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摘要:目的:分析重度顱脑损伤患者家属疾病不确定感相关因素与护理对策?方法:本研究选取54例重度颅脑损伤患者家属为对象,采用调查问卷调查其疾病不确定感和应对措施,并采用SAS量表和SDS量表对其进行心理评估,根据评估结果对其进行心理疏导和健康教育等护理干预措施?对比分析护理干预前后患者家属心理状态的变化?结果 54例重度颅脑损伤患者家属不确定感和应对措施得分平均为(93.12±13.21)分?文化程度高?中年家属?有职业的家属应对措施得分明显高于文化程度低?其他年龄段家属和无职业家属的应对措施得分,差异有统计学意义(P<0.05)?家属SAS评分?SDS评分均超过临界值?经过护理干预后SAS评分?SDS评分均有所下降,采用t检验分析进行数据统计,差异有统计学意义(P<0.05)?结论:重度颅脑损伤患者家属普遍存在疾病不确定感,且不确定感跟患者家属年龄?文化程度和职业情况等相关,同时均存在不同程度的焦虑?抑郁心理,及时对其进行心理疏导和健康教育等护理干预措施有助于改善其心理状态,从而以积极方式应对?
关键词:重度颅脑损伤患者家属;疾病不确定感;相关因素;护理对策
Family members of patients with severe craniocerebral injury and nursing measures of disease uncertainty feeling related factors
Abstract: Objective To analyze the uncertainty factors and nursing countermeasures of sense in families of patients with severe craniocerebral injury. Methods in this study,54 cases of severe craniocerebral injury patients families as the research object,using the questionnaire survey and the uncertainty in illness and coping measures,and the use of SAS scale and SDS scale for psychological assessment on them,according to the results of the assessment of the psychological counseling and health education and nursing intervention measures. Comparative analysis of changes in family members of patients psychological state before and after nursing intervention. Results of 54 cases of severe craniocerebral injury patients families of uncertainty and coping measures the average score was (93.12 + 13.21)%. Culture degree is high,the middle-aged families,families of professional score measures was significantly higher than that of the low level of education,age and occupation of other family members relatives measures score,the difference was statistically significant (P < 0.05). The family of SAS score and SDS score were more than the critical value. After the nursing intervention,the SAS score and SDS score were decreased,t was used to test the statistical data,the difference was statistically significant (P < 0.05). Family members of patients with widespread disease uncertainty conclusion severe craniocerebral injury,and the uncertainty associated with the families of patients age,education level and occupation,at the same time,there are different degrees of anxiety,depression,and the psychological counseling and health education and nursing intervention is helpful to improve their psychological state,thereby in a positive way to deal with.
Keywords: Family members of patients with severe traumatic brain injury; uncertainty in illness; related factors; nursing measures 【中图分类号】R651.1+5 【文献标识码】A 【文章编号】1672-8602(2015)05-0123-02
重度颅脑损伤患者发病急,病情危重,随时存在生命危险,而患者家属受到突如其来的打击,加上对疾病本身知识了解程度低,对医疗水平认识度低,因此无法很好对疾病进展和预后进行预测,从而产生疾病不确定感[1-2]?本研究分析了重度颅脑损伤患者家属疾病不确定感相关因素与护理对策,现将结果报告如下?
1.资料和方法
1.1一般资料
本研究选取54例重度颅脑损伤患者家属为对象,包括男性24例,女性30例;年龄24岁~75岁,平均年龄(47.54±11.13)岁;与患者关系为配偶20例?父/母15例?子/女12例?兄弟/姐妹7例;文化程度包括本科2例?大专8例?高中18例?初中20例?小学6例?所有研究对象均对患者负有照顾?赡养或抚养的法律责任,与患者共同生活时间≥2年?研究对象剔除精神异常?文盲?严重视力?听力?语言障碍?其他原因不能配合本研究者?
1.2方法
采用调查问卷调查其疾病不确定感和应对措施,并采用SAS量表和SDS量表对其进行心理评估,根据评估结果对其进行心理疏导和健康教育等护理干预措施?
问卷发放54份,回收54份?采用疾病不确定感家属量表进行评价,包括不明确性?复杂性?不可预测性以及信息缺乏性四个方面,分值在77.8以上则不确定感较高?采用简易应对方式量表对家属应对措施进行评分,分为积极和消极两个方面,分数越高,越积极[3]?
采用焦虑自评量表(SAS)?抑郁自评量表(SDS)评价患者家属心理状态?SAS量表共包括20项内容,每项采取四级评分法?将各项得分相加后乘以系数1.25,取整数部分得到标准分?临界值为50分,SAS评分>50分者认为存在焦虑心理,SAS评分越高,表示焦虑程度越严重[4]?
SDS量表共包括20项内容,每项采取四级评分法?将各项得分相加后乘以系数1.25,取整数部分得到标准分?临界值为53分,SDS评分>53分者认为存在抑郁心理,SDS评分越高,表示抑郁程度越严重[5]?
1.3护理方法
与患者家属进行深入沟通和交流,向其讲解疾病治疗方法和预期效果,目前医疗水平,使患者家属对疾病产生正确的认识?对家属给予安慰和鼓励,只要治疗?护理得当,患者病情会很快稳定,缓解其焦虑不安心理?
1.4数据处理
将本研究中所涉及疾病不确定感?应对措施评分?焦虑抑郁评分等数据采用SPSS18.0软件进行统计学分析,所有计量资料对比分析采用t检验,以均数±标准差(`x±s)表示?P<0.05表示差异有统计学意义?
2.结果
54例重度颅脑损伤患者家属不确定感和应对措施得分平均为(93.12±13.21)分?文化程度高?中年家属?有职业的家属应对措施得分明显高于文化程度低?其他年龄段家属和无职业家属的应对措施得分,差异有统计学意义(P<0.05)?家属SAS评分?SDS评分均超过临界值?经过护理干预后SAS评分?SDS评分均有所下降,采用t检验分析进行数据统计,差异有统计学意义(P<0.05)?见表1?表2.
3.讨论
近年来颅脑损伤发生率在交通事业及高层建筑事业快速发展的形势下不断增长,由于事发突然且外力冲击强,颅脑损伤一般较为严重[6]?相关报道称重度颅脑损伤在急性颅脑损伤中所占比例为13%至21%[7],易合并脑水肿等严重并发症,若救治不当造成患者死亡,病死率高达36.9%至65%,救治难度大?颅脑损伤后,由于脑血管受损,不能及时供应营养物质,脑细胞会出现缺血,缺氧?肿胀坏死,又加之血管破裂后大量出血,造成颅内压迅速升高,颅内压升高后,脑组织受压迫,从而加重缺血?缺氧,并增加了有害代谢产物的堆积,进一步加重脑损伤,如此恶性循环,给患者生命生命安全造成极大危害[8-9]?同时患者加速疾病不确定感染因素增多,因此,有效护理措施也是控制病情的关键?
本研究中54例重度颅脑损伤患者家属不确定感和应对措施得分平均为(93.12±13.21)分?文化程度高?中年家属?有职业的家属应对措施得分明显高于文化程度低?其他年龄段家属和无职业家属的应对措施得分,差异有统计学意义(P<0.05)?家属SAS评分?SDS评分均超过临界值?经过护理干预后SAS评分?SDS评分均有所下降,采用t检验分析进行数据统计,差异有统计学意义,显示患者均存在较高的疾病不确定感,而应对方式随着患者家属文化水平?年龄以及职业情况不同而出现明显的差异?另外,所有研究对象的SAS评分和SDS评分均超过临界值,这一结果提示心理问题在重度颅脑损伤患者家属中比较普遍,对其实施护理干预迫在眉睫?经过心理疏导和健康教育等護理干预措施后,患者家属SAS评分和SDS评分均有所下降[10]?
综上所述,重度颅脑损伤患者家属普遍存在疾病不确定感,且不确定感跟患者家属年龄?文化程度和职业情况等相关,同时均存在不同程度的焦虑?抑郁心理,及时对其进行心理疏导和健康教育等护理干预措施有助于改善其心理状态,从而以积极方式应对?
参考文献
[1] 肖向莉,王亚珍.强化社会支持对癌症患者及其家属疾病不确定感的影响研究[J].护理实践与研究,2009,6(21):3-5.
[2] 班亮阶,陆青梅,覃美兰等.脑性瘫痪患儿家属疾病不确定感?焦虑调查分析[J].中国医药导报,2012,09(3):159-160.
[3] 曾丽智,陈沁,刘辉等.过渡期护理模式对COPD病人家属疾病不确定感和应对方式的影响[J].护理研究,2013,27(32):3637-3639.
[4] 赵洪梅,尹斐.信息支持对冠状动脉介入治疗病人家属疾病不确定感的影响[J].护理研究,2012,26(23):2149-2150.
[5] 千永日,姜哲,崔敬爱等.慢性病病人家属疾病不确定感及其相关因素的调查分析与护理对策[J].全科护理,2011,09(31):2821-2823.
[6] Harred JF,KnightAR,McIntyre JS.Inventors. Dow chemical campany,assignee eXpoXidation process. USP atent3. 2012,3(17). 1927~1904
[7] ZhangY,LiW,YanT,et al.Early detection of lesions of dorsal artery of foot in patients with type 2 diabetes mellitus by hi gh-frequency ul trasonography. J HuazhongUniv Sci Technolog Med Sci,2011,29(3):387-390.
[8] Foley RN,ParfreyPS, Sarnak MJ. Epidemiology of cardiovasc- ula r disease in chronic renal disease. J Am Soc Nephrol,2013,9 (12Suppl):S1 6-23.
[9] Malyszko J. Mechanism of endothelial dysfunction in chronic kidney disease. Clin Chim Acta,2010,411(19/20):1412-1420.
[10] Izumi S,Muano T,Mori A,et al.Common carotid artery stiffness,cardiovascular function and lipid metabolism after menopause. Life Sci,2012,78 (15):1696-1701.
关键词:重度颅脑损伤患者家属;疾病不确定感;相关因素;护理对策
Family members of patients with severe craniocerebral injury and nursing measures of disease uncertainty feeling related factors
Abstract: Objective To analyze the uncertainty factors and nursing countermeasures of sense in families of patients with severe craniocerebral injury. Methods in this study,54 cases of severe craniocerebral injury patients families as the research object,using the questionnaire survey and the uncertainty in illness and coping measures,and the use of SAS scale and SDS scale for psychological assessment on them,according to the results of the assessment of the psychological counseling and health education and nursing intervention measures. Comparative analysis of changes in family members of patients psychological state before and after nursing intervention. Results of 54 cases of severe craniocerebral injury patients families of uncertainty and coping measures the average score was (93.12 + 13.21)%. Culture degree is high,the middle-aged families,families of professional score measures was significantly higher than that of the low level of education,age and occupation of other family members relatives measures score,the difference was statistically significant (P < 0.05). The family of SAS score and SDS score were more than the critical value. After the nursing intervention,the SAS score and SDS score were decreased,t was used to test the statistical data,the difference was statistically significant (P < 0.05). Family members of patients with widespread disease uncertainty conclusion severe craniocerebral injury,and the uncertainty associated with the families of patients age,education level and occupation,at the same time,there are different degrees of anxiety,depression,and the psychological counseling and health education and nursing intervention is helpful to improve their psychological state,thereby in a positive way to deal with.
Keywords: Family members of patients with severe traumatic brain injury; uncertainty in illness; related factors; nursing measures 【中图分类号】R651.1+5 【文献标识码】A 【文章编号】1672-8602(2015)05-0123-02
重度颅脑损伤患者发病急,病情危重,随时存在生命危险,而患者家属受到突如其来的打击,加上对疾病本身知识了解程度低,对医疗水平认识度低,因此无法很好对疾病进展和预后进行预测,从而产生疾病不确定感[1-2]?本研究分析了重度颅脑损伤患者家属疾病不确定感相关因素与护理对策,现将结果报告如下?
1.资料和方法
1.1一般资料
本研究选取54例重度颅脑损伤患者家属为对象,包括男性24例,女性30例;年龄24岁~75岁,平均年龄(47.54±11.13)岁;与患者关系为配偶20例?父/母15例?子/女12例?兄弟/姐妹7例;文化程度包括本科2例?大专8例?高中18例?初中20例?小学6例?所有研究对象均对患者负有照顾?赡养或抚养的法律责任,与患者共同生活时间≥2年?研究对象剔除精神异常?文盲?严重视力?听力?语言障碍?其他原因不能配合本研究者?
1.2方法
采用调查问卷调查其疾病不确定感和应对措施,并采用SAS量表和SDS量表对其进行心理评估,根据评估结果对其进行心理疏导和健康教育等护理干预措施?
问卷发放54份,回收54份?采用疾病不确定感家属量表进行评价,包括不明确性?复杂性?不可预测性以及信息缺乏性四个方面,分值在77.8以上则不确定感较高?采用简易应对方式量表对家属应对措施进行评分,分为积极和消极两个方面,分数越高,越积极[3]?
采用焦虑自评量表(SAS)?抑郁自评量表(SDS)评价患者家属心理状态?SAS量表共包括20项内容,每项采取四级评分法?将各项得分相加后乘以系数1.25,取整数部分得到标准分?临界值为50分,SAS评分>50分者认为存在焦虑心理,SAS评分越高,表示焦虑程度越严重[4]?
SDS量表共包括20项内容,每项采取四级评分法?将各项得分相加后乘以系数1.25,取整数部分得到标准分?临界值为53分,SDS评分>53分者认为存在抑郁心理,SDS评分越高,表示抑郁程度越严重[5]?
1.3护理方法
与患者家属进行深入沟通和交流,向其讲解疾病治疗方法和预期效果,目前医疗水平,使患者家属对疾病产生正确的认识?对家属给予安慰和鼓励,只要治疗?护理得当,患者病情会很快稳定,缓解其焦虑不安心理?
1.4数据处理
将本研究中所涉及疾病不确定感?应对措施评分?焦虑抑郁评分等数据采用SPSS18.0软件进行统计学分析,所有计量资料对比分析采用t检验,以均数±标准差(`x±s)表示?P<0.05表示差异有统计学意义?
2.结果
54例重度颅脑损伤患者家属不确定感和应对措施得分平均为(93.12±13.21)分?文化程度高?中年家属?有职业的家属应对措施得分明显高于文化程度低?其他年龄段家属和无职业家属的应对措施得分,差异有统计学意义(P<0.05)?家属SAS评分?SDS评分均超过临界值?经过护理干预后SAS评分?SDS评分均有所下降,采用t检验分析进行数据统计,差异有统计学意义(P<0.05)?见表1?表2.
3.讨论
近年来颅脑损伤发生率在交通事业及高层建筑事业快速发展的形势下不断增长,由于事发突然且外力冲击强,颅脑损伤一般较为严重[6]?相关报道称重度颅脑损伤在急性颅脑损伤中所占比例为13%至21%[7],易合并脑水肿等严重并发症,若救治不当造成患者死亡,病死率高达36.9%至65%,救治难度大?颅脑损伤后,由于脑血管受损,不能及时供应营养物质,脑细胞会出现缺血,缺氧?肿胀坏死,又加之血管破裂后大量出血,造成颅内压迅速升高,颅内压升高后,脑组织受压迫,从而加重缺血?缺氧,并增加了有害代谢产物的堆积,进一步加重脑损伤,如此恶性循环,给患者生命生命安全造成极大危害[8-9]?同时患者加速疾病不确定感染因素增多,因此,有效护理措施也是控制病情的关键?
本研究中54例重度颅脑损伤患者家属不确定感和应对措施得分平均为(93.12±13.21)分?文化程度高?中年家属?有职业的家属应对措施得分明显高于文化程度低?其他年龄段家属和无职业家属的应对措施得分,差异有统计学意义(P<0.05)?家属SAS评分?SDS评分均超过临界值?经过护理干预后SAS评分?SDS评分均有所下降,采用t检验分析进行数据统计,差异有统计学意义,显示患者均存在较高的疾病不确定感,而应对方式随着患者家属文化水平?年龄以及职业情况不同而出现明显的差异?另外,所有研究对象的SAS评分和SDS评分均超过临界值,这一结果提示心理问题在重度颅脑损伤患者家属中比较普遍,对其实施护理干预迫在眉睫?经过心理疏导和健康教育等護理干预措施后,患者家属SAS评分和SDS评分均有所下降[10]?
综上所述,重度颅脑损伤患者家属普遍存在疾病不确定感,且不确定感跟患者家属年龄?文化程度和职业情况等相关,同时均存在不同程度的焦虑?抑郁心理,及时对其进行心理疏导和健康教育等护理干预措施有助于改善其心理状态,从而以积极方式应对?
参考文献
[1] 肖向莉,王亚珍.强化社会支持对癌症患者及其家属疾病不确定感的影响研究[J].护理实践与研究,2009,6(21):3-5.
[2] 班亮阶,陆青梅,覃美兰等.脑性瘫痪患儿家属疾病不确定感?焦虑调查分析[J].中国医药导报,2012,09(3):159-160.
[3] 曾丽智,陈沁,刘辉等.过渡期护理模式对COPD病人家属疾病不确定感和应对方式的影响[J].护理研究,2013,27(32):3637-3639.
[4] 赵洪梅,尹斐.信息支持对冠状动脉介入治疗病人家属疾病不确定感的影响[J].护理研究,2012,26(23):2149-2150.
[5] 千永日,姜哲,崔敬爱等.慢性病病人家属疾病不确定感及其相关因素的调查分析与护理对策[J].全科护理,2011,09(31):2821-2823.
[6] Harred JF,KnightAR,McIntyre JS.Inventors. Dow chemical campany,assignee eXpoXidation process. USP atent3. 2012,3(17). 1927~1904
[7] ZhangY,LiW,YanT,et al.Early detection of lesions of dorsal artery of foot in patients with type 2 diabetes mellitus by hi gh-frequency ul trasonography. J HuazhongUniv Sci Technolog Med Sci,2011,29(3):387-390.
[8] Foley RN,ParfreyPS, Sarnak MJ. Epidemiology of cardiovasc- ula r disease in chronic renal disease. J Am Soc Nephrol,2013,9 (12Suppl):S1 6-23.
[9] Malyszko J. Mechanism of endothelial dysfunction in chronic kidney disease. Clin Chim Acta,2010,411(19/20):1412-1420.
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