半封闭病房住院烧伤患者家属的心理需求横断面调查及影响因素分析

A cross-sectional study on psychological needs of family members of critically ill inpatients in semi-closed wards and analysis of influence factors

目的分析并探讨半封闭病房住院烧伤患者家属的心理需求及其相关影响因素。方法选择上海交通大学医学院附属瑞金医院灼伤整形科2018年10月—2019年4月收治的符合入选标准的82例半封闭烧伤病房住院烧伤患者及其家属,进行横断面调查。采用一般资料调查问卷调查烧伤患者及其家属的一般资料,涉及患者烧伤原因、性别、年龄、烧伤总面积、烧伤深度、烧伤严重程度、烧伤部位、医疗保险类型及其家属与患者亲属关系、性别、年龄、有无监护隔离病房陪护经验、职业、文化程度、月收入,共计15个指标。采用重危患者家属需求量表(CCFNI)评估患者家属5个因子:医护人员的支持(SS)、家属自身的舒适(CS)、获取信息、亲近患者的需求(PS)、病情保证共包含45个条目的各条目、各因子得分及总得分情况。按一般资料分类后采用CCFNI评估患者及其家属总得分,对数据行独立样本t检验或单因素方差分析。选取前述分析中差异有统计学意义的指标行多元线性回归分析,筛选患者家属心理需求的独立影响因素。按前述筛选出独立影响因素患者年龄、烧伤总面积及其家属性别、文化程度、监护隔离病房陪护经验进行分类,采用CCFNI评估患者及其家属的得分情况,对数据行独立样本t检验或单因素方差分析。结果本次研究发放调查问卷82份,回收有效问卷80份,回收率为97.6%。80例患者中,男45例、女35例;≤14岁的有35例(43.75%);大部分患者为火焰和热力烧伤;中、重、特重度烧伤患者分别为33例(41.25%)、21例(26.25%)、26例(32.50%);无医疗保险患者只有3例(3.75%)。80名患者家属中,男34名(42.50%)、女46名(57.50%);62.50%的患者家属年龄集中在18-45岁;有监护隔离病房陪护经验的有12名,占15.00%。家属CCFNI总得分为(141±14)分,包含的5个因子:病情保证、PS、获取信息、CS、SS各条目的得分分别为(3.77±0.23)、(3.43±0.37)、(3.53±0.34)、(2.50±0.59)、(2.69±0.45)分。家属心理需求排名前5的条目集中在病情保证、PS、获取信息这3个因子,条目“保证患者得到最佳的救治”排在首位,得分为(3.99±0.11)分。不同年龄、烧伤总面积、烧伤严重程度患者及不同性别、文化程度、是否有监护隔离病房陪护经验患者家属的CCFNI总得分比较,差异有统计学意义(F=4.378、5.481、5.913、t=4.027、14.339、7.265,P<0.05或P<0.01)。多元线性回归分析显示患者年龄(≤14、15-45岁)、烧伤总面积(11%-30%、31%-49%、≥50%TBSA)及其患者家属性别、文化程度、监护隔离病房陪护经验均可影响患者家属心理需求(t=3.133、2.260、2.297、2.433、3.015、2.200、-2.102、2.463,P<0.05或P<0.01)。不同年龄段患者家属的病情保证因子得分比较,差异有统计学意义(F=4.390,P<0.05);不同烧伤总面积患者的家属的SS和病情保证2个因子得分比较,差异有统计学意义(F=5.042、3.131,P<0.05或P<0.01);有监护隔离病房陪护经验的患者家属的病情保证因子得分低于无监护隔离病房陪护经验者(t=-1.040,P<0.05);大专及以上文化程度的患者家属的SS因子得分高于高中(中专)及以下者(t=0.657,P<0.05);大专及以上文化程度的患者家属的获取信息因子得分低于高中(中专)及以下者(t=-1.438,P<0.05);患者男性家属的SS因子得分低于女性(t=4.149,P<0.05)。结论半封闭病房住院烧伤患者家属对保证患者得到最佳的救治的需求最为迫切。患者年龄、烧伤总面积及其家属性别、文化程度、监护隔离病房陪护经验是影响患者家属心理需求的主要因素。

Objective To analyze and discuss the psychological needs of family members of critically ill burn inpatients in semi-closed wards and their related influence factors.Methods A cross-sectional survey was conducted among the 82 burn patients,who met the inclusion criteria and were admitted to the Department of Burns and Plastic Surgery of Ruijin Hospital of Shanghai Jiao Tong University School of Medicine from October 2018 to April 2019,and their family members.A general condition questionnaire of 15 indexes was applied to investigate the general data of burn patients and their family members including cause of burn,gender,age,total burn area,burn depth,burn severity,burn site,and type of medical insurance of patients,kinship with the patients,gender,age,experience of accompanying in intensive care isolation wards,occupation,education level,and monthly income of their family members.The Critical Care Family Needs Inventory(CCFNI)was used to assess each item,each factor,and total scores of the family members of patients including 5 factors and 45 items such as support scale(SS),comfort scale(CS),information scale(IS),proximity scale(PS),assurance scale(AS).CCFNI was used to assess the total scores of patients and their family members after classification according to the general data,the data were statistically analyzed with one-way analysis of variance or independent sample t test.Indicators with statistical significance in the above analysis were selected for multiple linear regression analysis to screen the independent influence factors of psychological needs of patients'family members.CCFNI was used to assess each dimension scores of patients and their family members after classification according to the aforementioned selected independent influence factors including age and burn area of patients,gender,educational level,and experience of accompanying in intensive care isolation wards of their family members,and the data were statistically analyzed with one-way analysis of variance or independent sample t test.Results A total of 82 questionnaires were sent out in this study,and 80 were effectively received,with s a recovery rate of 97.6%.In 80 patients,there were 45 males and 35 females;35 cases(43.75%)were≤14 years;most of the patients had flame and thermal burns;33 patients(41.25%),21 patients(26.25%),and 26 patients(32.50%)had moderate,severe,and extremely severe burns,respectively;and only 3 patients(3.75%)had no health insurance.In 80 family members of patients,34(42.50%)were males and 46(57.50%)were females;62.50%in the family members of patients were concentrated between 18 and 45 years old;and 12 family members of patients had experience of accompanying in intensive care isolation wards,accounting for 15.00%.The total CCFNI score of the family members was(141±14)points,and the scores of AS,PS,IS,CS,and SS were(3.77±0.23),(3.43±0.37),(3.53±0.34),(2.50±0.59),and(2.69±0.45)points,respectively.The top five items of the psychological needs of family members of patients were concentrated in three factors(AS,PS,and IS),and the item"ensuring that patients receive the best treatment"ranked the first,with a score of(3.99±0.11)points.There were significant differences on the CCFNI total scores of patients with different age,total burns area,and severity of burns and of their family members with different gender,education level,and whether or not experience of accompanying in intensive care isolation unit(F=4.378,5.481,5.913,t=4.027,14.339,7.265,P<0.05 or P<0.01).Multiple linear regression analysis showed that the patient's age(≤14,15-45 years)and total burn area(11%-30%,31%-49%,≥50%TBSA)and the patient's family members'gender,educational level,experience of accompanying in intensive care isolation unit could affect the psychological needs of family members of patients(t=3.133,2.260,2.297,2.433,3.015,2.200,2.102,2.463,P<0.05 or P<0.01).There was statistically significant difference in AS score of the patients'family members with different age(F=4.390,P<0.05).There were significant differences in both IS and AS scores of the patients'family members of patients with different burn area(F=5.042,3.131,P<0.05 or P<0.01).The AS score of the patients'family members with experience of accompanying in intensive care isolation unit was significantly lower than those without(t=-1.040,P<0.05).The SS score of the patients'family members with college education or above was significantly higher than those with high school(technical secondary school)or below(t=0.657,P<0.05).The IS score of the patients'family members with college education or above was significantly lower than those with high school(technical secondary school)or below(t=-1.438,P<0.05).The SS score of male family members of patients was significantly lower than those of female patients(t=4.149,P<0.05).Conclusions The family members of burn patients in semi-closed ward have the most urgent need to ensure the patients receive the best treatment.Patients'age,total burn area,and their family members'gender,education level,experience of accompanying in intensive care isolation unit are the main factors affecting the psychological needs of family members of patients.