河北省三級(jí)醫(yī)院ICU護(hù)士死亡焦慮現(xiàn)狀調(diào)查及干預(yù)研究
發(fā)布時(shí)間：2018-08-18 11:39
【摘要】：目的:隨著社會(huì)的不斷發(fā)展、現(xiàn)代生活節(jié)奏越來(lái)越快,心理壓力在普通人群中都有所提升。眾所周知,生死交替是人類(lèi)進(jìn)化的必然階段,是每個(gè)人都必須要經(jīng)歷和承受的。ICU是醫(yī)院危急重癥患者的集中地,每天都上演著生離死別。我國(guó)學(xué)者目前大部分心理狀況的研究集中在重癥患者及家屬,較少對(duì)直接參與臨終關(guān)懷的醫(yī)護(hù)人員給予關(guān)注,這類(lèi)醫(yī)護(hù)人員在重癥患者救治的過(guò)程中發(fā)揮著舉足輕重的作用。當(dāng)ICU護(hù)士出現(xiàn)相關(guān)不良心理應(yīng)激或者死亡焦慮的反應(yīng)時(shí),給患者及其家屬的心理慰藉和社會(huì)精神支持等方面帶來(lái)負(fù)面作用。常年奮戰(zhàn)在ICU一線的護(hù)士作為人民健康的保健護(hù)航者,其死亡焦慮水平理應(yīng)引起更廣泛的社會(huì)關(guān)注。本次調(diào)查研究主要為了了解河北省三級(jí)醫(yī)院ICU護(hù)理人員死亡焦慮現(xiàn)狀,探討護(hù)理人員死亡焦慮的相關(guān)影響因素,針對(duì)可控性因素實(shí)施相應(yīng)對(duì)策,為今后有效降低ICU護(hù)士的死亡焦慮感提供數(shù)據(jù)支持。方法:從2016年3月至2016年12月,采用便利抽樣法,抽取河北省三級(jí)醫(yī)院ICU護(hù)士作為研究對(duì)象,使用中文版五級(jí)死亡焦慮量表,調(diào)查三級(jí)醫(yī)院ICU護(hù)士死亡焦慮現(xiàn)狀。共發(fā)放調(diào)查問(wèn)卷450份,回收409份,有效回收率為90.89%。本調(diào)查研究分為兩部分內(nèi)容:第一,納入護(hù)理人員的一般狀況包括性別、年齡、民族、婚姻狀況、學(xué)歷、護(hù)齡、職稱(chēng)、宗教信仰、工作科室等;第二,把護(hù)士是否接受過(guò)死亡教育或親歷死亡事件納入到調(diào)查范疇。以35分認(rèn)為調(diào)查人群處于高死亡焦慮狀態(tài)。采用SPSS22.0數(shù)據(jù)包對(duì)所得結(jié)果進(jìn)行分析,計(jì)數(shù)資料間的對(duì)比采用卡方檢驗(yàn)、計(jì)量資料采用方差分析和t檢驗(yàn)進(jìn)行分析;涉及到兩兩比較的數(shù)據(jù)采用SNK-q檢驗(yàn)進(jìn)行對(duì)比;死亡焦慮的影響因素分析采用多元條件Logistic回歸方法;培訓(xùn)前后死亡焦慮得分情況對(duì)比采用配對(duì)t檢驗(yàn)。結(jié)果:1ICU護(hù)士死亡焦慮評(píng)分(45.16±6.07)普遍得分較高,386人(94.38%)表現(xiàn)出較高死亡焦慮水平。其中女性護(hù)士存在死亡焦慮比例達(dá)95.3%,高于男性護(hù)士的86.4%,差異有統(tǒng)計(jì)學(xué)意義,P0.05。2ICU護(hù)士一般情況與死亡焦慮評(píng)分的對(duì)比情況如下:年齡≤25歲的護(hù)士死亡焦慮評(píng)分為38.74±5.66,明顯低于25歲的護(hù)士得分水平47.32±4.45,t=-15.761,p0.001;icu男性護(hù)士的死亡焦慮評(píng)分為43.43±7.97明顯低于女性護(hù)士的45.37±5.78,t=-2.006,p=0.046;護(hù)士初始學(xué)歷是中專(zhuān)、大專(zhuān)和本科水平的護(hù)士死亡焦慮評(píng)分分別為46.63±6.02、45.78±5.24和42.53±7.44,三者對(duì)比有統(tǒng)計(jì)學(xué)差異,f=12.230,p0.001,學(xué)歷越高死亡焦慮評(píng)分越低;職稱(chēng)水平分別為護(hù)士、護(hù)師、主管護(hù)師和副主任護(hù)師及以上的護(hù)士死亡焦慮評(píng)分分別為43.81±5.36、44.73±6.03、46.16±5.46和40.57±4.86,四者對(duì)比有統(tǒng)計(jì)學(xué)差異,f=3.259,p=0.033,主管護(hù)師的死亡焦慮水平高于護(hù)師和護(hù)士,但是副主任護(hù)師及以上的高死亡焦慮評(píng)分最低;不同婚姻狀況、最高學(xué)歷、用工形式以及是否為科室?guī)Ы汤蠋�、科室�(guī)ЫM組長(zhǎng)和工作年限等對(duì)護(hù)士死亡焦慮評(píng)分情況無(wú)影響,差異沒(méi)有統(tǒng)計(jì)學(xué)意義,p0.05。3是否接受過(guò)死亡教育及事件對(duì)死亡焦慮評(píng)分影響情況參加過(guò)死亡教育或臨終關(guān)懷的培訓(xùn)或?qū)W習(xí)的護(hù)士死亡焦慮評(píng)分為42.37±6.92,明顯低于未參加過(guò)死亡教育或臨終關(guān)懷的培訓(xùn)或?qū)W習(xí)的護(hù)士46.01±5.52,差異有統(tǒng)計(jì)學(xué)意義,t=-5.293,p0.001;參與患者或親人的臨終處置的護(hù)士死亡焦慮評(píng)分為44.52±6.63,明顯低于未參與患者或親人的臨終處置的45.62±5.59,差異有統(tǒng)計(jì)學(xué)意義,t=-2.017,p=0.045;是否目睹過(guò)嚴(yán)重事故或威脅生命事件對(duì)死亡焦慮評(píng)分的情況無(wú)影響,差異沒(méi)有統(tǒng)計(jì)學(xué)意義,p0.05。4將23例不存在死亡焦慮的護(hù)士作為研究對(duì)象,按照1:2比例進(jìn)行科室、性別、家庭環(huán)境進(jìn)行匹配,追溯其填寫(xiě)的調(diào)查問(wèn)卷,采用條件logistic回歸研究死亡焦慮評(píng)分的影響因素。研究表明有參與親人臨終處置的經(jīng)歷和曾經(jīng)系統(tǒng)參加臨終關(guān)懷相關(guān)培訓(xùn)工作是死亡焦慮的“保護(hù)因素”。5采用就近原則的方法,在河北省胸科醫(yī)院組織對(duì)45名icu護(hù)士(之前均未參加過(guò)類(lèi)似培訓(xùn)或者教育經(jīng)歷)進(jìn)行死亡焦慮培訓(xùn)工作,觀察培訓(xùn)前、培訓(xùn)中、培訓(xùn)后死亡焦慮評(píng)分的變化情況。培訓(xùn)前我院icu護(hù)士死亡焦慮評(píng)分為45.36±5.93,培訓(xùn)過(guò)程中調(diào)查發(fā)現(xiàn)icu護(hù)士死亡焦慮評(píng)分降低至44.68±5.62,培訓(xùn)結(jié)束后icu護(hù)士死亡焦慮評(píng)分降低至42.35±6.15。結(jié)論:1三級(jí)醫(yī)院ICU護(hù)士死亡焦慮評(píng)分普遍得分較高,94.38%表現(xiàn)出較高死亡焦慮水平,并且存在性別差異,其中女性護(hù)士死亡焦慮水平高于男性護(hù)士。2 ICU護(hù)士死亡焦慮評(píng)分在年齡、初始學(xué)歷、職稱(chēng)水平上存在差異,年齡≤25歲的護(hù)士死亡焦慮評(píng)分明顯低于25歲的護(hù)士得分水平;初始學(xué)歷越高死亡焦慮評(píng)分情況相應(yīng)越低;職稱(chēng)水平升高,死亡焦慮評(píng)分情況相應(yīng)升高。3參加過(guò)死亡教育或臨終關(guān)懷的培訓(xùn)或?qū)W習(xí)以及參與患者或親人的臨終處置的護(hù)士死亡焦慮評(píng)分低于沒(méi)有上述經(jīng)歷的護(hù)士。4條件Logistic回歸研究死亡焦慮評(píng)分的影響因素,結(jié)果表明年齡≤25歲、有參與親人臨終處置的經(jīng)歷和曾經(jīng)系統(tǒng)參加臨終關(guān)懷相關(guān)培訓(xùn)工作有助于降低ICU護(hù)士死亡焦慮水平。5組織ICU護(hù)士開(kāi)展的死亡焦慮系統(tǒng)培訓(xùn)工作行之有效,在參加過(guò)培訓(xùn)后,死亡焦慮水平降低效果顯著。
[Abstract]:Objective: With the continuous development of society, the pace of modern life is getting faster and faster, and psychological pressure is rising in the general population. As we all know, life-death alternation is the inevitable stage of human evolution, which everyone must experience and accept. ICU is the concentration of critically ill patients in hospitals. Life-death parting takes place every day. At present, most of the researches on psychological status focus on the critically ill patients and their family members, and few of them pay attention to the medical staff directly involved in hospice care. These medical staff play an important role in the treatment of critically ill patients. Psychological comfort and social and spiritual support from family members have brought about negative effects. Nurses working hard all the year round in ICU as health care escorts of the people should arouse wider social concern about their level of death anxiety. Methods: From March 2016 to December 2016, ICU nurses in Hebei tertiary hospitals were selected by convenience sampling method, and the Chinese version of the fifth level of death anxiety was used. A total of 450 questionnaires were sent out and 409 of them were recovered with an effective recovery rate of 90.89%. The study was divided into two parts. First, the general conditions of nurses included gender, age, nationality, marital status, educational background, nursing age, professional title, religious belief, and work room, etc. The results were analyzed by SPSS22.0 data package. The comparison of the counting data was analyzed by Chi-square test, and the measurement data was analyzed by ANOVA and T-test. The data were compared by SNK-q test; the influencing factors of death anxiety were analyzed by multivariate conditional logistic regression method; and the scores of death anxiety before and after training were compared by paired t test. Results: 1 The death anxiety score of ICU nurses was generally higher, 386 (94.38%) showed higher level of death anxiety. The proportion of nurses with death anxiety was 95.3%, which was higher than 86.4% of male nurses. The difference was statistically significant (P 0.05.2). The score of death anxiety of nurses was 43.43+7.97, which was significantly lower than that of female nurses (45.37+5.78, t=-2.006, p=0.046); the score of death anxiety of nurses with initial education was 46.63+6.02, 45.78+5.24 and 42.53+7.44, respectively, and the difference was statistically significant (f=12.230, p0.001). The scores of death anxiety of nurses with professional titles were 43.81 (+5.36), 44.73 (+6.03), 46.16 (+5.46) and 40.57 (+4.86), respectively. There was statistical difference between the four groups, f = 3.259, P = 0.033. The level of death anxiety of nurses in charge was higher than that of nurses and nurses in charge, but the level of death anxiety of nurses in charge and above was higher than that of nurses in charge. The scores of high death anxiety were the lowest; different marital status, the highest educational background, the type of employment and whether or not to be a teaching teacher, the head of the Department and the length of work had no influence on the scores of death anxiety, the difference was not statistically significant, p0.05.3 whether or not to receive death education and events had participated in the impact of death anxiety scores. The score of death anxiety of nurses trained or trained in death education or hospice care was 42.37 + 6.92, which was significantly lower than that of nurses trained or trained in death education or hospice care (46.01 + 5.52). The difference was statistically significant (t = - 5.293, P 0.001); the score of death anxiety of nurses involved in hospice care of patients or relatives was 44.52 + 6.63. It was significantly lower than that of the patients or relatives who had not participated in the hospice treatment, the difference was statistically significant, t = - 2.017, P = 0.045; whether or not witnessed serious accidents or life-threatening events had no effect on the score of death anxiety, the difference was not statistically significant, p0.05.4 23 nurses without death anxiety as the study object, according to the 1:2 ratio. Case matched with department, gender, family environment, retrospective questionnaire and conditional logistic regression were used to study the influencing factors of death anxiety score. Methods Forty-five ICU nurses (who had not participated in similar training or educational experience before) were trained in Hebei Thoracic Hospital to observe the changes of the scores of death anxiety before and after training. The death anxiety score of U nurses was reduced to 44.68+5.62, and the death anxiety score of ICU nurses was reduced to 42.35+6.15 after training. Conclusion: The death anxiety score of ICU nurses in Grade 1 tertiary hospitals was generally higher, 94.38% of them showed higher level of death anxiety, and there were gender differences, among them, the death anxiety level of female nurses was higher than that of male nurses. The scores of U nurses'death anxiety were significantly lower than those of 25-year-old nurses. The higher the initial educational background, the lower the score of death anxiety; the higher the professional title, the higher the score of death anxiety. 3. Nurses who participated in the training or learning of care and hospice treatment of patients or relatives had lower scores of death anxiety than those who did not. 4 conditional logistic regression was used to study the influencing factors of death anxiety score. The results showed that the age of nurses who participated in hospice treatment of relatives was less than 25 years old. It is helpful to reduce the level of death anxiety of ICU nurses. 5 It is effective to organize the training of death anxiety system for ICU nurses. After participating in the training, the level of death anxiety decreased significantly.
【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R47
本文編號(hào)：2189353
[Abstract]:Objective: With the continuous development of society, the pace of modern life is getting faster and faster, and psychological pressure is rising in the general population. As we all know, life-death alternation is the inevitable stage of human evolution, which everyone must experience and accept. ICU is the concentration of critically ill patients in hospitals. Life-death parting takes place every day. At present, most of the researches on psychological status focus on the critically ill patients and their family members, and few of them pay attention to the medical staff directly involved in hospice care. These medical staff play an important role in the treatment of critically ill patients. Psychological comfort and social and spiritual support from family members have brought about negative effects. Nurses working hard all the year round in ICU as health care escorts of the people should arouse wider social concern about their level of death anxiety. Methods: From March 2016 to December 2016, ICU nurses in Hebei tertiary hospitals were selected by convenience sampling method, and the Chinese version of the fifth level of death anxiety was used. A total of 450 questionnaires were sent out and 409 of them were recovered with an effective recovery rate of 90.89%. The study was divided into two parts. First, the general conditions of nurses included gender, age, nationality, marital status, educational background, nursing age, professional title, religious belief, and work room, etc. The results were analyzed by SPSS22.0 data package. The comparison of the counting data was analyzed by Chi-square test, and the measurement data was analyzed by ANOVA and T-test. The data were compared by SNK-q test; the influencing factors of death anxiety were analyzed by multivariate conditional logistic regression method; and the scores of death anxiety before and after training were compared by paired t test. Results: 1 The death anxiety score of ICU nurses was generally higher, 386 (94.38%) showed higher level of death anxiety. The proportion of nurses with death anxiety was 95.3%, which was higher than 86.4% of male nurses. The difference was statistically significant (P 0.05.2). The score of death anxiety of nurses was 43.43+7.97, which was significantly lower than that of female nurses (45.37+5.78, t=-2.006, p=0.046); the score of death anxiety of nurses with initial education was 46.63+6.02, 45.78+5.24 and 42.53+7.44, respectively, and the difference was statistically significant (f=12.230, p0.001). The scores of death anxiety of nurses with professional titles were 43.81 (+5.36), 44.73 (+6.03), 46.16 (+5.46) and 40.57 (+4.86), respectively. There was statistical difference between the four groups, f = 3.259, P = 0.033. The level of death anxiety of nurses in charge was higher than that of nurses and nurses in charge, but the level of death anxiety of nurses in charge and above was higher than that of nurses in charge. The scores of high death anxiety were the lowest; different marital status, the highest educational background, the type of employment and whether or not to be a teaching teacher, the head of the Department and the length of work had no influence on the scores of death anxiety, the difference was not statistically significant, p0.05.3 whether or not to receive death education and events had participated in the impact of death anxiety scores. The score of death anxiety of nurses trained or trained in death education or hospice care was 42.37 + 6.92, which was significantly lower than that of nurses trained or trained in death education or hospice care (46.01 + 5.52). The difference was statistically significant (t = - 5.293, P 0.001); the score of death anxiety of nurses involved in hospice care of patients or relatives was 44.52 + 6.63. It was significantly lower than that of the patients or relatives who had not participated in the hospice treatment, the difference was statistically significant, t = - 2.017, P = 0.045; whether or not witnessed serious accidents or life-threatening events had no effect on the score of death anxiety, the difference was not statistically significant, p0.05.4 23 nurses without death anxiety as the study object, according to the 1:2 ratio. Case matched with department, gender, family environment, retrospective questionnaire and conditional logistic regression were used to study the influencing factors of death anxiety score. Methods Forty-five ICU nurses (who had not participated in similar training or educational experience before) were trained in Hebei Thoracic Hospital to observe the changes of the scores of death anxiety before and after training. The death anxiety score of U nurses was reduced to 44.68+5.62, and the death anxiety score of ICU nurses was reduced to 42.35+6.15 after training. Conclusion: The death anxiety score of ICU nurses in Grade 1 tertiary hospitals was generally higher, 94.38% of them showed higher level of death anxiety, and there were gender differences, among them, the death anxiety level of female nurses was higher than that of male nurses. The scores of U nurses'death anxiety were significantly lower than those of 25-year-old nurses. The higher the initial educational background, the lower the score of death anxiety; the higher the professional title, the higher the score of death anxiety. 3. Nurses who participated in the training or learning of care and hospice treatment of patients or relatives had lower scores of death anxiety than those who did not. 4 conditional logistic regression was used to study the influencing factors of death anxiety score. The results showed that the age of nurses who participated in hospice treatment of relatives was less than 25 years old. It is helpful to reduce the level of death anxiety of ICU nurses. 5 It is effective to organize the training of death anxiety system for ICU nurses. After participating in the training, the level of death anxiety decreased significantly.
【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R47
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