize the theme and the theoretical framework of acceptability was used to identify the obstacle factors that could be improved by intervention.Results The age of 11 patients was 18-46 years old,the duration of mechanical ventilation was 9.5-312.3 h.The age of 8 medical staff was 26-54 years old,the length of service in ICU was 2-30 years.A total of 14 themes were extracted.For patients:defensive mood,difficulty in presenting information,introverted personality,communication tools are hard to use,emergency treatment conflict,deny the ability to communicate,thought slowness.For medical staff:defensive mood,cognitive load,high time cost,lack of humane communication strategies,poor training,other priorities,loss of confidence in effective communication,awareness of the importance of communication was not enough.Conclusions There are many factors that can be improved for patients with mechanical ventilation in ICU.It is suggested to speed up the research and development of high-tech and personalized alternative communication tools in China,reduce negative communication between doctors and patients and nurses and patients,and implement evidence-based multi-mode and progressive communication intervention strategies.

关 键 词：呼吸 人工 定性研究 可接受性理论 沟通障碍 

分 类 号：R473[医药卫生—护理学]