恶性梗阻性黄疸患者经皮肝穿刺胆道引流术后带管生活体验的质性研究

Qualitative Study on Experience of Malignant Obstructive Jaundice Patients Living with a Catheter after Percutaneous Transhepatic Cholangial Drainage

目的深入了解恶性梗阻性黄疸患者在经皮肝穿刺胆道引流术(PTCD)后带管生活的真实感受与内心体验,为制订有效的护理干预方案提供参考依据。方法2022年6-12月,采用目的抽样法选取17例恶性梗阻性黄疸PTCD后带管生活1个月以上的患者,对其进行半结构式访谈,利用Colaizzi七步法对资料进行整理分析。结果通过分析得出3个主题,分别为积极体验、益处发现(改善黄疸症状、积极自我调适,提高自我管理);消极体验、负性感受(日常生活的限制和压力、睡眠障碍、躯体的负性经历、心理的负性情绪);期望与需求(对支持性照护的多样性需求,渴望社会支持)。结论医护人员在临床工作中应注重患者身心感受的动态评估,制订差异化心理干预措施,通过加强患者疾病认知和健康教育支持提高患者出院准备度,同时进一步完善社会支持系统,帮助患者更好地实现自我管理。

Objective To deeply understand the true feelings and inner experience of malignant obstructive jaundice(MOJ)patients living with a catheter after percutaneous transhepatic biliary drainage(PTCD),aiming to provide a reference for formulating an effective nursing intervention plan.Methods From June to December 2022,17 MOJ patients living with a catheter for more than one month after PTCD were selected by purposive sampling.Semi-structured interviews were conducted and the data obtained were sorted out and analyzed using Colaizzi's seven-step method.Results The following three themes were extracted from the analysis:1)positive experience and benefits(resolved jaundice symptoms,positive self-adaptation,and enhanced self-care abilities),2)negative experience and feelings(limitations and stress on daily life,sleep disorders,negative physical experience,negative psychological emotions),and 3)expectations and needs(diverse needs for supportive care,and desires for social support).Conclusion Healthcare providers should continuously monitor the physical and mental well-being of patients in clinical practice,formulate tailored psychological intervention measures and improve their readiness for discharge by enhancing their understanding of their conditions and providing health education.Moreover,strengthening the social support system is vital in enabling patients to better look after themselves.